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The lateral sutures.

 

This is an older technique and except for very small patients with very unstable joints we rarely perform this procedure. The advantages are that it is the least invasive, potential complications can normally be easily dealt with and it requires minimal instrumentation to perform. The disadvantages are that dogs are generally very uncomfortable afterwards and the mechanism of action is just to create scarring around the joint.

 

The more recent methods using osteotomies (bone cuts) produce far superior results. The goal of these procedures is to accurately change the geometry of the knee joint so that the cruciate ligament is no longer required. In the vast majority of cases we achieve a rapid improvement in comfort and function with many dogs weight bearing the day following surgery (healing though does take up to 8 weeks and with off lead exercise at 12 weeks) The disadvantages are that they all require far more experience and considerable instrumentation. Complications which are fortunately rare can be more serious.

 

TTA.

 

We have been performing TTAs since 2014. This involves making a cut in the tibia to advance the insertion of the patella tendon. A titanium spacer cage plus plate is then used to stabilise the bone. There are a variety of newer methods available from the TTA Rapid to the MMP. They have advantages as they require less instrumentation but I still feel the original is superior.

There is debate as to the exact mechanism of action as studies have shown the knee can still be unstable, but the vast majority of patients return to very good function. Research is on going, but with increased instability, these joints may be more prone to arthritis. If the tibial plateau (articular surface) is too steep then this method is not suitable. We have performed TTAs in patients from 10-55kg. Whilst we still occasionally perform TTAs, we now feel that TPLO type procedures are more suited to most patients.

 

TPLO

 

These procedures require far greater experience and more instrumentation. For a radial cut TPLO we have invested over £12k on a dedicated saw alone and also carry a considerable stock of implants. Studies show that these surgeries create a much more stable joint.

 

Cranial closing wedge TPLO.

 

This is the original version and involves removing a precise wedge of bone from the tibia to reduce the tibial plateau angle to 3-5 degrees. The tibia is then stabilsed with a locking plate and 6-9 screws. Sometimes an additional pin and wire are used.

This method is especially suited for smaller dogs, dogs with steep plateaus and can be performed in any size. For immature patients that are still growing this is the most suitable method.

We have performed this procedure in dogs ranging from 5-50 kg

 

Radial cut TPLO.

 

This method involves making a precise curved cut below the tibial plateau. This piece of bone then is precisely rotated and then secured with a locking plated and 6-9 screws. The goal is to again reduce the plateau angle to 3-5 degrees. This method is especially suited for larger dogs over 20kg. This is the most common of the advanced procedures to be performed in the uk.

 

 

Price list

 

TTA. 1750

TPLO. (5-40kg). 2000

TPLO. (40-50kg). 2250