TTA vs TPLO - Similar until there are complications

By: Kate Fitzwater, DVM, MS, DACVS

Cranial cruciate ligament rupture is the most common orthopedic injury in dogs. There are multiple surgical procedures that can be done to treat this disease, but two of the most popular “osteotomy” (cut in the bone) procedures are the TPLO (tibial plateau leveling osteotomy) and TTA (tibial tuberosity advancement).

Both procedures can provide excellent outcomes and both have their potential complications. Infection can occur with any surgical procedure, but with orthopedic surgeries that involve implants, the risk is higher. That is why prior to an elective orthopedic procedure, the skin is evaluated for infection and antibiotics are used during the procedure and postoperatively to lessen this risk. If a dog licks or chews at the incision, this is highly likely to result in an infection in the immediate postoperative period.  Late infections are also a potential possibility as well, because urinary tract, skin, oral, or ear infections can spread to the site of an implant or area of inflammation (osteoarthritis). If the site of an orthopedic surgery becomes infected, the implants have to be removed to clear that infection completely. This is because the stainless steel implants do not have a blood supply and the bacteria stay on the implant in a “biofilm”. The implants can be removed as long as the bone has healed.

 

When we are dealing with removal of TPLO or TTA implants, the level of difficulty and invasiveness is dramatically different between the two procedures. Below are radiographs of each procedure showing the metal implants. The TTA implants involve a cage (square) that acts as a spacer, and during healing bone grows into this cage. There is also a fork plate and screws that hold the osteotomy in place. When removing TTA implants, the fork plate and screws easily can be removed, but the cage must be “cut” out of the bone, leaving a large defect that has a high risk of fracture. This surgery to remove the cage that is encased in bone is invasive and difficult. The TPLO, on the other hand, doesn’t have a cage and only has a plate and screws, which can easily be removed because the bone doesn’t grow into them.

  TTA radiographs showing cage,
fork plate/screws             

 TTA radiographs showing cage,
fork plate/screws             



TPLO radiographs showing
plate/screws 

TPLO radiographs showing
plate/screws

 

 

 

 

 

 

 

 

 

 

 

 

 

So, when discussing the surgical options for a cranial cruciate ligament rupture, all the potential complications need to be discussed and the risks weighed. Infection risk is low at 7.4% (Gallagher AD et al. Implant removal rate from infection after TPLO in dogs. Vet Surg. 2012), but if it is your dog that needs the implants removed, the process is less complicated to have had a TPLO over the TTA!

“I can’t believe I ate the whole thing…”

By Rebecca Ball, DVM, MS, DACVS-SA

Kitrina is an 11 year old female spayed Shih Tzu mix that presented for gagging and restlessness after eating one of her favorite chew bone treats the night before. Kitrina, like many pets, really enjoys her chew treats.

 

Kitrina’s family veterinarian took an x-ray and suspected that she may have overzealously eaten the entire bone, whole! She received barium (a contrast agent that shows up  as white on x-rays) to see if it could help determine if she had indeed eaten the bone whole. Unfortunately the x-ray showed that she not only had eaten the bone whole, but that it was stuck in her esophagus.

Here is an x-ray that shows the barium (white) in Kitrina’s esophagus outlining the chew bone (black) stuck in her esophagus.

 

 

In this picture, the chew bone has been outlined with blue arrows.

 

Kitrina was referred to Circle City Veterinary Specialty and Emergency Hospital and evaluated to see if her chew bone could be removed with an endoscope. An endoscope is a camera that can be inserted into the esophagus and instruments passed through to grab and remove objects. Unfortunately, Kitrina’s chew bone was so tightly stuck in her esophagus that it could not be removed. Kitrina had to undergo emergency surgery to remove the stuck chew bone.

An incision was made through the side of Kitrina’s chest and another incision was made into her esophagus. The chew bone was successfully removed piece by piece and the incision into Kitrina’s esophagus was repaired.

The esophagus is a very delicate area to perform surgery on and because of the movement associated with swallowing and other anatomical factors, complications with esophageal surgery can be high. Because of these factors and the fact that the chew bone was in Kitrina’s esophagus overnight causing inflammation and irritation, it was decided that it would be best to allow her esophagus to rest for at least a few days after surgery to let it heal. In the meantime however, Kitrina would still need to eat! A gastrostomy tube (a tube inserted surgically through the skin into the stomach) was placed and allowed us to continue to feed Kitrina while also letting her esophagus rest and heal.

 

Kitrina did well after surgery and after one week she was allowed to begin to eat soft solid foods by mouth. Again, Kitrina did well and after two weeks her gastrostomy tube was removed and she was allowed to continue to eat soft foods by mouth and will begin to eat dry foods in the near future.

Kitrina’s family is delighted to have their wonderful dog back, healthy, and happy!