TPLO surgery is a procedure performed to stabilize the knee joint in dogs. It is a preferred treatment for dogs who have torn or injured the anterior cruciate ligament (ACL), also called the CCL ligament of the knee.

The surgery involves making a small incision in the knee, reorienting part of the bone, and then attaching a metal plate (implant). The procedure itself takes around 45 minutes and is the most common type of orthopedic surgery performed at SurgiPet.

Recovery following the TPLO Surgery is relatively short. It takes about 8 weeks for the bone to heal and an additional 8 weeks (for a total of 16 weeks) before the pet can resume regular, unrestricted activity.

TPLO surgery has a high success rate. Over 90% of dogs regain full function of the knee. The pain and limping resolve and they return to all pre-surgery activities.

TPLO surgery is not an emergency surgery. However, it is best to perform TPLO surgery within days of injury to avoid muscle weakness.

Following an ACL injury, your dog will tend to favor the injured leg. This will fairly quickly cause the thigh muscles to get weaker and smaller because they’re not being used as much as they should be. Following TPLO surgery, the weak muscles often slow down healing and recovery and make it harder for the dog to return to full mobility and agility.  Therefore, it is important to schedule the surgery promptly.

• Proven benefits
• Fast recovery as compared to other treatments
• High success rate
• Improved long-term outcome
• Best chance to return to high performance

• It stabilizes the knee joint in a very efficient, optimal manner
• It offers faster recovery as compared to other surgical treatments
• It has a well-documented and proven high success rate of above 90%
• It is considered a gold standard treatment in all but the smallest dogs
• It gives the best prospect of your pet’s return to high performance
• It helps to slow down the progression of arthritis, improving long-term outcome

TPLO surgery is the preferred treatment for all dogs with torn ACL ligament.
Working and competing dogs benefit the most from TPLO surgery, as it allows them to return to their respective duties and sports.

A successful recovery will return your pet’s leg to full function. Statistically, following TPLO surgery, over 90% of the dogs regain regular or near-regular leg use. In the remaining 10% of pets, concurrent arthritis in the other joints or advanced knee arthritis affects leg function. However, these pets still benefit from the surgery as it helps restore the knee’s function and alleviates pain. Similarly, TPLO surgery frequently improves comfort and mobility in dogs that were previously operated on using another technique.

The following signs can be intermittent or persistent, depending on the level of injury and your pet’s pain threshold. They may worsen after even short exercise and get better with rest:

• Unwillingness to play, run, fetch, and/or reduced activity
• Not putting weight on the back leg
• Limping or lameness (favoring the injured leg)
• Trouble getting up, difficulty jumping
• Pain and stiffness in the back leg
• Popping noise or swelling of the knee

There isn’t strong evidence showing the most optimal type of surgery in toy breeds of dogs weighing less than 4-5kg (10-11 pounds). Since their tibia (the bone below the knee) is very small, the TPLO surgery is technically challenging. Some studies also suggested a higher risk of complications related to TPLO surgery in very small dogs.
Therefore, a preferred technique to repair torn CCL ligament is very small patients is a lateral suture stabilization (LSS). In toy breeds of dogs it provides similar outcomes to TPLO surgery without higher risk of complications.

The first part of the surgery involves removing the torn ends of the ACL and examining the menisci (two unique “cushions” inside the knee). If the meniscus is damaged, the surgeon will remove part or all of it. The second part of the surgery involves making a unique cut into the top of the tibia and then rotating the top, so the tibial plateau (pictured as yellow line on radiographs) is flatter.

A titanium plate and screws are placed to hold the tibia in a more optimal angle. This helps to stabilize the knee joint and prevent the forces that caused the ACL tear from continuing to damage the joint.

As with any surgery, complications may arise. Infection is an uncommon complication, as a strict sterile technique is used during the surgery, the procedure is performed in a dedicated surgery suite, and antibiotics are administered during and after the procedure. Nevertheless, about 2% of dogs following TPLO surgery eventually need the metal implants removed because of infection. Recently, the use of Titanium implants has seemed to help reduce the risk of infection to even fewer patients.

Poor bone healing can occur if the pet is too active, especially during the first 2 months after TPLO surgery. If steroids are used to treat conditions such as allergies, healing of the bone may also be diminished.

After TPLO surgery, the soft tissues surrounding the knee joint must also heal and strengthen. Unconstrained activity too early following TPLO surgery can cause injury to the other knee components and lead to a prolonged recovery. Straining of the patellar ligament is especially common.

Bone cancer can develop in the tibia bone due to the presence of surgical implants (bone screws and plate); however, this complication is very rare, most recently estimated at 0.001% (1 in 100,000).

Knee arthritis is usually present at the time of TPLO surgery. It will progress to some degree regardless of treatment or no treatment. Unfortunately, the arthritic and degenerative state of the joint cannot be reversed. Still, the surgery helps to slow the progression of arthritis. Anti-inflammatory medications can help reduce a flare-up of arthritis.

TPLO surgery recovery is generally fast. About half of the dogs will start cautiously walking on the operated leg within 48 hours after the surgery. Five days after the surgery, most dogs will put some weight on the operated leg. By 2 weeks, the amount of weight placed on the leg notably increases.
Eight weeks following TPLO surgery, recheck x-rays are taken to assess bone healing. At this time, most pets have mild to no limping, so easy exercise in the form of lead walks is started and gradually increased each week.

Four months after surgery, most exercise restrictions can be removed. Regular working tasks (tracking, agility, search & rescue, etc.) can begin 5 months after TPLO surgery.

More detailed information about recovery can be found in our TPLO surgery recovery guide here: TPLO Recovery Week by Week.

At our veterinary surgery, we use titanium implants for almost all TPLO Surgeries. Titanium is an amazing metal routinely used in human medicine, and we want to offer our patients the same standard of care. Although they are more expensive than other types of implants, we believe that they are worth the cost.
You can learn more about Titanium implants here: What’s Good for You is Good for Your Pet!

Non-surgical approaches are rarely recommended. They may include rehabilitation, long-term activity restriction, knee braces, weight loss, dietary supplements, PRP therapies, and pain control. None of these truly fixes the ACL injury because none stabilizes the injured knee. For this reason, this form of therapy is not ideal. Still, it may be considered for pets with inactive lifestyles, small dogs, or pets who have other severe medical problems.

Similarly, although other surgical options, such as a tibial tuberosity advancement (TTA) or a lateral suture stabilization (LSS), exist, the outcome is much better with TPLO Surgery which remains a gold standard for treatment of torn ACL ligament in dogs.

TPLO surgery costs in Southern California vary based on the type of hospital and location. Pet owners may see estimates in the $8,000-$10,000 range, especially in large emergency hospitals.The lowest price currently advertised in SD county for dogs weighing below 90 pounds is $2,900, but it is not clear if this price includes the cost of anesthesia, radiographs, bloodwork, sedation or rechecks (2024).

At SurgiPet the following items are included in the cost of TPLO surgery:

• In-person consultation with the surgeon
• In-person consultation with the anesthesiologist
• All orthopedic X-rays for the first 4 months post surgery
• Pre-anesthesia bloodwork and chest x-rays (if needed)
• Surgical equipment, including C-arm imaging (live x-rays images obtained in surgery)
• Surgery room expenses
• Anesthesiologist (Doctor) supervision and all anesthesia charges (medications, fluids, equipment)
• Sophisticated local block (numbing block) for pain-free recovery performed by the anesthesiologist just before surgery
• The cost of surgery, including Surgeon (Doctor) fees and Titanium implants
• Post-operative monitoring, medications, and fluids
• Pain medications for the first 2 weeks
• Medications (sedatives, antibiotic, anti-nausea) to help keep your pet calm for the first 2 weeks
• Sling to support your pet during the first week post surgery
• Suture removal
• Sedation for x-rays (if needed)
• All follow-up consultations with the surgeon for the first 4 months post surgery

The all-inclusive package fee for TPLO surgery at SurgiPet (2024):

• For dogs weighing below 101 pounds (45 kg), the cost is $4,500
• For dogs weighing 101 to 120 pounds (46 to 55 kg), the cost is $4,800
• For dogs weighing over 120 pounds (over 55 kg), the cost is $6,250

What’s Not included? In general, the following things are not included in the flat fee for TPLO surgery at SurgiPet:

• Advanced anesthesia medications and equipment required for high-risk anesthesia patients
• Major surgical complications that may arise
• Medications needed to treat the complications
• Medications beyond the first 2 weeks (typically sedatives)
• Rehabilitation sessions
• Care required after 4 months post surgery (since recovery is completed)

TPLO surgery is the most common orthopedic surgery performed at SurgiPet. The all-inclusive flat fee covers everything from your initial consultation to post-surgical rechecks and x-rays. Here are the steps:

1. Consultation and examination. You meet the surgeon in person to discuss your pet’s symptoms, overall health, and lifestyle. The surgeon explains why TPLO surgery is recommended, the surgery and post-surgery care. Our goal is to address all your questions to ensure you feel comfortable proceeding.
2. Anesthesiologist. Just like in a human hospital, if you have anesthesia-related questions, the anesthesiologist will meet you in person to address your concerns and answer all questions.
3. Surgery Day.
   • Anesthesia and Pain Control. Your pet is anesthetized and supervised by an anesthesiologist, using human-grade equipment to monitor and deliver the anesthesia. To manage pain, the anesthesiologist performs a local block (numbing block). This block ensures your pet will feel no pain at all during the surgery and for up to 48 hours after the surgery.
   • The surgery is performed in one of our modern operating rooms. Titanium implants are used in nearly all cases. C-arm (live X-ray) images are obtained during the surgery to ensure that all implants are placed in the optimal way.
4. Immediately after the surgery. Your pet is moved to the quiet, dedicated recovery area and is closely monitored by a registered veterinary technician (RVT) until fully awake. The anesthesiologist remains close-by to supervise the recovery.
5. Home by the evening. Modern anesthetics at SurgiPet allow fast recovery and allow your pet to come home the same day. Your pet will be so much more comfortable recovering right next to you!
6. Discharge. Before you leave the hospital, the team covers the post-surgery care: recovery, expected progress, sling use, medications, and diet. You’ll receive everything needed (sling, medications) with detailed instructions (print and digital). We answer all questions before helping you get your pet into the car.
7. Recovery at home. Our team is available to help you 7 days a week. During the first week we call to check on you and your pet to make sure the recovery goes smoothly. We made a short video to show you the most important aspects of taking care of your pet. We stand by for the entire 16 weeks to answer any questions and ease the stress.
8. Follow-ups. There are two scheduled follow-up visits with the surgeon. First, at 2 weeks, to evaluate your pet’s mobility and to remove the sutures. The second recheck is scheduled 8 weeks after the surgery and includes x-rays to assess the bone healing. The scheduled rechecks, all additional rechecks, and all the x-rays and sedation (if needed), are covered in the surgery fee for up to 4 months after the surgery.