TPLO Plate shifing

[lehughes]

MY question for surgeons and rehab persons working with TPLO's:

Have you ever heard of a plate shifting as determined by x-ray at the 8 week post-op check (large/giant-breed dog)?
We have a surgeon saying that rehab caused this (early stage P-mgmt rehab, then twice a week UWT & Laser, home program, and Q2weeks physio checks / home program updating.)

We've never had this reported. I've never heard of it. Did a literature search - nothing.
Could it be that the surgeon used too small of a plate? Or have others heard this reported.

Thanks!

Laurie

[David Lane]

This is called a "roll back" and is a reported TPLO complication. ie: it happens, and it may have as much to do with the dog's body weight as anything else. It this a dog that leaps to his feet instead of getting up slowly? What is the dog's BCS? Bone density? Owner compliance with exercise restriction? There are a bunch of factors to consider without this being anyone's fault.

Although I am not aware of research offhand that demonstrates this, many/most surgeons feel that the incidence of roll back dropped significantly after the introduction of locking plates and screws. Failure to use a locking plate system in a large dog has to be considered a contributing factor.

There was a survey paper in the CVJ 2-3 years ago that looked at TPLOs with and without rehab. It found that the complication rate was the same between both groups (ie: no evidence that early rehab increases complication rates), and that at the 8 week mark, those owners who had done rehab were 30% more likely to report a positive outcome from surgery... so there is that.

Bottom line is unless someone can point to an action taken by a specific party that deviates from normal practice, or that has a strong temporal relationship to the complication (ie: "he started limping right after I took him dock diving to celebrate the 3 week anniversary of his surgery"), it is unfair to project blame. For what that's worth...

[lehughes]

I enjoy your sense of humour David!

I did a literature search to look up information on the topic and found plenty that backs up exactly this (large dogs, normal change in tibial plateau angle by about 5 degrees, lack of locking screws...)

Glad to hear the same from a surgeon however! I think it's always easier to blame the other party than be objective! So for now, we don't see this surgeons patients until 4 weeks post op!

Thanks!

Laurie