TPLO

My first TPLO was $3500 (3 yrs ago) in MI. We had our second one done at Michigan State University Vet School. It was significantly cheaper and it went better/smoother than the first. Not that we had issues with the first (except customer service) everything about the second was better.

Do you have a good teaching hospital near you? You might investigate that option. However, I have heard astronomical prices for THR's in CA, compared to what I paid. A $4000 quote for the TPLO does sound in the ballpark. It does make you ill though. I COMPLETELY understand. As I said TPLO 2005, TPLO 2006, THR 2007 broke 2008 but worth it my dogs are happy and running around pain free.

Two years ago I paid around $2,800.00 here in Texas.  This included all Xrays and follow up.  It's a lot of money but I don't have any regrets.

$2,800 sounds like a gift right now.. lol

Callie had suggested that I go to Davis which is a bit of travel, but would be very do able. So I called and they are full up till January. And as I am not looking for a complete tear I will do something here in the LA area. I hadn't even thought of Western. It is a crappy vet school so I'd be wary. I have another consult at 4:20. The estimate I was given over the phone was about the same as the first one. BUT they are closer to home. 

I am not looking for the cheapest available surgery. She is a young dog that I want to have around and keep her comfortable for 10++++ years. I think I am just a little overwhelmed that I will be forking out $5500+ for 2 surgeries in under 6 weeks. I swear If I ever hear another owner grumble about their equine vet I will show them what my little bundles of joy cost me this month alone! 

The $4000 is "all inclusive" post op and x rays and visits and meds. I guess I should be happy because they won't nickle and dime me for every visit. I guess when I look at it that way, it's not so bad.

Is it common for them to get an epidural?  Fentanyl patch. and lidocaine? And can I ask for a Fentanyl patch for me? I might need it if she is a wreck post surgery. A little narcotic pain killer might be nice.. kidding.

And everyone is happy with their dogs after surgery? Quality of life is excellent. No horror stories?

Her growth plates are still open, that won't effect the healing process. I am kind of surprised that they are still open she is 15 months, which isn't that old I suppose. I just would have thought dogs close quicker than horses (who often don't close till mid to late in their 2 year old year).

It is VERY common for them to get an epidural but I have a question. Is the epidural a morphine epidural??

Success:

A successful outcome will return your dog to full function on the limb.  In my experience, about 90% of the dogs having the TPLO regain normal or near normal function of the limb (full weight-bearing); this information is based on a retrospective survey that we conducted on our patients.  The remaining 10% of dogs have concurrent arthritis in other joints of the operated limb or advanced degenerative joint disease in the stifle; most of these dogs in this group are still helped by the surgery.

We have found that most working dogs will return back to full working function. 

Dogs that have sustained a blowout fracture of the tibial plateau as a complication of falling after surgery may have residual stiffness or lameness.

Dogs that have been previously operated using another technique frequently are improved with the TPLO surgery, but the outcome may not be as good, versus a virgin knee that has received the TPLO surgery. 

Potential Complications: (not to scare you)

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, inspiratory and expiratory carbon dioxide levels, and respiration rate), the risk of problems with anesthesia is minimized.

Infection is an unusual complication as strict sterile technique is used during the surgery and antibiotics are administered during the procedure.

Poor healing of the bone can occur if the pet is too active, especially during the first 2 months after surgery. If steroids are given to a pet for reasons such as skin allergies, healing of the bone may be severely impaired. Breakage of plates or screws or backing of screws out of the bone can occur if activity is not limited during the first 2 months. Even after the bone has healed, the soft tissues need to also heal.

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

Fracture of the narrow front part of the tibial crest can occur. This is not common, and usually will heal without any surgical intervention.  Recovery will be delayed, but the final result still should be very good.

A blow-out fracture of the tibial plateau has been seen in 0.4% of the cases (in a series of 700 cases) at our hospital.  The cause of this is due to the dog falling on the stifle after surgery.  Reoperation is performed in these cases.

Loosening of the screws with shifting of the slope of the plateau may occur if the pet is not restricted during the healing phase.  If the plateau has shifted a significant amount reoperation is performed.  This complication is more common in the giant breed dog, as a result we generally use a larger TPLO plate and 8 screws, instead of the standard sized TPLO plate and 6 screws to help prevent this problem. 

It has been reported that dogs that have a very steep tibial slope (greater than 35 degrees) are at greater risk of having complications (shifting of the bones, fracturing of bones, loosening of implants). However, once the healing had taken place the function of these dogs too was very good and client satisfaction was usually very good.

A bone cancer can develop in the tibia bone due to the presence of the surgical implants (bone screws and plate), however, this complication is rare. Removal of the plate after healing takes place may help to prevent this complication. Because the formation of this tumor is so uncommon, there is no study available that has truly shown that removing the implants is helpful.

Arthritis usually is present at the time of surgery and will progress to some degree regardless of treatment or no treatment. Unfortunately we cannot reverse the arthritic and degenerative state of the joint, but the surgery may help to minimize the progression of this. I have seen cases receiving the TPLO surgery that have developed minimal arthritis years later, yet other cases have developed a lot of arthritis as seen on x-rays. Just because arthritis may be seen on x-rays does not mean that your dog will be lame on the limb. Warning signs of clinical arthritis include stiffness associated with heavy exercise and cool damp weather. Anti-inflammatory medications are useful to ameliorate a flare-up of arthritis.

Tearing of the meniscus (cartilage pad in the knee) may occur following TPLO surgery and additional surgery would be needed. This complication occurs less frequently following the TPLO versus when other surgical techniques used to stabilize the stifle joint.

Good Luck and Godspeed to you!!

(from vetsurgerycentral.com) 

I personally would never do TPLO; very risky, very invasive, not proven to be better than traditional repair or new minimally invasive methods to correct the problem. Whatever method you decide on, go for intensive physical therapy starting ten days after the surgery and forget the traditional "crate the dog for four months" suggestion. Dogs given intensive correct PT have a much faster, much better recovery than dogs crate-rested.

Thank you for this reply and your frankness.

Yes, Morphine epidural.

She is to be sent home with antibiotics It's on the schedule of fees.

I was hesitant about TPLO. My ex and I had a lab that had the sutures or elastic sugery and It did serve him well.  BUt he was never 100% . he wasn't really 80% . He was older and not as active as Maven is. She is HIGH energy, and all involved seem to agree that TPLO would serve her best. I hope this is the case.  One of my fears is keeping her quiet post surgery. They are sending us home with tranq and I have ample Ace if needed.

I asked about  bone cancer. I think I did read that here somewhere. And they don't use the titanium plate any more, I think she said surgical steel plate? Does that right? MAybe I have that backward.

With a plate,  and her still growing some will that cause any developmental handicap?  If her growth plates aren't closed, how much growth is possible or probable for "long ish" bone?

She has a partial tear. and there is about an inch of muscle difference between left and right gaskin (sorry horse is all I know). WIll there be much in the way of arthritic changes? And is that something the surgeon will address and clean up the joint some?  She has minimal effusion. Would there not be a fair amount of effusion if the joint were being effected in a significant way? Or not so much? Can I supplement with Lubrisyn to help with that? Dogs can have that, I think?

They project 3 weeks confinement. and after three weeks she can start on short walks. With a loose goal of three months before she is able to be off leash in the yard. Is that being really hopeful or accurate?

 My neighbor's golden (HUGE, 28" at the withers, long bodied, and 110lbs or so) who is about 7 had one knee done in March and the other in July or so.  He was playing and just laid down and couldn't get up.  When they looked into it both knees had been gone for ages but only suddenly the one was a problem.

Back to my point - he is in so much better shape than before the first surgery it is incredible.  his activity level has risen and he is back to the dog I knew when he was about 3.  Honestly the TPLO procedure seems scary but seeing this huge, heavy not very in shape dog recover so well has made a believer of me.  On the other hand a friend had her lab get the less invasive procedure and a year later he is not 100%.

Yes, the surgical steel does sound quite right.

Oh I must've missed the comment about open growth plates. I would be wary of that and ask many questions to see if it could harm the developmental process. I truly don't know about that.

These dogs frequently have arthritis in the knee joint even before the tear in the cruciate is obvious on physical examination, but early changes such as mild joint swelling may be detected with x-rays. So maybe but I gotta run sorry. Good Luck!! 

So second surgical opinion. Completely opposite of # 1. Growth plates mostly closed, he's not convinced it is cruciate, but is convinced that she has patella luxation (sp). Which is only a $2,000 surgery, but of course once she is laid out on the table and there is a cruciate issue he will address the cruciate. So I am looking at a 2, 4 or maybe 6 thousand dollar surgery. and I wouldn't know going in???

Seriously????

What do I do???  Who do I believe???  Who's not raping my pocket book???? 

Help. Please.

Well I'm thinking *IF* it is a cruciate it should probably be around 2526 so go with that. I'm so sorry that these jerks are making this already hard time even harder. If you ever need any support or have more questions just PM me. Thanks

With two different opinions, I would have Maven's x-rays sent to a veterinary radiologist.  Let the radiologist interpret them, & go from there.  That way, you get an expert's opinion.

Thanks. This so sucks. 

I was just reading this and wondered when you say surgical consult--are you seeing an orthopedic specialist?