Sierra's Rehab from TPLO Surgery

[trtexas]

As some of you know Sierra had a TPLO done on Feb. 6. She is recovering and doing great. Just trying to control her energy. The procedure was done by John J. Haburjak, DVM Diplomate ACVS of Veterinary Surgical Centers of the Delta. I can not thank him and his staff enough. They did a fabulous job. They are very helpful in the recovery process about answering questions. Of course she played the deserving pitiful part and gots lots of loving and ear rubs from the staff.

I am not sure how she tore her ACL. I think she did it on a slick floor reaching for a treat at the pet store. I thought she just pinched something in her leg. We were then at the San Mateo ISE event and she was acting like a crazed knucklehead running around on the dock and ramp. I then noticed she was lifting her left leg and limping some. I rested her and it was a more noticeable limp. It did not slow her down. She was running around the house on three legs.

Here are some pictures of Sierra "Pitiful Pearl", named by Aunt Sandra

http://i257.photobucket.com/albums/hh204/trtexas/PitifulPearl021008.jpg

Sunbathing!!!!

http://i257.photobucket.com/albums/hh204/trtexas/feelbetter021008.jpg

This is a great fly attractor!!! I get signals from space!!

Thanks for all your emails, thoughts and advice.

[R Williams]

Good to hear that they did a great job.

[R Williams]

Doesn't seem like that long ago Sierra beat us in competition in Katy Tx. Tony, do you remember how hot the event was in Katy?

[trtexas]

Yes, it was very HOT and thank God we had firemen to spray us down!!!!
Sierra is getting older and she will be back to her old form in 6 months!!!!

[ssejrnv]

Tony,
Hope Sierra is feeling better soon. You are a good dad to take care of her so well and get her what she needs. I'm sure she will be back up on the dock in no time.
JJ
PS-I've had my own trouble keeping a very high drive dog on crate rest. Thank god it was only for 10 days and of course it helps that Riot is a food hound and so he could be bribed with all kinds of different chewies.

[MickeyD'sMom]

Here is a picture of my "Pitiful Pearl Girl"
http://i120.photobucket.com/albums/o185/sandraestewart/Sierra102102008.jpg

[GoodLabs]

Tony -- glad to know she is doing better. Look forward to seeing both of you soon.

Sandy & Lizzie

[trtexas]

Tibial Plateau Leveling Osteotomy

By John J. Haburjak, DVM Diplomate ACVS

Introduction

The stifle joint of the dog is very similar to a human’s knee. The cranial (anterior) cruciate ligament is located inside the joint and is responsible for maintaining a stable joint during running and play. One of the important functions of the ligament is to prevent forward and backward sliding of the femur on the tibia bone (drawer motion). Cranial cruciate ligament rupture is the most common orthopedic problem that we treat. This problem affects all ages and breeds of dog. Frequently, cruciate ligament rupture is a gradual process and not simply due to a single traumatic injury (so called: partial tear). Most dogs have a predisposing factor such as age-related ligament degeneration, pre-existing inflammation, anatomical abnormalities and excessive slope of the top of the tibial bone that may cause the ligament to rupture.

Clinical signs of early cruciate disease include stiffness or very mild lameness. As the tear advances and the ligament progressively weakens, the lameness becomes more pronounced. Complete tears initially result in nonweight-bearing on the limb, but as time goes on the pet will generally begin to gradually use the limb. It is unusual that the lameness will resolve to an acceptable level in a large breed dog without surgery.

Background

Cranial cruciate ligament (CrCL) insufficiency is considered the most common orthopedic problem in dogs. This derangement results in degenerative changes (osteoarthritis) in the stifle (knee) joint, including cartilage damage, osteophyte (bone spur) production, and meniscal injury. A considerable number of techniques to stabilize the CrCL insufficient stifle have been described, all of which have produced variable and inconsistent results. All of these techniques long-term have been associated with advanced degenerative joint disease. These intra and extra-capsular surgical techniques are based on a traditional or passive model of stifle stability that relies on stabilizing the stifle against drawer movement. In the dog, this model incompletely explains ligament damage in the absence of trauma, the actual mechanisms of ligament and meniscal damage, or the mostly inconsistent surgical outcomes.

The more plausible, active canine model expands upon the passive model taking into consideration the biomechanics of the stifle that reflects the forces created by muscles and weight bearing. Forces created by muscles and weight bearing in relation to the conformation of the joint requires the recruitment of passive components (cruciate ligaments, joint capsule, caudal horn of the medial meniscus) to stabilize the motion of cranial thrust of the tibia. The magnitude of this thrust is subsequent to compression between the femur and tibia, and is proportional to the slope of the tibial plateau. When this forward thrust of the proximal tibia exceeds the integrity of the CrCL, tearing of this ligament as well as tearing and stress of the meniscus occurs. This thrusting results in excessive wear of the cartilage within the joint. In addition, as the tibia thrusts forward it causes stretching of the tissues surrounding the joint. These tissues are richly innervated with sensory fibers. Excessive cranial tibial thrust also can result in tearing of one of the cartilage pads in the knee called the medial meniscus.

TPLO Surgery

The objective of the Tibial Plateau Leveling Oseteotomy (TPLO) is to redesign the stifle so the cranial cruciate is unnecessary for joint stability. The ‘new’ design of the dog’s knee, then begins to rely on mother nature’s redundancies (other ligaments within the knee) to stabilize the knee over time. The success of the TPLO procedure has been based on the return to full flexion of the stifle, muscle mass and limb function, and the apparent lack of joint inflammation or progression of degenerative joint disease within the joint. The persistence of cranial drawer after a TPLO is not a valid test for stifle stability and is not a sign of failure. The TPLO procedure has provided performance dogs with the ability to return to normal function while handling the highly competitive demands of their sport or work. Thus, a family pet is even better able to participate in normal daily activities without restriction of activities or residual lameness that can frequently be seen with other types of repair.

The TPLO involves making a curved cut in the tibia bone at the level of the tibial plateau. The tibial plateau is then rotated in order to flatten the slope. The plate and screws are used to hold the tibial plateau in place so that the bone can heal.

Healing Phases after TPLO surgery

+Unlike the convalescence from other techniques, recovery from TPLO surgery frequently is more rapid and complete. Typically, within 5-7 days after surgery weight-bearing on the operated will begin.

+At 2 weeks after surgery, a moderate amount of weight-bearing can be expected.

+Radiographs taken at 6 to 8 weeks post-op should reveal healing of the osteotomy site.

+At 2 months after surgery, exercise in the form of leash walks should be gradually increased each week. Increasing the number of walks per day tends to be better than just increasing the duration of each period. Complete recovery can take between 3-5 months.

+At 4 months after surgery most exercise restrictions can be eliminated. Full working activities (hunting, agility, coursing etc) can begin at 6 months after surgery. Unconstrained activity prior to this time can cause spraining of the soft tissues of the stifle (patellar ligament strain) resulting in a prolonged recovery.

+Yearly radiographs of the stifle should be taken to evaluate the degree of arthritis. The TPLO procedure should stop or minimize the progression of degenerative joint disease. Surgeons in the USA who perform this technique have found this to be true for most cases.

+A successful outcome should allow your pet to return to full function on the limb. In general, most dogs will regain normal function of the limb after healing takes place. Only a small number of patients do not respond well to this type of surgery.

Complications

+As with any surgery, complications may arise. Even though rare, anesthetic death can occur. With the use of modern anesthetic protocols and extensive monitoring devices (blood pressure, EKG, pulse oxymetry, carbon dioxide and respiratory rate), most risk problems with anesthesia are minimized.

+Infection is also an unusual complication given that strict sterile technique is used during the surgery and anitibiotics are administered while the pet is in the hospital and dispensed for at home use as well.

+Poor healing of the bone can occur if the pet is too active during the initial 2 months after surgery. Failure of the implants (breakage of plate or screws) is nearly always due to lack of compliance to the restriction period.

+If activity is unleashed prematurely, straining of the patellar ligament can occur. Rest and anti-inflammatories are used to resolve this problem.

+Fracture of the tibial crest (narrow front part of the tibia) can occur. This is not common, and usually will heal without any surgical intervention.

+Arthritis usually is present at the time of surgery. Unfortunately, we cannot reverse the arthritic and degenerative state of the joint, but the surgery can help to minimize the progression of this. Clinical signs of arthritis include stiffness associated with heavy exercise and cool damp weather. Anti-inflammatories are useful to settle a flare-up of arthritis.

+Tearing of the meniscus (cartilage pad in the knee) is also a potential complication requiring additional surgery is required. This complication occurs less frequently following the TPLO versus other surgical techniques.

The TPLO is an extremely technique sensitive procedure requiring formal surgical training and exceptional orthopedic expertise, obligatory training and a substantial orthopedic caseload for proficiency. We at Special Veterinary Services are proud to be a premier facility in the San Francisco bay area offering the TPLO.

[Sassy Girl]

aaah....pittiful pearl - very good nickname...

I love the fact that even w/that damn lampshade on Sierra is still smiling!

[Team Chloe]

Sierra....stay calm in your crate...give that Knee a chance to heal good!!! I know it's hard...but it is what's best!! Our thoughts are with you Tony and Sierra!!!

Dave

[Linda Hettich]

This is some absolutely great information on TPLO. That's funny that you call Sierra a knucklehead, because that's what I was thinking about Tessa! If she wasn't such a knucklehead and hit her head, who knows when I would have looked in her mouth! And I mean knucklehead in the best, sweetest way possible!!

[trtexas]

Here was the day she had the x-rays on her knee.

http://i257.photobucket.com/albums/hh204/trtexas/P1010176.jpg

I'm getting tired!!

http://i257.photobucket.com/albums/hh204/trtexas/P1010181.jpg

Daddy I am feeling woozy!!

http://i257.photobucket.com/albums/hh204/trtexas/P1010185.jpg

Dude!!!

[snapple]

Hey Tony,

I hope Sierra's recovery is quick. Snapple has had a slight tear tear in his right rear ACL for about a year now and the vet suggested the same type of surgery, but I opted for acupunture treatments instead (the surgery was a little out of my price range). He'll just never be able to splash-jump as far as he used to.
Anyway, hope Sierra is back to her normal self self soon, so she and Snapple can resume their "rivalry" at the next Splash Event they're both at.

[Libby the lab]

Tony- hope all goes well with the rehab!!
Cindy, Libby and Hank

[choco's mom]

Sending love to Sierra from TX! Get well soon!