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Knowing ahead of time what TPLO failure and complications may occur in dogs may possibly appear to be overall a good strategy. Preparedness is a wise choice, and as the saying goes, "forewarned is forearmed." 

The main purpose of TPLO surgery is to ultimately stabilize the knee. As with any types of surgical procedures, there are always risks for complications. Fortunately, success rates are higher.

Following is some information on possible complications that may arise with this type of surgery and the signs of TPLO failure in dogs.

The Goal of TPLO Surgery in Dogs 

In order to better understand what may possibly go wrong with a TPLO, it helps to firstly have some basic knowledge on what happens exactly when a dog undergoes a TPLO. 

This is information that the veterinary surgeon should have shared with you, but sometimes lack of time may put a dent or you may have not grasped well the explanations.

In a nutshell, a dog's knee (stifle) is quite similar to a human knee. The dog's knee depends on four ligaments which are responsible for stability of the stifle. Namely, these ligaments consist of the the cranial cruciate, caudal cruciate, medial collateral, and lateral collateral ligaments. 

In dogs, the most common knee injury is the tear or rupture of the cranial cruciate ligament.  Because this ligament in humans is called the anterior cruciate ligament (ACL), you'll often hear it incorrectly referred to in dogs as an ACL injury.

TPLO is the surgery that helps repair the unstable knee. TPLO stands for Tibial Plateau Leveling Osteotomy. This procedure to repair a dog's ruptured knee ligament was first developed in Eugene, Oregon in the early 1990s by Dr. Barclay Slocum.

Because this surgery was around for so long, it is believed to be the "gold standard" for treating ACL tears in dogs. TPLO surgery nowadays still remains the most popular choice for dogs with torn ACLs.

The TPLO's popularity is based on two main factors – yielding long-term results and warranting a shorter recovery time than other ACL repair options. Dogs that have undergone TPLO are usually starting to be weight-bearing the day after the surgery.

The concept behind the procedure is to completely change the knee's dynamics so that the torn ligament's original function becomes obsolete. This may sound complicated, but it is, in fact, quite simple.

Namely, when the dog stands, the normal knee position is slightly bent. This means the knee joint is always load-bearing and under tension. Therefore, when the ACL tears, the femur ends up rubbing against the backside of the tibia, causing pain.

The TPLO surgery consists of cutting (osteotomy) and rotating the tibia and then fixing it with a metal plate and screws. By changing the angle at which the tibia and femur communicate, the TPLO prevents rubbing, explains veterinarian Dr. Ivana Crnec in an article on the costs of ACL surgery in dogs

TPLO complications in dogs may be classified as minor, major or catastrophic depending on the underlying dynamics at play

TPLO complications in dogs may be classified as minor, major or catastrophic depending on the underlying dynamics at play

Signs of Normal Recovery

Usually the normal recovery time for dogs undergoing TPLO is roughly 8 weeks or so. 

Following surgery, some level of swelling is considered normal since the surgery has involved cutting through bone and rotating the tibia to then putting a plate on to stabilize the knee. This is normal post surgical inflammation.

Despite the invasiveness of the TPLO procedure, dogs show the first signs of being comfortable in the first 24 to 48 hours and start bearing weight on the affected leg within days. 

The first days and weeks are very important. The dog must be prevented from licking or chewing the incision. Excessive activity can be deleterious during the delicate recovery stage, therefore, it's fundamental to to enforce it.

After the first 10 to 14 days it's a good idea to see the vet to check the incision and possibly remove the sutures. 

The recovery period of TPLO surgery is about 8 weeks. This timeframe allows the bone to heal and form good scar tissue. 

In general, it's a good idea to do a recheck X-ray around 6 to 8 weeks after surgery just to ensure everything looks good with the bone plate and that the leg is healing properly.

TPLO Complications in Dogs

TPLO complications in dogs may be classified as minor, major or catastrophic depending on the underlying dynamics at play. 

A minor complication is generally considered as one that can be easily solved without treatment. A major complication is one requiring further surgical or medical treatment and a catastrophic one is one that leads to devastating effects such as death or loss of mobility and quality of life leading to potential consideration of euthanasia. 

According to a study, TPLO complications in dogs range from 10 to 34 percent and include infection, dehiscence, plate and screw breakage, patellar tendonitis, avulsion fracture of the tibia, fracture of the tibia or fibula, meniscal tear, and delayed union.

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 About 2 to 4 percent of dogs require surgery to fix the complication. Complication rates tend to increase when both rear legs are repaired simultaneously.

Surgical Wound Infection

As with other types of surgery, it is possible for an incision infection to occur. Signs include redness, oozing and bad odor. The incidence of surgical wound complications following TPLO is estimated to occur in 7.8 percent of cases. 

If you notice signs of incision infections, report promptly to the vet. Even superficial soft tissue infections have shown an inclination to progress to implant infections and bone infections, when not treated timely and appropriately. 

Patellar Tendinosis

Patellar tendinosis is the inflammation of the patellar tendon which connects the knee cap (patella) to the tibia. 

This is a benign process known to occur in a high percentage of dogs after TPLO (80 to 100 percent).  Affected dogs develop pain and lameness, but this condition once again is rather benign and gets better with rest and medications. 

A Screw Loosening/Breaking

A screw loosening can be pressing on a nerve and cause localized pain in the affected dog. Since the plate needs to stay in place for a minimal of 12 weeks to allow the bone to heal and correct the knee, a broken screw compromises healing and can potentially cause damage to the joint. 

The Plate Slipping, Bending or Breaking

The plate can sometimes pull away from the bone or even break. Although both plates and screws are  strongly made, in some uncommon circumstances, these can bend or even break. 

Damage to the plate or screws often occurs when the dog is allowed too much activity early on in the healing process.

In some cases, the dog's body can also reject the TPLO plate as it perceives it as a foreign object.

A Fracture of the Bone

In this case, more precisely, there is a fracture of the tibia or fibula happening during the recovery period. 

Tibial tuberosity fractures are reported to occur in 1 to 9 percent of dogs following a TPLO surgery. Risk factors include inaccurate positioning, use of oversized saw blades and simultaneous bilateral TPLO surgeries. 

According to a study, fibular fractures occurred in 5.4 percent of TPLO procedures. Body weight, change in tibial plateau angle (TPA), and preoperative TPA were significantly higher in dogs developing this type of fracture. 

An Infection of the Bone

Osteomyelitis, the medical term used to depict a bone infection, is not very easy to treat. 

This type of infection requires strong antibiotics and usually takes 4 to 6 months of therapy to resolve. A culture of the wound can help identify which antibiotics will work best. 

Infections can unfortunately happen any time a dog undergoes surgery, despite the fact that surgeons take many precautions to work in sterile conditions. The risks for infections further heighten when implants are inserted in the body.

 Infection will interfere with healing therefore it's important that it's solved. While antibiotics are given to reduce the chances of an infection as a precautionary step, it must be considered that it can be challenging for antibiotics to reach an infection that's located around the implant.

Case numbers from numerous studies report that implant-associated infection occurred in 3.4 percent, with osteomyelitis occurring in 0.6 percent of cases. 

A Meniscal Tear

Generally, during the TPLO surgery the meniscus is often removed if the surgeon notices any signs of damage. When it is not removed, there are risks that it will later tear requiring a second surgery. 

 It is estimated that, in the months following TPLO,  meniscal tears are found in 1.8 to 10.5 percent of cases where the meniscus was considered normal at the time of surgery.

Dogs with a meniscal tear often show what's known as "meniscal click" basically, a clicking noise that is one of  telltale signs of a meniscal injury, points out veterinarian Dr. Gary.

Signs to Watch Out For

If your dog develops any of these signs during the recovery time, consult at once with your vet. The earlier the issue is tackled, the better chances for recovery. 

  • Swelling lasting more than 5-7 days after surgery.
  • Large amounts of discharge
  • Discharge with a bad odor
  • Signs of pain despite medications
  • Inability to bear weight 5-7 days after surgery
  • Anything unusual or concerning

TPLO Benefits Outweigh the Risks! 

Despite the risks for complications, the benefits of a TPLO surgery outweighs the risks. The likelihood of a fully functioning limb again is over 90 percent. On top of this, even when complications occur, according to a study, most of them are resolved with non-surgical treatment.

Did you know? Dog owners are often responsible for the costs of post-surgical complications when they occur as a result of  noncompliance, such as not allowing the dog to wear the Elizabethan collar to prevent licking the incision open or too much activity resulting in damage to the TPLO plate or screws. 

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