Further your surgical skills with Dr Bruce Smith

As vets we all strive to improve the quality of life of our patients. Sometimes in order to achieve this goal, our patients may require surgical procedures which are technically challenging. Surgical procedures involving the patella and stifle are often complex but rewarding. Are you up to the challenge of furthering your skills in this area?

Dr Bruce Smith enjoys the challenges involved with surgery to joints, in particular the stifle and patella. His current roles as Clinical Director, Small Animal Veterinary Teaching Hospital, University of Queensland & Councillor, Australian & New Zealand College of Veterinary Scientists allow Bruce to devote a significant amount of time to help other specialists and clinicians achieve their goals. VetPrac is fortunate to have Bruce as an educator at the upcoming Patella and Stifle workshop.

Let’s get to know Bruce, and his pathway to becoming a specialist surgeon and committed educator.

 

 

What inspired you to become a veterinarian and then go onto specialise in surgery?
“I recall that of all the clinical disciplines (and I was determined to be a clinician) it was surgery that grabbed my attention and imagination as an undergraduate and it grew from there”.

Do you have a favourite surgery or procedure that you like to perform?
“Definitely those procedures that can restore function, reduce pain and allow the animal to express itself in movement – so orthopaedic and spinal. More specifically I have a deep appreciation and respect for engineers and bio mechanists and the implants and procedures that they have made possible”.

What is it about surgery involving the patella and stifle that you enjoy the most?
“The surgical management of a dynamic structure – such as a joint – are intellectually and technically challenging and rewarding. The patella is certainly such a challenge”.

Do you have any advice for general practitioners that wish to pursue further education in orthopaedic surgery?
“Motivation is the key; if you have it you will persist and if you persist you can achieve. There is so much access to informational and skills knowledge these days that a purposeful practitioner can easily self-inform. However, surgery is ultimately a balance of knowledge, technical skill, and good judgement. As such surgery has to be repeatedly & correctly practiced to become a skilled performance. This takes discipline, constant vigilance and good habits, both technical and mental. Developing good habits takes lots of time and hard work – there are no short-cuts, but practical instruction courses are a start”.

Are you working on any projects at the moment?
“Currently my time is primarily taken up with helping other specialists & clinicians achieve their goals. However, I maintain a keen interest in what is new and will cheerfully get involved in intern and resident projects”.

What do you enjoy about teaching?
“Ultimately teaching is learning, and this is a professional habit that I have nurtured over my career and it has rewarded me well. I see younger veterinarians facing the same challenges I did in developing their career, and believe that the exchange of skills, knowledge and experience is one of the true joys of being a professional”.

What do you like to do to wind down? What do you like to do for fun?
“Not a lot these days – slowing down, taking time to “smell the roses” and to catch up on a mountain of reading”.

Dr Bruce Smith can be contacted at basmith@ozemail.com.au

 

Join Dr Bruce Smith, Dr John Punke and Dr Peter Young at Patella & Stifle Surgery in November. This practical hands-on workshop has limited places available. Book your spot now or download the brochure for more information.

 

Dr Charles Kuntz reviews the iM3 tabletop mouth gag

Treatment for respiratory and associated ailments in brachycephalic patients are proving common due to the popularity of these breeds. VetPrac’s Fix the Face: Brachycephalic and Ear Surgery workshop is open for registrations and we’re fortunate to have a wonderful education team led by Dr Charles Kuntz.

Register now to join us in October for hands on training with expert educators and experience using the latest equipment such as the iM3 TTMG tabletop mouth gag (TTMG).

The TTMG was designed by iM3 with the help of specialists to hold anaesthetised patients in the best possible posoition for examination and treatment of the oral cavity.

Dr Charles Kuntz has provided this review about his experience using the tabletop mouth gag (TTMG).

 


 

“I have been using the iM3 tabletop mouth gag (TTMG) for about 4 years for positioning of the head for numerous procedures, most commonly brachycephalic airway surgery. This device is absolutely perfect for positioning dogs’ heads for this procedure and saves a lot of time and expense (think endless rolls of tape) normally required for positioning brachy’s heads for surgery. The other really nice thing is that it is adjustable. We can have the head in one position for the nares and then change the position for the soft palate and saccules. I strongly recommend the use of the TTMG for this purpose”.

Dr Charles Kuntz
Specialist Surgeon
DVM, MS, MACVSc, Diplomate of the American College of Veterinary Surgeons, Registered Specialist of Small Animal Surgery, Fellow of Surgical Oncology.

 

 

Join us in October! Dr Charles Kuntz, Dr Tania Banks, Dr Abbie Tipler and Dr Kat Crosse are our wonderful team of educators for this practical hands-on training. Registrations are open for the Fix the Face workshop and places are limited so book now to secure your place.

 

Vet Tips for Patella & Stifle Surgery

We’re looking forward to VetPrac’s Patella & Stifle Surgery workshop at the University of Queensland, Gatton Campus, in June. Have you booked your place yet?

Join Dr John Punke, Dr Peter Young and Dr Bruce Smith at this practical hands-on workshop to develop your skills and practice modern techniques in cruciate repair.

Dr Punke has kindly developed these tips for us to share with you. Be sure to register to join us in June for more tips and expert advice regarding Patella & Stifle Surgery. We hope to see you there!


Tip 1

Tibial tuberosity transposition (TTT) is the most important and nerve-wracking procedure to perform in the majority of medial patellar luxation cases. Indeed, failure to perform this procedure is the most common cause of surgical failure. Build confidence through our specialist’s practical tips and tricks created from years of experience.

 

Tip 2

Dogs with medial patella luxation (MPL) have been shown to have an INCREASED risk of rupturing their cranial cruciate ligament (CCL).  MPL surgery earlier in life can minimize osteoarthritis and protect the CCL long term resulting in a happier and healthier patient.

 

Tip 3

There is very much an art to performing surgery for MPL. The trochlear wedge recession and a more recent modification, the trochlear block recession technique, both allow elevation of the articular cartilage in the trochlear groove, deepening of the groove, and replacement of the cartilage. As there are no fixations, simply the pressure of the patellar to hold in the newly formed piece of cartilage, the success of the procedure relies upon the surgeons fine carving skills. With the support of highly skilled specialist surgeons and real tissues, you can hone your carving skills for better patient outcomes.

 

Register now to secure your place in the Patella & Stifle Surgery workshop. Dr John Punke, Dr Peter Young & Dr Bruce Smith will be on hand to guide you through the intricacies of this focused arthroplasty workshop. Registrations are limited so we recommend you book now to avoid missing out!

Dr Peter Young – A world of experience for younger generations

Dr Peter Young is a private practice surgeon and he’s joining the education team at not one but two VetPrac workshops in 2020. These workshops are an opportunity for veterinarians to get hands-on experience under the tutelage of industry experts, such as Dr Peter Young, who has been working in the industry for almost 40 years!

Peter’s career commenced in dairy work before he moved on to general and referral surgical practice in regional NSW. He spent almost a decade as a surgical educator at Charles Sturt University while working as a referral surgeon for their small animal clinic and completing research. He’s now working a shorter week as a general surgeon in Albury and we’re thankful for the opportunity to have him part of our educator teams.

Dr Young will join us on the 17th-19th April for Practical Skills Bootcamp and again in June for the Patella & Stifle Surgery workshop. We look forward to sharing more about Peter over the coming months. Here’s a glimpse of the legend that is Dr Peter Young.


 

Pete lives life to the full, enjoying competitive karate, trekking in Nepal, and volunteering overseas for Vets Beyond Borders and the Iditarod Dog Sled Race. Last year he travelled to Cape York – I’m sure he’s got plenty of fascinating stories to share from those adventures!

Pete has worked in both private practice and in university settings, as a lecturer, researcher and surgeon. In a university setting he found the case load to be challenging and interesting, however sometimes he found university clinical practice to be frustrating because the bean counters often do not have an appreciation of the clinical needs regarding staff, equipment and the need to do after-hours. He finds private practice to be very rewarding if you are in a supportive well-equipped practice with good professional standards.

When Pete was asked what advice he would give new graduates or those vets are aren’t confident with performing surgery, he cheekily stated “To appreciate that the first 25 chapters of Tobias and Johnson are critical to confidence and success (☹- sorry for that). Work in a supportive practice that will invest in appropriate level of equipment. Don’t let your enthusiasm exceed your ability. Take every opportunity to have mentorship and every case is an opportunity to learn something new.”

 


 

Join Dr Peter Young at Practical Skills Bootcamp this 17th-19th April at UQ Gatton. This workshop is suitable for experienced veterinarians in search of a refresher course, new grads, and veterinarians returning to work after a break.

We’ve crammed a lot of information into this 3-day workshop with topics in surgery, dentistry, animal behaviour, communication, and so much more! Seven other educators are joining forces with Dr Young and class size is limited to ensure participants receive the attention required to have them job-fit and able to immediately implement the skills in practice.

Register now for Practical Skills Bootcamp before the workshop fills or download the brochure for more information.

 

 

Part 2 Anaesthetic considerations during Laparoscopy

Last week we explored the impact laparoscopy has on the pulmonary and cardiovascular systems.

So how can we manage our patients’ anaesthetic to achieve the best possible outcome when performing laparoscopic procedures?

Ventilatory support in the form of intermittent positive pressure ventilation (IPPV), with a mechanical ventilator, is recommended for patients where the procedure is anticipated to last longer than 15 minutes.

 

Mechanical ventilation should be commenced once the patient is stable under general anaesthesia as follows:

1. Monitor ETCO2 – the normal range is 35 mmHg – 45 mmHg and this is crucial for decision making about the ventilation requirements of the patient.

2. Tidal volume 10 – 20ml/kg – set the ventilator at 10 ml/kg and increase as required. In order to avoid barotrauma, it is wise to set tidal volume at no more than 20ml/kg, and to adjust the respiratory rate.

3. Respiratory rate 10 – 12 breaths/min, adjusted to the requirement of the patient. Changing the rate up or down based on the degree of increase or decrease, respectively, in ETCO2 is a sound strategy to manage ventilation. This protects the lung from being damaged by barotrauma due to over ventilation in the face of an expanded abdomen and minimises the decrease in venous return that occurs when the thorax is expanded due to positive pressure ventilation. Blood pressure monitoring is strongly recommended for laparoscopic procedures.

 

While mechanical ventilation is recommended, it is possible to manually or hand ventilate a patient during laparoscopy of longer than 15 minutes duration. If this is the only option available then a dedicated person, or “human ventilator”, is recommended to squeeze the reservoir bag to provide a breath to the patient, during the procedure.

Manual positive pressure ventilation criteria:

1. Monitor ETCO2 – essential to the success of any IPPV whether it is instituted mechanically or manually, because this guides you to successful beginning and end points of ventilation.

2. Use a manometer (pressure gauge) connected to the breathing system so that you know what pressure you are delivering, ideally 10 – 12 cm H20. If you don’t have a manometer then observe the thorax as you deliver a breath and make sure that this looks like a reasonable respiratory excursion. Remember positive pressure ventilation impacts the cardiovascular system by decreasing venous return, lowering cardiac output and blood pressure. Again, blood pressure monitoring is strongly recommended.

3. Respiratory rate see Point 3 above.

 

Laparoscopy is such a valuable skill to utilise in your clinic. Appropriate planning, and vigilant monitoring of ETCO2 and blood pressure during anaesthesia will help achieve an optimal outcome for your patients.

 

If you want to learn more about Laparoscopy this is the workshop you don’t want to miss! Dr Brenton Chambers, Dr Peter Delisser & Dr Kathryn Duncan are combining their expertise and we’re keen to share it with you. This workshop is proving to be very popular so don’t delay! Register HERE for the Laparoscopy: Principles and Practice Workshop at Gatton on February 7-9, 2020.

 

Other interesting reads:
Part 1: Anaesthetic considerations during Laparoscopy
From Laparoscopy to surgery on large land-based predators (Dr Brenton Chambers)
A peek into Laparoscopy with Dr Peter Delisser
Dr Kathryn Duncan joins the laparoscopy educator team

 

Part 1 Anaesthetic considerations during Laparoscopy

When planning for laparoscopy, have you ever thought about its impact on your patients’ ability to tolerate general anaesthesia? The key to success, as always, is preparation and vigilant monitoring.

The abdominal insufflation required during laparoscopy will impact on both the pulmonary and cardiovascular systems. Understanding the changes that occur when the abdomen is insufflated will help you plan appropriate ventilation strategies. This, along with considering the primary presenting disease and any co-morbidities, will help set you up for success.

This blog will discuss the impact laparoscopy has on pulmonary physiology. A subsequent blog will discuss some possible ventilation management strategies.

 

Impact on pulmonary physiology during laparoscopy


When laparoscopy is performed gas is used to insufflate the abdomen to a pressure of up to 15 mmHg. The resulting significantly increased abdominal pressure limits normal movement of the diaphragm. Lung tissue becomes less compliant, tidal volume decreases and there is a decreased lung functional residual capacity. This results in a significant decrease in gas exchange throughout the respiratory cycle. Insufflation may also lead to a mismatch in ventilation/perfusion, where deoxygenated blood is carried back to the arterial side of the circulation, causing a reduction in delivery of oxygen to the tissues. Bottom line the greater the insufflation pressure the greater the impact on pulmonary physiology.

In spontaneously breathing patients, the reduction in tidal volume results in significant hypoventilation, and respiratory muscle fatigue can occur when breathing against an expanded abdomen. This leads to an increase in end-tidal carbon dioxide (ETCO2). This increase is further exacerbated by the fact that carbon dioxide (CO2), a highly diffusible gas, is the most commonly used insufflation gas. CO2 will enter the blood stream contributing to the rise in arterial CO2 (PaCO2) and ETCO2.

High ETCO2 leads to a respiratory acidosis, which drives down body pH, leading to an acidaemia and a significant disruption to cellular metabolic processes within the body.  If the patient is already vulnerable due to an established disease process then this will only exacerbate the situation, increasing the risk of anaesthesia and potentially exposing the patient to a poor outcome.

 

Next week we’ll discuss some strategies for managing ventilation of patients during laparoscopy.

 


 

If you want to learn more about Laparoscopy this is the workshop you don’t want to miss! Dr Brenton Chambers, Dr Peter Delisser & Dr Kathryn Duncan are combining their expertise and we’re keen to share it with you. This workshop is proving to be very popular so don’t delay! Register HERE for the Laparoscopy: Principles and Practice Workshop at Gatton on February 7-9, 2020.

 

 

Other interesting reads:
Part 2: Anaesthetic considerations during Laparoscopy
From Laparoscopy to surgery on large land-based predators (Dr Brenton Chambers)
A peek into Laparoscopy with Dr Peter Delisser
Dr Kathryn Duncan joins the laparoscopy educator team

 

Welcome to the VetPrac Laparoscopy team Dr Kathryn Duncan

Dr Kathryn Duncan graduated from the University of Melbourne in 2015 and will complete her residency at Southpaws Specialty and Referral Hospital early 2020. She is passionate about all aspects of small animal surgery with a particular interest in cardiothoracic surgery and neurosurgery.

Kathryn joins the VetPrac educator team in the Laparoscopy Workshop at Gatton on February 7-9th 2020. We’re proud to welcome her to our family and spent a little time getting to know Kathryn a little better:


What do you like to do for fun?
Running, playing netball and catching up with family and friends.

 

How do you pend your days off?
Most free time is sadly spent studying at the moment but otherwise I love spending time with my friends in Melbourne.

 

In your own words, what it is about laparoscopy that you find interesting and that you believe general practitioners would benefit from learning and performing better?
Performing less invasive surgical procedures should always be something that we strive towards as veterinarians to reduce the morbidity for our patients!

 

Would you like to share any horror or hero stories from any of the procedures we’ll be addressing to inspire readers to assess and grow their skills?
It’s better to have some experience under your belt before attempting a completely laparoscopic gastropexy on the surgical specialist’s puppy!

 

What have you learned from experience that you didn’t learn from a textbook? What practical advice would you offer fellow vets?
I gained most of my experience with fracture repairs from hands on experience and courses aiming to improve your technical skills. Attending practical courses can be so great to consolidate knowledge, enhance your skills and expose you to huge numbers of case examples and are really worthwhile signing up for.

 

What procedure/technology/medication have you used and realized that there was a better alternative?
Orthovoltage radiation therapy – it is unfortunate that we are so limited in our access to megavoltage radiation/linear accelerators in Australia, because they are an incredible tool in the medical profession. We are fortunate to have an orthovoltage radiation unit that can be useful in some scenarios, but the megavoltage radiation units are so versatile in comparison.

 

What have you tried that doesn’t work? What have you tried that does work and may be surprising to other vets?
I am always pleasantly surprised about the benefit that palliative radiation therapy can provide to patients with osteosarcoma that are not able to undergo amputation due to concurrent disease. This can be a really helpful management tool for pain relief in these dogs.

 

What practical surgical tips that you learned from experience would you share with general practitioners?
Immersing yourself in fields of interest such as surgery can be so beneficial to your learning. Reading a textbook front to back can be demoralizing, and so if you are interested in a specific field then try to spend some time with other practitioners who work in that area (e.g. visit specialty centers) and see what you pick up along the way!

 

What advice would you give new graduates?
You are entering an amazing industry with so many resources that you can reach out to, whether it is for case advice, work-life balance advice or mental health support – never be afraid to ask for help or input from others around you to improve your patient’s outcomes and to improve your own personal challenges.

 

 

If you want to learn more about Laparoscopy this is the workshop you don’t want to miss! Dr Brenton Chambers, Dr Peter Delisser & Dr Kathryn Duncan are combining their expertise and we’re keen to share it with you. This workshop is proving to be very popular so don’t delay! Register HERE for the Laparoscopy: Principles and Practice Workshop at Gatton on February 7-9, 2020.

 

Dr Kathryn Duncan can be contacted by email – CLICK HERE.

 

Other interesting reads:
Dr Kathryn Duncan’s experience, publications and awards
From Laparoscopy to surgery on large land-based predators (Dr Brenton Chambers)
A peek into Laparoscopy with Dr Peter Delisser
Brochure: Laparoscopy Workshop 2020

From Laparoscopy to surgery on large land-based predators

What do you get when you cross a veterinary surgeon with a fine dose of good humour?  Dr Brenton Chambers!

Dr Chambers is a UQ graduate with a mixture of general, emergency and referral practice experience, a stint as a lecturer at the University of Melbourne in Small Animal Surgery, and he’s a Fellow of the Australian and New Zealand College of Veterinary Scientists.

Brenton will lead the education team in the 2020 Laparoscopy Workshop at Gatton on February 7-9th 2020. We spent a little time getting to know Brenton a little better and hope you enjoy his insight as much as we do:


What do you like to do for fun?
I enjoy photography, woodwork, music and reading.

 

How do you spend your days off?
Trying not to worry about surgery.

 

In you own words, what is it about Laparoscopy that you find interesting and that you believe general practitioners would benefit from learning from and performing better?
Laparoscopy and laparoscopic -assisted procedures provide an avenue to access the peritoneal space via a minimally invasive approach with unparalleled visualization and illumination whilst minimizing the morbidity inflicted on our patients. It has a learning curve like any other procedure and some capital expenditure is required, but once the basic techniques are learned, the principles (and also the equipment) can be applied to many situations.

 

What have you learned from experience that you didn’t learn from a textbook? What practical advice would you offer fellow vets?
Surgery, more than most disciplines has a significant manual component. Whilst the concepts and cerebral component can be learnt from a textbook, the fine nuance of any surgical procedures are learned from doing and watching others doing the same procedure. Practical courses provide a good introduction, but finding an experienced and skilled mentor is invaluable and will allow you to fine tune your techniques and troubleshoot your complications.

 

What procedure/technology/medication have you used and realized that there was a better alternative?
Intra-corpeal suturing without needle drivers.

 

What practical surgical tips you’ve learned from experience would you share with general practitioners?
When performing surgery on large, land-based predators which have been anaesthetized by some-one else, know where the exits are and don’t be the slowest person in the room.

 

What advice would you give new graduates?
Find a supportive environment in which to work, ideally with a mentor. Keep in touch with your peers to help support each other. Don’t stay in a situation that doesn’t suit you.

 

 

If you want to learn more about Laparoscopy this is the workshop you don’t want to miss! Dr Brenton Chambers, Dr Peter Delisser & Dr Kathryn Duncan are combining their expertise and we’re keen to share it with you. This workshop is proving to be very popular so don’t delay! Register HERE for the Laparoscopy: Principles and Practice Workshop at Gatton on February 7-9, 2020.

 

Dr Brenton Chambers can be contacted at
Centre for Animal Referral & Emergency
Email: bchambers@carevet.com.au

 

Other interesting reads:
Dr Brenton Chambers’ experience, publications and awards
A peek into Laparoscopy with Dr Peter Delisser
Brochure: Laparoscopy Workshop 2020

 

A peek into Laparoscopy with Dr Peter Delisser

Dr Peter Delisser is a formidable specialist in Small Animal Surgery. From his undergraduate degree at the University of Queensland to his surgical residency at the University of Bristol, Dr Delisser has completed his PhD studying the effects of mechanical loading on bone tissue and its relevance to osteoporosis in people.

In his ‘spare time’ he’s published an impressive collection of scientific papers and presented at conferences on various topics from urinary incontinence in bitches to fracture repair techniques, and bone mechanobiology to name a few.

Pete returns to the VetPrac education team in 2020 for the Laparoscopy Workshop at Gatton on February 7-9 2020. He last joined us at our Perineal & Urogenital Surgery Workshop in 2018 so we’re thrilled to be in his fine company again.

We took some time out with Pete to get to know him a little better:


What do you like to do for fun? 
Skiing, beach holidays, camping, or golf. I spend my time off with my children mostly which is far less adventurous than it used to be.

 

What is it about Laparoscopy you find interesting and believe general practitioners would benefit from learning from and performing better?
Laparoscopy is fun, challenging and beneficial for the patient from a comfort and recovery point of view.

 

Can you share any horror or hero stories from procedures we’ll be addressing in the workshop that may inspire others to assess and grow their skills?
My supervisor lacerated a spleen and required a conversion and splenectomy when doing a laparoscopic spay.

This week I had to convert a lap-assisted cystoscopy for the first time. The bladder didn’t inflate very well so I couldn’t visualize the stones and suction made it harder rather than easier.

The best advice I can share with general practitioners is to “Practice, practice, practice…”

 

What have you learned from experience that you didn’t learn from a textbook?
Tilt the dog more than you think you can. It makes it easier!!

Suture the camera portal closed around the port if you are getting air leakage or the port keeps slipping out when changing instruments.

 

What procedure/technology/medication have you used and realized there was a better alternative?
Open cryptorchid – laparoscopic removal is so much nicer!

 

What have you tried that may be a surprising tip to other vets?
A metal reusable straw works for bladder stone suctioning and allows bigger stones to be vacuumed up.

 

Do you have any advice for new graduates?
Keep learning!!!

 

If you want to learn more about Laparoscopy this is the workshop you don’t want to miss! Dr Brenton Chambers, Dr Peter Delisser & Dr Kathryn Duncan are combining their expertise and we’re keen to share it with you. This workshop is proving to be very popular so don’t delay! Register HERE for the Laparoscopy: Principles and Practice Workshop at Gatton on February 7-9, 2020.

 

Dr Peter Delisser can be contacted at
Veterinary Specialist Services (Underwood)
Email: pdelisser@vss.net.au
Phone: (07) 3841 7011

 

Other interesting reads:
Struggling with rear end encounters? Dr Peter Delisser can help! (August 01, 2018)
Brochure: Laparoscopy Workshop 2020
Dr Peter Delisser’s experience, publications and awards

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 March 5th – 7th 2021. 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 2021 TPLO Workshop is currently taking registrations.

Click here to download the brochure.