TPLO Case Study: Dr John Punke and Lilly

The Tibial Plateau Leveling Osteotomy requires skills in orthopaedic surgery to achieve good healing and better ranges of locomotion. It is the only technique unanimously recommended for dogs with steep tibial plateau angles, and the best technique for dogs with conformation problems. The TPLO workshop at UQ Gatton on September 27-29 is at capacity. This workshop offers hands-on training by masters of the technique and will optimise clinical outcomes for your patients. It also includes how to manage patella luxation with TPLO.

VetPrac is delighted to welcome Dr John Punke back to the education team for this workshop and we extend our thanks to him for providing the case study below. It demonstrates how well small breed dogs can do with TPLO, and that TPLO can also reverse chronic caudal stifle subluxation secondary to chronic CCL injury.


“Lilly” is an 8-year-old FS Maltese X. She ruptured her right CCL at 9 months of age. Her veterinarian did not recommend surgery at that time due to the fact that Lilly was a small breed dog. However, Lilly never did very well on that limb.

At 8 years of age, Lilly ruptured her left CCL. On radiographs, Lilly has a very large tibial plateau slope (33 degrees) in both knees. The right knee is caudally subluxated due to the chronic CCL rupture.

 

Right lateral pre-op angle

 

Dorso-ventral view of right ccrd pre-op

 

Lilly also had a grade I medial patella luxation on the right limb, and obvious caudal subluxation.  The left stifle had a grade II medial patella luxation in addition to a more recent CCL rupture.

 

Left lateral pre-op plan

 

John performed left TPLO for Lilly in February 2019. He was more optimistic that this stifle would do well since it was a more acute injury.  He treated the medial patella luxation with lateral imbrication of the joint capsule and medial release.

Lilly did very well and was completely sound on exam at 8 weeks post-surgery. Radiographs revealed excellent healing.  The MPL was stable with no residual luxation.

 

Left crcd 8 weeks post-op

 

The owners were so happy with how well the left TPLO went, they requested that John do a right TPLO for the chronically subluxated right stifle.  Lilly did very well on the right stifle as well.  At 8 weeks post-surgery, Lilly was completely sound and functional on both limbs.  She has continued to do very well on both rear limbs long term.

 

Right lateral post-op

 

Lilly’s case is an example of how well small breed dogs can do with TPLO.  In John’s opinion they recover even quicker than large breed dogs.  John commented that “TPLO was a great option for Lilly since she had a very high tibial plateau slope.  Lilly has taught me that TPLO can also reverse chronic caudal stifle subluxation secondary to chronic CCL injury”.

 


VetPrac’s 2019 TPLO Workshop is at capacity. We are coordinating a Patella & Stifle Surgery workshop in June 2020. Join our VIP Waitlist to receive early opportunity to register before enrolments are open to everyone else.

CLICK HERE to join the waitlist.