tta

Canine Tibial Tuberosity Advancement

Jeff Mayo, DVM, CVLS, Dipl ABVP

www.jeffmayodvm.com


Preoperative Radiograph Technique	Dr Mayo prepares for surgery	Modified arthrotomy technique utilizing retractors

Placement of the TTA jig	Drilling of holes for placement of tension band plate	Bending of tension band plate prior to placement in the leg

Placement of the forks into the tension band plate	Completed placement of the forks into the tension band plate	Placement of the spacer

Placement of a synthetic bone graft into the osteotomy site		Completed surgery

Post-Operative Instructions

Tibial Tuberosity Advancement/Tibial Plateau Leveling Osteotomy

THE MOST COMMON POSTOPERATIVE COMPLICATION IS SWELLING IN THE LEG:
This can be prevented by using a graft from a different part of the leg to fill the osteotomy site, or using a synthetic grafting material.

Historically, rehabilitation on knee surgeries in general has been limited to one common recommendation – cage rest! Veterinarians have been reluctant to allow their patients to perform even the slightest of exercise movements postoperative, for fear that the patient will ruin the work (and expense) already performed. If we have learned one thing from human medicine, the sooner the patient is up and using the leg, the quicker will be the recovery. There is only one modification to this thought that should be stated here, if the leg does not hurt, the dog will use it, and premature overuse of the leg will result in critical damage to the proper healing process. We cannot overemphasize enough, do not let your dog run loose until the doctor has pronounced the surgery a success.

First Two Weeks: The first couple days when your pet comes home, the pain will be the worst. Why? Dogs are pretty smart, and they figure out right away that when they act like they are in pain, they will get more attention from their owners. It is important to not let your pet loose to run freely, particularly up and down stairs without assistance. They can go outside ON A LEASH to go to the bathroom, and then they must return inside and rest.

(1)            First 5 days – ice packs 2-3 times daily for 10-20 minutes. This will help significantly with the swelling.

(2)            Pain medication – as written by the doctor. If this is not working, do not overdose, call the office for further recommendations or additional medications. The most common protocols of pain medication include combinations of a non-steroidal medication and an additional medication called tramadol.

(3)            After 5 days, apply heat to the area 2-3 times daily for 10-20 minutes. Afterwards, begin GENTLE range of motion of the leg that was operated on after the heat pack has been applied. If you are not clear about this, ASK! Do not move the leg through range of motion if it is significantly swollen.

(4)            No other exercise is recommended for the first two weeks.

(5)            Clean the wound daily if needed with dilute hydrogen peroxide or warm soapy water, and do not allow the dog to lick it. If he attempts to lick the wound, please get an e-collar.

Second Two Weeks: At this point, walking on leash is tolerated.

(1)            Pain medication – should be off of prescription medicine, however, giving one aspirin for the average 50-100# dog 30 minutes prior to any physical therapy is advisable.

(2)            Apply heat to the leg for 20 minutes, then exercise the leg through range of motion.

(3)            Walking on a leash is acceptable, but begin with one block and stop. If the dog returns home and is not in pain, you may increase this in 1 block increments every 4-5 days as tolerated, provided your dog is not in pain when the walk is over.

(4)            While walking, push the dog’s hips towards the operated leg slightly to help convince him/her that the leg can be used.

(5)            Lift the front end of the dog for 5 second intervals prior to starting the walk to increase the strength of the leg. Try several repetitions.

(6)    Ask your pet to sit and stand several times a day to help strengthen the limb.

Third Two Weeks: By this time, walks should be in the 20 minute range or better, and tolerated well. Do not run yet. Increase the duration of walking as much as you can without causing the dog pain. Do not exceed the 20 minute range. If you have access to a pool, some hydrotherapy is ok, but NOT unattended nor allowed to swim in water over the dog’s head. Any hydrotherapy over 10 minutes is more likely to exaggerate patellar tendon inflammation and result in lameness.

Fourth Two Weeks: At the end of this period, it is time to come in for the follow up x-ray. We want to make sure everything has healed prior to increasing the exercise as tolerated. Be forewarned that if you just go home and turn the dog loose, he will be in pain. This is the point where you can SLOWLY build back up to full exercise.

reprinted with kind permission from Jeff Mayo, DVM, CVLS
Diplomate, American Board of Veterinary Practitioners
Certified in Canine and Feline Practice
Mayo Veterinary Services www.jeffmayodvm.com

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This is just one of many Post Operative schedules, all of them differ from time to time. Please check with your veterinary surgeon before embarking on any protocol

The above information is simply informational. It's intent is not to replace the advice of a veterinarian nor to assist you in making a diagnosis of your pet. Please consult with your own veterinarian for confirmation of any diagnosis. Your pets life may depend on it.