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Complications of tibial plateau levelling osteotomy in dogs
01 September 2011
Accepted 10 March 2012
18 December 2017 (online)
The tibial plateau levelling osteotomy (TPLO) is one of the most common surgical procedures used to treat cranial cruciate ligament disease in dogs. Complications occurring during or after TPLO can range in severity from swelling and bruising to fracture and osteomyelitis. Ten to 34% of TPLO surgical procedures are reported to experience a complication and approximately two to four percent require revision surgery to address a complication. Although the risk factors for many complications have not been fully assessed, the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure. Identification of known or suspected risk factors and intraoperative technical errors allow subsequent action to be taken that is aimed at decreasing postoperative morbidity. There is a need for prospective studies with consistent data reporting in order to fully reveal the incidence risk factors for complications associated with TPLO.
- 1 Johnson JA, Austin C, Breur GJ. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 through 1989. Vet Comp Orthop Traumatol 1994; 7: 56-69.
- 2 Pacchiana PD, Morris E, Gillings SL. et al. Surgical and postoperative complications associated with tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 397 cases (1998-2001). J Am Vet Med Assoc 2003; 222: 184-193.
- 3 Priddy NH, Tomlinson JL, Dodam JR. et al. Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001). J Am Vet Med Assoc 2003; 222: 1726-1732.
- 4 Stauffer KD, Tuttle TA, Elkins AD. et al. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Anim Hosp Assoc 2006; 42: 44-50.
- 5 Gatineau M, Dupuis J, Planté J. et al. Retrospective study of 476 tibial plateau levelling osteotomy procedures. Rate of subsequent ‘pivot shift’, meniscal tear and other complications. Vet Comp Orthop Traumatol 2011; 24: 333-341.
- 6 Jandi AS, Schulman AJ. Incidence of motion loss of the stifle joint in dogs with naturally occurring cranial cruciate ligament rupture surgically treated with tibial plateau leveling osteotomy: longitudinal clinical study of 412 cases. Vet Surg 2007; 36: 114-121.
- 7 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474.
- 8 Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
- 9 Haaland PJ. Sjöström Luxation of the long digital extensor tendon as a complication to Tibial Plateau Leveling Osteotomy. A presentation of four cases. Vet Comp Orthop Traumatol 2007; 3: 224-226.
- 10 Moles A, Glyde M. Anatomical investigation of the canine cranial tibial artery: A potential source of severe haemorrhage during proximal tibial osteotomies. Vet Comp Orthop Traumatol 2009; 22: 351-355.
- 11 Pozzi A, Samii V, Horodyski MB. Evaluation of vascular trauma after tibial plateau levelling osteotomy with or without gauze protection. A cadaveric angiographic study. Vet Comp Orthop Traumatol 2011; 24: 266-271.
- 12 Farrell M, Calvo I, Clarke SP. et al. Ex vivo evaluation of the effect of tibial plateau osteotomy on the proximal tibial soft tissue envelope with and without the use of protective gauze sponges. Vet Surg 2009; 38: 636-644.
- 13 Cook JL, Luther JK, Beetem J. et al. Clinical comparison of a novel extracapsular stabilization procedure and tibial Plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg 2010; 39: 315-323.
- 14 Corr SA, Brown C. A comparison of outcomes following tibial plateau leveling osteotomy and cranial tibial wedge osteotomy procedures. Vet Comp Orthop Traumatol 2007; 20: 312-319.
- 15 Unis MD, Roush JK, Bilicki KL. et al. Effect of bandaging on post-operative swelling after tibial plateau levelling osteotomy. Vet Comp Orthop Traumatol 2010; 23: 240-244.
- 16 Drygas KA, McClure SR, Goring RL. et al. Effect of cold compression therapy on postoperative pain, swelling, range of motion, and lameness after tibial plateau leveling osteotomy in dogs. J Am Vet Med Assoc 2011; 238: 1284-1291.
- 17 Barnhart MD. Results of single-session bilateral tibial plateau leveling osteotomies as a treatment for bilaterally ruptured cranial cruciate ligaments in dogs: 25 cases (2000-2001). J Am Anim Hosp Assoc 2003; 39: 573-578.
- 18 Conkling AL, Fagin B, Daye RM. Comparison of tibial plateau angle changes after tibial plateau leveling osteotomy fixation with conventional or locking screw technology. Vet Surg 2010; 39: 475-481.
- 19 Vasseur PB, Levy J, Dowd E. et al. Surgical wound infection rates in dogs and cats. Data from a teaching hospital. Vet Surg 1988; 17: 60-64.
- 20 Frey TN, Hoelzler MG, Scavelli TD. et al. Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005-2006). J Am Vet Med Assoc 2010; 236: 88-94.
- 21 Thompson AM, Bergh MS, Wells KL. et al. Tibial plateau levelling osteotomy implant removal: A retrospective analysis of 129 cases. Vet Comp Orthop Traumatol 2011; 24: 450-456.
- 22 Dunning D. Surgical wound infection and use of antimicrobials. In: Slatter DH. editor. Textbook of Small Animal Surgery. Vol. 1, Edition 3. Philadelphia, PA: Saunders; 2003. pg. 113-116
- 23 Lipowitz AJ. Surgical wounds. In: Caywood DD, Newton CD. editors. Complications in Small Animal Surgery: Diagnosis, Management, Prevention. Philadelphia, PA: Williams & Wilkins; 1996. pg. 1-6
- 24 Eugster S, Schawalder P, Gaschen F. et al. A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg 2004; 33: 542-550.
- 25 Weese JS, Halling KB. Perioperative administration of antimicrobials associated with elective surgery for cranial cruciate ligament rupture in dogs: 83 cases (2003-2005). J Am Vet Med Assoc 2006; 229: 92-95.
- 26 Whittem TL, Johnson AL, Smith CW. et al. Effect of perioperative prophylactic antimicrobial treatment in dogs undergoing elective orthopedic surgery. J Am Vet Med Assoc 1999; 215: 212-216.
- 27 Boudrieau RJ, McCarthy RJ, Sprecher CM. et al. Material properties of and tissue reaction to the Slocum TPLO plate. Am J Vet Res 2006; 67: 1258-1265.
- 28 Boudrieau RJ. Tibial plateau leveling osteotomy or tibial tuberosity advancement?. Vet Surg 2009; 38: 1-22.
- 29 Shmon C. Assessment and preparation of the surgical patient and operating team. In: Slatter DH. editor. Textbook of Small Animal Surgery. Vol. 1, Edition 3. Philadelphia, PA: Saunders; 2003. pg. 167-168
- 30 Thieman KM, Tomlinson JL, Fox DB. et al. Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcomes in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35: 705-710.
- 31 Case JB, Hulse D, Kerwin SC. et al. Meniscal injury following initial cranial cruciate ligament stabilization surgery in 26 dogs (29 stifles). Vet Comp Orthop Traumatol 2008; 21: 365-367.
- 32 Hulse D, Beale B, Kerwin S. Second look arthroscopic findings after tibial plateau leveling osteotomy. Vet Surg 2010; 39: 350-354.
- 33 Pozzi A, Hildreth 3rd BE, Rajala-Schultz PJ. Comparison of arthroscopy and arthrotomy for diagnosis of medial meniscal pathology: an ex vivo study. Vet Surg 2008; 37: 749-755.
- 34 O'Brien CS, Martinez SA. Potential iatrogenic medial meniscal damage during tibial plateau leveling osteotomy. Vet Surg 2009; 38: 868-873.
- 35 Thieman KM, Pozzi A, Ling HY. et al. Comparison of contact mechanics of three meniscal repair techniques and partial meniscectomy in cadaveric dog stifles. Vet Surg 2010; 39: 355-362.
- 36 Cook JL, Fox DB. A novel bioabsorbable conduit augments healing of avascular meniscal tears in a dog model. Am J Sports Med 2007; 35: 1877-1887.
- 37 Johnson KA. Meniscal Release in TPLO - A necessary evil?. In: Proceedings of the ESVOT Congress. 2006. September 7-10 Munich, Germany: pg. 98.
- 38 Pozzi A, Litzky AS, Field J. et al. Pressure distributions on the medial tibial plateau after medial meniscal surgery and tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 2008; 21: 8-14.
- 39 Kim SE, Pozzi A, Scott AB. et al. Effect of tibial leveling osteotomy on femorotibial contacts mechanics and stifle kinematics. Vet Surg 2009; 38: 23-32.
- 40 Reif U, Hulse DA, Hauptman JG. Effect of tibial plateau leveling on stability of the canine cranial cruciate-deficient stifle joint: an in vitro study. Vet Surg 2002; 31: 147-154.
- 41 Scrivani PV. Magnetic resonance imaging of the stifle. In: Muir P. editor. Advances in the Canine Cranial Cruciate Ligament. Ames, IA: Wiley Blackwell; 2010. pg. 137-138
- 42 Warzee CC, Dejardin LM, Arnoczky SP. et al. Effect of tibial plateau leveling on cranial and caudal tibial thrusts in canine cranial cruciate-deficient stifles: an in vitro experimental study. Vet Surg 2001; 30: 278-286.
- 43 Carey K, Aiken SW, DiResta GR. et al. Radiographic and clinical changes of the patellar tendon after tibial plateau leveling osteotomy 94 cases (2000-2003). Vet Comp Orthop Traumatol 2005; 18: 235-242.
- 44 Mattern KL, Berry CR, Peck JN. et al. Radiographic and ultrasonographic evaluation of the patellar ligament following tibial plateau leveling osteotomy. Vet Radiol Ultrasound 2006; 47: 185-191.
- 45 Boudrieau RJ, McCarthy RJ, Sisson Jr. RD. Sarcoma of the proximal portion of the tibia in a dog 5.5 years after tibial plateau leveling osteotomy. J Am Vet Med Assoc 2005; 227: 1613-1617.
- 46 Straw M. What is your diagnosis? Synovial sarcoma. Vet Clin Pathol 2005; 46: 457-459.
- 47 Harasen GLG, Simko E. Histiocytic sarcoma of the stifle in a dog with cranial cruciate ligament failure and TPLO treatment. Vet Comp Orthop Traumatol 2008; 21: 375-377.
- 48 Craig LE, Julian ME, Ferracone JD. The diagnosis and prognosis of synovial tumors in dogs: 35 cases. Vet Pathol 2002; 39: 66-73.
- 49 Charles AE, Ness MG. Crevice corrosion of implants recovered after tibial plateau leveling osteotomy in dogs. Vet Surg 2006; 35: 438-444.
- 50 Kergosien DH, Barnhart MD, Kees CE. et al. Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy. Vet Surg 2004; 33: 468-474.
- 51 Bergh MS, Rajala-Schultz P, Johnson KA. Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs. Vet Surg 2008; 37: 374-382.
- 52 Duerr FM, Duncan CG, Savicky RS. et al. Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle. Vet Surg 2008; 37: 49-62.
- 53 Tomlinson J. Fractures of the patella. In: Johnson A, Houlton J, Vannini R. editors. AO Principles of Fracture Management in the Dog and Cat. New York, NY: Thieme; 2005. pg. 305-308.
- 54 Tuttle TA, Manley PA. Risk factors associated with fibular fracture after tibial plateau leveling osteotomy. Vet Surg 2009; 38: 355-360.
- 55 Taylor J, Langenbach A, Marcellin-Little DJ. Risk factors for fibular fracture after TPLO. Vet Surg 2011; 40: 687-693.
- 56 Arthurs GI, Langley-Hobbs SJ. Patellar luxation as a complication of surgical intervention for the management of cranial cruciate ligament rupture in dogs. A retrospective study of 32 cases. Vet Comp Orthop Traumatol 2007; 20: 204-210.
- 57 Dudley RM, Kowaleski MP, Drost WT. et al. Radiographic and computed tomographic determination of femoral varus and torsion in the dog. Vet Radiol Ultrasound 2006; 47: 546-552.
- 58 Wheeler JL, Cross AR, Gingrich W. In vitro effects of osteotomy angle and osteotomy reduction on tibial angulation and rotation during the tibial plateau-leveling osteotomy procedure. Vet Surg 2003; 32: 371-377.
- 59 Lozier SM. Tibial plateau leveling osteotomy: two years of clinical experience and findings. Proceedings of the 7th American College of Veterinary Surgeons Symposium. 1997. October 16-19 Orlando, FL, USA: pg. 271-275.
- 60 Palmer RH. Tibial plateau leveling osteotomy. Proceedings of the 10th American College of Veterinary Surgeons Symposium. 2000. September 21-24 Arlington, VA, USA: pg. 271-275.
- 61 Kowaleski MP, Apelt D, Mattoon JS. et al. The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: An in vitro study. Vet Surg 2005; 34: 332-336.
- 62 Lozier S. TPLO complication, causes and solutions. In: Proceedings of the ESVOT Congress. 2004. September 10-12 Munich, Germany: pg. 80-82.
- 63 Schulz K. Cranial cruciate ligament rupture. In: Fossum TW. editor. Small Animal Surgery. St Louis: Mosby; 2007. pg. 1254-1276
- 64 Cook JL. Outcomes-based patient care in veterinary surgery: what is an outcome measure?. Vet Surg 2007; 36: 187-189.
- 65 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39: 905-908.