If you are reading this, Tibial Plateau Leveling Osteotomy (TPLO) surgery is probably something you’re considering for your dog or already have scheduled.
My rescued pitbull, Scooby, tore his cranial cruciate ligament (the CCL… a dog’s version of a human ACL) while happily playing with other dogs. After much research and advice, we chose TPLO surgery.
My goal is to help you feel better about it though it is no substitution for the advice of veterinary professionals. I do not regret the surgery one bit. Our dog has recovered brilliantly and in less time than I had anticipated.
I had actually expected to write a week by week series of posts but after the first few weeks, there was nothing to chronicle other than improved walking every day and, of course, his rehabilitation. Rehab is time intensive but I think what expedited his recovery.
You will also need to buy some gear. Though I covered what we bought in my planning for TPLO surgery post, I’ve inserted some links (This site generates income via purchases made through links to carefully-curated travel and lifestyle brands.) to helpful products for consideration. And, he takes new supplements now that I’ll tell you about, too, that have in addition drastically improved his allergy-ridden skin.
Grab a coffee and let’s get started.
Why We Chose TPLO Surgery
First things first, I thought I’d address why we chose such an invasive surgery for our dog. First, our vet and surgeon recommended it. I looked at conservative management and could not imagine keeping such a normally-active dog sedentary as well as on anti-inflammatories and painkillers… forever. Prolonged use of the anti-inflammatories leads to arthritis setting in earlier and more aggressively than usual, I’m told.
As surgery date neared his limp increased. Seeing him in pain broke my heart. The day before surgery, I started to hear an unbearable clicking noise when he walked, which meant his meniscus was now torn, too. He couldn’t live like that either.
Also, we have pet insurance that covered a significant portion, but not all, of the costs.
Scooby was not able to have food after midnight or anything to drink after 5:00 a.m. the morning of the TPLO surgery. I checked him in around 7:00 a.m. so that they could take radiographs and complete his blood work in time for afternoon surgery.
The surgeon called to say that a mass on his leg and penis should be cut out at the same time. Our dog has allergies and is prone to random lumps and bumps. I did notice the red bump—it looks like a blood blister—on his penis had gotten bigger. Since he was already having surgery anyway, it was a good time to cut it out and send it away for biopsy (which turned out, thankfully, to be benign). The poor guy was stitched along his leg for TPLO and also in two other spots for the mass removals.
Once the surgery was over, the surgeon called to say it had been successful and that Scooby was resting comfortably. He’d spend the night under observation and I’d receive a call in the morning with pick-up instructions based on how he was doing.
I have a 9-year-old daughter who is very attached to our dog. To keep her mind off of the surgery, I scheduled a sleepover for her at our house. Crazy? Maybe. I dare say that despite the extra work, it helped keep my mind from wandering, too.
Day After TPLO Surgery
Before he came home, my daughter and I set up the queen tri-fold mattress we’d bought on the floor. Knowing how needy Scooby is, we figured he’d want to lay with us for the rest of the day.
My instructions were to pick him up at 1:00 p.m. and to plan for about an hour visit. The doctor would go over care and medication instructions in detail. I put one of his dog beds in the back of my SUV along with his ramp and headed off to the hospital. If you don’t use a bed, make sure where your dog sits in the car on the way home is free from dirt, sand or anything that might get into the wound.
The doctor brought him out using a sling under his hind hips as a precaution because they have slippery floors. She said he otherwise didn’t need it. Scooby looked great and seemed to be walking almost normally, which was I’m sure fueled by the adrenaline of leaving the hospital and seeing us. She let him walk quite fast, but said that slow is better.
I had her help me lift him into the car as he wasn’t yet good with using a ramp to get in.
Scooby, thankfully, received stitches that absorb over time in lieu of staples. However, the stitches for his masses were the kind that need to be removed. The bevy of medicines we took home included painkillers, antibiotics, an anti-inflammatory, and a sedative.
We spent the rest of the day in our little mattress camp. He stood up to eat and to go to the bathroom. His walking was not nearly as good as it was at the hospital and looked truly painful.
As boy dogs lift their leg to pee, he couldn’t quite figure out what he should do. He squatted once but the next time he went outside to pee I nearly squealed in pain as he lifted up his good leg, putting all weight on the injured leg. He limped back into the house with a lesson learned. I was told later by his rehab therapist that this is the beauty of TPLO surgery… they can put weight on the operated leg like that almost immediately.
I gave him a precautionary sedative and slept with him on the mattress. While I left his e-collar (cone of shame) on all night, I had his leash in my hand so I knew if he moved. He slept well but pulled himself completely up five or more times in the night to slowly shift around.
I cut the amount of food he eats by 1/3 because of his lack of activity.
I did not use the harness we bought during his recovery. It proved to be more helpful in the days leading up to the surgery when he was really hurting and I will definitely keep it for when he is older. The car ramp though is something we’ll use for the rest of his life.
We were instructed to apply an ice pack for 10-15 minutes, 3 times for the first 24 hours and then a warm compress 3-4 times per day after that. It is very helpful to have a reusable hot-cold compress that can be placed in the freezer or microwave depending on what we need.
I will say that from this day forward, it is up to pet owners to make sure the dog rehabs well. You can always call the surgeon/vet/hospital for assistance but don’t expect a ton of handholding throughout unless you ask for or need it.
I was totally exhausted. Several people told me to be prepared to devote two weeks to recovery and they weren’t kidding.
Scooby hobbled out to the kitchen to eat but then refused his pills. As a dog who takes daily allergy medicine, he often goes through spurts where he figures out they’re being hidden in peanut butter, bread, hot dogs… you name it.
I tried hot dogs, string cheese, bread, pizza and several other things he rejected. Finally, we settled on butter. When you’re taking 8 pills… that’s a lot of butter. He threw up only the pills about 20 minutes later and, miraculously, kept his breakfast in his stomach.
I called the doctor who advised that I give him only the painkillers and antibiotics and skip the rest of the pills temporarily. In the meantime, my husband had gone to the store to get eggs. Scooby loves egg yolks. I slipped the pills in fried egg yolk (leaving the yolk a little soft so they don’t fall out) and we were back in business.
The crate plus e-collar combo was confusing to him as he kept whacking the e-collar along the crate’s panels. I moved our tri-fold mattress into the kitchen and left him on it instead of using the crate. He was so mellow that he laid there almost all day with his e-collar on. I was working in the kitchen so could stop him from getting up to walk around if need be but he never tried.
Going outside to pee proved difficult for him. He could put a little pressure on the injured leg but not much. I could tell he was still confused about how to pee.
There was no need for sedatives today as he was still fairly groggy. His leg looked much more bruised.
About an hour after he took painkillers, I started the passive range of motion exercises. My instructions were basically to bend and extend his operated leg. I massaged his quadriceps before and after the massage. I couldn’t bend it in all the way—only slightly which seemed like enough for one day after surgery. He was fighting the movements. This is a routine we’d continue until he was using his legs well during walks.
I ice packed it in the morning but by the time the evening hit, it was time for warm compresses.
Swelling on this day was unsettling. It happened above his incision and looked like a big red bag was hanging over his stitches. His leg also looked far more bruised and red.
The e-collar was really causing him unhappiness so I bought a few alternatives that were even worse. He could maneuver around the donut-style inflatable collar to lick his leg if need be, though it would be a great solution if he had, say, an incision on his back. I tried a floppy collar but it was so floppy that it covered his entire head and he couldn’t see. Back to the e-collar we went. I see why vets prefer it.
The reason for the cone is that licking results in complications like an infection that may lead to additional procedures.
Still groggy, I let him sun himself outside today while keeping a close eye on him. He was very lethargic so no sedatives were needed. He finally pooped, too, which was a huge relief.
I gave up floor sleeping so put him in the crate. He was so lethargic though that it was manageable.
This was a difficult day. He’d decided that he’d had enough pills and started gumming every single food item I slipped them in so that he could find them and spit them out. Sneaky.
I went to PETCO and saw the rolls of chilled food in the refrigerated section. While a little pricey, I bought a roll of salmon and veggies by FreshPet thinking I could chop it up and hide the pills in that. It worked like a charm (and he’s eaten it for meals since then).
He was putting weight on his leg so we walked around outside for about 5 minutes, per our care instructions.
Major fatigue had set in on my part which is why I didn’t keep much of a diary during this time. The swelling was pretty major until about day 7. I had to sit with him to keep him calm which means not a lot got done at work or around the house.
He was a very happy dog during this time, however. I think about how grumbly I’d be after such a major surgery and he showed zero signs of suffering or pain.
He seemed to get a little energy back so I tried using the sedatives to keep him calm. They didn’t really work as he could fight through the maximum recommended dose after say a good hour initial nap.
The cone was pretty depressing for him so I kept it on him when he was out of my sight but took it off otherwise. He is not really a licker though and pretty mellow so this worked for us.
We were walking about 5-10 minutes, twice a day. I think he could have handled more but I was nervous to push him too hard. He would still raise his hurt leg when standing still, which I’m told is normal.
As I said, he required more attention from me to keep him from moving around too much. I had to keep him on a leash at all times when outside of the crate. Toward the end of this timeframe, we felt O.K. to leave him for short spurts alone in the house inside of his crate. Until this, someone had always been home with him.
Earlier in this timeframe, he was still so mellow that I let him sleep in his normal bed outside of the crate (he did not like being crated). I kept his leash on and slept with it looped on to my arm so that I knew when he was getting up. He did need to get up a few times at night to go to the bathroom.
When he became a bit more active at the end of this timeframe, I put the crate around his bed. Our crate has 6 panels which can be extended into a rather large sleeping area. I felt he needed the extra room to shift around as he is a big dog. However, he did start to also want to jump back into our bed so I put the top on the crate eventually.
He’d been so well behaved and mellow that I allowed him to walk around the house on his own (it’s one-story with no stairs). Well, he jumped on my daughter’s bed. Granted, her bed is low to the ground. It’s the most comfortable bed in the house and he knows it. I nearly lost it. I lifted him off the bed and he did limp but, thankfully, did not re-injure himself.
Lesson learned. He was on a leash at all times for the next week.
The stitches were removed today thank goodness but they still wanted him to restrict movement and wear the cone for a few days while the incision healed a bit more. Things looked pretty good though.
As long as he was willing to walk, it was O.K. to walk him as far as he could handle as long as I didn’t have to carry him home. (Your doctor may say otherwise.) We did not need to continue the passive range of motion exercises but the surgeon suggested that I continue with massage.
Day 18 – Formal Rehabilitation Begins
This is the face of, “Why am I doing this?”
Today, he started rehabilitation at a canine therapy center near our house. Our consultation started with measuring muscle atrophy that occurred in both legs, which is normal given this type of surgery. The goal is to rebuild muscle in both legs to prevent injury in the good leg. Apparently, there have only been a handful of dogs at this center who have injured the good leg after completing their recommended rehab.
They loaded him into the water treadmill, filled it and had him slowly walk. As a dog who hates water, this was quite a shock to him (and also funny to watch). The buoyancy of the water reduces the amount of painful downward impact on joints and muscles during exercise.
Some dogs love the water treadmill. Mine needed a toy in his mouth to act as a pacifier.
He was on the treadmill for about 25 minutes, dried off and then had cold laser therapy and a massage for another 30 minutes. Cold laser therapy uses a beam of light to stimulate cellular regeneration that helps reduce swelling, promote healing and relax the muscles.
Luckily for us, this rehabilitation is partially covered by our pet insurance but I would gladly pay for it out of pocket. I truly believe that he has recovered quickly because of it.
He did 10 sessions of rehab and at the end was able to run but was still not allowed to pivot, chase balls or play with other dogs just yet.
We have a one story house with no stairs or hazards like slippery tile. He was free to walk around the house and yard at leisure. I was worried about him constantly standing up and laying down but the therapist said this is actually good to help him strengthen the leg and not to worry about it.
Walks were upped to about 20–30 minutes twice per day. He did slow down toward the end of the walks. I am used to taking him on a long walk once a day so this is a bit tough on me during busy days but one walk for twice as long was not doable for him at this point.
A few other exercises were added in. I slowly walk him up and down curbs and stairs and for a few minutes every day. And, around week 5 it was suggested that I take him to the beach as walking in the sand will also help strengthen his muscles.
He continues to go to rehab twice a week and was still hilarious to watch on the water treadmill.
He is walking normally.
Other than the fact that his leg is still every so slightly shaved, you can’t tell he had the surgery. He likes to run on the leash a little which we allow on a limited basis. Rehab continues twice a week.
We headed back to the surgeon for a routine check-up. This is where they take further radiographs to see how the bone has healed. Because he needs to be sedated for radiographs, he was not allowed to eat anything after midnight the night prior.
Everything looked good. By this point most dogs have 100% bone healing, however, Scooby only had 80%. The surgeon wasn’t at all worried about it because we were going to rehab, he looked great and was walking fine.
We were told that this was the last time we needed to see him.
Rehabilitation also ended this week. His good knee no longer showed any signs of muscle atrophy associated with the surgery. Our instructions were to climb stairs for a few minutes several times per week, walk in deep sand and use the ocean as our water treadmill. Walking the dog in the ocean at just below their shoulder height is good for them.
So then we were on our own. I can pretty much get him to do everything but walk in the ocean. We live in San Diego and he’s deathly afraid of it.
Change of Diet and Supplements
As part of a campaign I was working on with the pet food company, Petcurean, I interviewed their nutritionist about how what a dog eats impacts their joints and ligaments. It does and you can read her interview using the link below.
I discovered that we were probably over-feeding him as cutting his intake by 1/3 has kept him in the ideal weight range. We’ll continue at the reduced level.
Also based on advice from the surgeon and veterinarian, we continue with a high-quality glucosamine supplement. Apparently, the quality matters. He takes a brand called Dasuquin that is a little bit cheaper on Amazon than at my vet. It’s a chewable pill in a flavor that he likes.
He will also need daily Omega 3’s forever to help reduce inflammation. Right now, I’m using a salmon oil supplement that I pump into his food that he seems to like. I used to use another brand but the pump was constantly getting clogged. I think that consistent use of this brand has his skin looking way better than it did with his previous Omega 3. I also wonder if adding the Ligaplex II below has helped his skin in some way, too, but I have no proof.
His therapist recommended Ligaplex II, a food-based supplement that promotes joint and ligament health that many people rave about online. You can now buy it on Amazon or get it for a little bit cheaper through a healthcare provider. I can get it through his rehabilitation center or through a plastic surgery center for humans closer to my house. You simply break open the tablets and sprinkle the supplement on top of food. Or, just toss the tablets into food.
(Almost) No Table Scraps
I read that processed grains and carbohydrates lead to inflammation in dogs, too. That means no bread and little scraps my husband used to feed him. He’ll get the occasional raw carrot or cooked egg but that’s about it.
I’m really grateful for our medical and rehab team and that we had a good result with TPLO surgery. Again, I don’t regret it.
I hope that your dog never needs TPLO surgery. If he or she does, I wish you all a very speedy recovery!