On May 31, 2000, our four-year old Bernese Mountain Dog Kodi underwent a cruciate repair procedure called a TPLO (tibial plateau leveling osteotomy) on his left leg. The surgery was performed at Tufts University Veterinary School in Grafton, Massachusetts. On August 8, 2000, not quite 10 weeks later, he underwent a TPLO on his right leg. This is our account of what led to the surgeries and what followed after.

-- Laurie and Bill Bryce


Who is this site for? If you're facing a cruciate repair surgery with your dog and are interested in the TPLO, you may find our experience of some value. Note that it is only one family's account, and has not been reviewed or verified by an orthopedic specialist. Any information you find here is meant to augment your own research, not replace it.

Where to start: This page contains an overview of our experience. If you're interested in the nitty-gritty of how we made the decision to go with a TPLO (twice) over the other available methods of cruciate repair, and how the recoveries went (with pictures), visit the Before and After pages.

To get a handle on what exactly a TPLO is, visit the Cruciate Links page. I haven't attempted to explain the procedure here because it's complex, and as a layperson I don't think I could do it justice. The vet-written technical explanations on the Links page will provide much more accurate information. Having an orthopedic surgeon explain it in person is even better -- I don't think I truly understood the mechanics of it until someone at Tufts walked me through it.

If you'd like to browse the personal experiences of other dog owners who have been through cruciate repair surgery (both TPLO and traditional), please see the Cruciate Stories page.

I hope this site is useful to you.

Summary

Last updated May 2004. We lost Kodi on May 22, 2004 to histio (an aggressive cancer common in Berners). His two TPLOs served him well for the last four years of his life.

Once Kodi was fully out of recovery (late fall 2000), we found we could take long, off-leash walks with no sign of discomfort or soreness afterwards. During the last four years, I watched him run on the beach, tear through wet grass, leap over fallen logs, plow through deep snow and all sort of other amazing activities with no apparent difficulties or limitations.

He never limped or showed any signs of discomfort in his knees since he recovered from the surgeries. He did have some arthritis in his elbows, which he had since he was a puppy. In the last year of his life, he did start going up stairs more slowly than he used to -- one step at a time instead of bounding up. Probably related to his age and his elbows more than his knees.

Kodi got a maintenance dosage of FreshFactors and GlycoFlex to help ease the elbow arthritis (and it's probably also beneficial for his knees too). Other than that, he played and went for walks in deep snow right along with our other Berner Maddie.

No question, we were extremely pleased with our TPLO experience and wouldn't hesitate to recommend it to owners who are facing a cruciate problem with their dog. People often ask me if the surgeries were "worth it." I tell them I'm convinced the TPLOs would have been "worth it" even if Kodi had only lived one more winter after having them -- seeing him romping around in the snow in early 2001, with no pain, was priceless. Every day since just made us happier with the outcome. It was "worth it" ten times over.

If you're considering TPLO for your dog, keep in mind that I do believe the quality and experience of the surgeon is of critical importance, as is careful management of the dog's activity during recovery. Reading the other cruciate stories on this site will vividly reinforce both of those points.

I should note, however, that I also believe it's possible to be overly cautious about the dog's movement during the recovery period. We were so frightened of stairs and any movement on Kodi's part at first, and it certainly made it a stressful time for us. I've talked to many owners who thought they'd need to sedate their dogs to keep them perfectly still -- but perfectly still isn't necessary. There's a difference between "confined" and "motionless."

By the second surgery we knew that confining Kodi in an x-pen was just as effective as crate confinement -- and in fact I believe it's better. I think the getting up and lying down, shifting around type of movement will do no harm to the dog, and may even help stretch the leg and help the dog be more comfortable. Certainly Kodi was happier in the pen than he would have been in a crate. We could configure it all sorts of ways with more or less room, access to us but not the couch, etc. (Please see the Confinement page for more on this subject.)

In summary, there are many methods of cruciate repair in use, and the TPLO is among the newest, most expensive and most invasive (it involves fracturing and rotating a section of bone). The surgeons we spoke with at Tufts, however, believe it offers a more pain-free recovery and better long-term return to function, especially for large dogs, when compared to the more traditional methods. Our own research and experience fully support that belief.

A Conversation with Slocum Clinic -- 7/31/00

I had a fascinating and informative chat with "Mindy" at the Slocum Clinic today (where the TPLO was developed). I wish I had called them before Kodi has his first TPLO -- they were so helpful and friendly, and filled in many of the gaps I'd had in my understanding of the procedure. Here's a rundown of what we talked about (somewhat random, I apologize):

-- Having the other cruciate go after the first surgery (a topic high on my list right now!)
Mindy confirmed the percentage I heard from Tufts: 30%. Surprisingly, she says the cause of the second leg going is NOT because of the recovery with the first. That is, it's not because of extra weight put on the good leg. A Slocum Clinic study done some time ago demonstrated that with a rear-leg injury, dogs redistribute their weight among the remaining three legs, with much of the added pressure going to the front legs.

So why do some dogs end up with two torn cruciates? There are really too many variables to determine why this happens to some dogs and not others, but tibial angle is a known factor. Dogs with steep tibial angles (30 degrees or more) tend to end up needing both knees done. Kodi's left tibial angle was 27 degrees, if I recall correctly from Tufts, and Mindy confirmed that with that angle it was likely that we'd have to do both legs at some point.

Timing: It really varies. Some dogs have the other leg go very soon after the first surgery, while others go for two or three years.

-- Osteosarcoma and TPLO
I asked if the Clinic considered the possibility of osteosarcoma at the fracture site a known risk. Mindy said that a link between a fracture and later development of osteosarcoma is suspected, but not proven. (I should note that Tufts refutes this -- they don't consider osteosarcoma a high risk with a TPLO either, but they said a link between foreign implants and bone cancer has absolutely been proven. They also had a case where a dog DID develop a tumor at the site, only six months after surgery.) Mindy said TPLOs have been done by Slocum Clinic for 20 years and that perhaps 1% of the dogs later develop a tumor near the fracture site (I don't know if they track the dogs for their full lifetimes or how accurate this data is). Owners who are concerned about the possibility can elect to have the metal plate removed after a year or so. This is normally not recommended, though, since it puts the dog through yet another invasive surgery and in any case the holes where the screws go will still be there forever.

An interesting aside: Mindy mentioned they sometimes have field trial dogs who need the plates removed because they work in icy water conditions, and the plate itself can get cold and make them uncomfortable!

December 31, 2000 -- I received some reassuring comments on the osteosarcoma issue from Dr. John Payne, an orthopedic surgeon in Cincinnati, Ohio who lectures frequently on orthopedic subjects at veterinary meetings. He graciously agreed to allow me to post his comments on the site. Here's what he said:

"Fracture-associated Osteosarcomas are much rarer than 1%. They are fairly well proven to be associated with chronic low grade infection at the fracture site and have been associated with all types of fractures and types of fixation. They are very rare, only a few cases per 10,000 fractures. I have seen only about 3 in my career -- 18 years. The TPLO is the most common surgery I do."

Thanks, Dr. Payne!

-- Stairs
I explained the whole ordeal with the stairs during Kodi's recovery -- conflicting answers from Tufts, the heavy and cumbersome Vari-Kennel, the eventual guilty use of the sling -- and guess what she said? The clinic requires that dogs handle stairs on leash, under control, slowly, with a sling to prevent banging the leg or slipping ... but that with those restrictions, dogs can walk up and down stairs from the first day. There is nothing about the action of going up or down stairs that will impede their recovery. !!!!

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