What Is TPLO Surgery? Recovery, Cost and What to Expect

TPLO — tibial plateau levelling osteotomy — is the most commonly performed orthopaedic surgery in dogs and the gold standard treatment for cranial cruciate ligament (CCL) rupture. If your dog has been diagnosed with a torn cruciate ligament, understanding what TPLO surgery involves, what the recovery looks like, and what outcomes to expect will help you make an informed decision and prepare appropriately.

If your dog is limping on a hind leg and you suspect a cruciate ligament injury, contact Walker Lake Veterinary Centre at (587) 786-6771 for an assessment.

CCL rupture is the most common orthopaedic injury in dogs and one of the most frequently performed surgeries in veterinary medicine. TPLO has been performed for over 30 years and has an extensive evidence base demonstrating excellent long-term outcomes in the majority of dogs.

Understanding Cruciate Ligament Disease in Dogs

What Is the Cranial Cruciate Ligament?

The cranial cruciate ligament (CCL) is the canine equivalent of the human anterior cruciate ligament (ACL). It is one of the two cruciate ligaments inside the stifle joint — the dog’s knee — and its primary function is to prevent the tibia from sliding forward relative to the femur during weight bearing.

Without an intact CCL, the stifle joint is unstable — the tibia shifts forward with every step the dog takes, causing pain, joint inflammation, and rapid progression of osteoarthritis.

How CCL Rupture Differs From Human ACL Injuries

In humans, ACL tears typically result from a single traumatic event — a sudden twist, a fall, a collision. In dogs, CCL rupture is usually a degenerative condition. The ligament weakens progressively over months to years before it tears — often with minimal or no apparent trauma. A dog may rupture their CCL jumping off the sofa or changing direction during a walk — activities that would not cause injury in a dog with a healthy ligament.

This degenerative nature has important implications. The opposite stifle is frequently affected — studies suggest that 40 to 60% of dogs that rupture one CCL will rupture the other within 1 to 2 years. This is not bad luck — it reflects the fact that the same degenerative process is occurring in both ligaments simultaneously.

Signs of CCL Rupture

• Sudden hind leg lameness — often appearing during or after exercise
• Toe-touching lameness — the dog places the foot down briefly but does not bear full weight
• Sitting with the affected leg extended to the side rather than tucked normally under the body
• Muscle wasting of the affected thigh — develops over weeks of reduced use
• Stifle joint swelling — the joint appears thicker than normal
• Pain on palpation of the stifle
  

What Is TPLO Surgery?

The Mechanical Problem TPLO Solves

The CCL prevents forward sliding of the tibia during weight bearing because of the angle of the tibial plateau — the surface at the top of the tibia on which the femur rests. The slope of this surface (the tibial plateau angle) creates a force that would drive the tibia forward were it not resisted by the intact CCL.

TPLO eliminates this forward sliding force — not by replacing the ligament — but by changing the geometry of the joint. The tibial plateau is cut (osteotomy) and rotated to reduce its slope to approximately 5 degrees. At this angle, the stifle is mechanically stable during weight bearing regardless of whether the CCL is present or not. The instability is eliminated, pain decreases, and the joint can heal.

The Surgical Procedure

TPLO is performed under general anaesthesia and typically takes 60 to 90 minutes per stifle. The procedure involves:

• A surgical incision over the medial aspect of the stifle
• Examination and treatment of the joint interior — damaged meniscal cartilage is assessed and any torn portions are removed
• A curved osteotomy cut through the tibial plateau using a specialised saw
• Rotation of the tibial plateau segment to the target angle, measured intraoperatively using fluoroscopy (real-time X-ray)
• Fixation of the rotated segment with a bone plate and screws
• Closure of the joint capsule, soft tissues, and skin in layers

Post-operative X-rays confirm correct plate and screw positioning and the achieved tibial plateau angle.

Why TPLO Over Other Surgical Options?

Several surgical techniques exist for treating CCL rupture in dogs. The most commonly performed alternatives to TPLO are:

Extracapsular repair (lateral suture or TightRope) — places an artificial ligament outside the joint to provide temporary stability. Simpler and less expensive than TPLO. Most appropriate for small dogs under 15 to 20kg. Less durable in larger, more active dogs.

TTTA (tibial tuberosity advancement) — a different osteotomy technique that achieves stifle stability through a different geometric principle. Outcomes are comparable to TPLO in most studies.

TPLO is preferred for most medium to large breed dogs because of its proven long-term durability, predictable outcomes across a wide range of dog sizes and breeds, and the large body of evidence supporting its use.

Which Dogs Are Candidates for TPLO?

TPLO is appropriate for most dogs with complete or significant partial CCL rupture. It is particularly recommended for:

• Medium to large breed dogs — generally over 15 to 20kg
• Active or working dogs of any size
• Dogs with a high tibial plateau angle — common in certain breeds
• Young dogs where long-term joint health is a priority
• Dogs where other techniques have failed
  

High-risk breeds for CCL rupture — and therefore common TPLO candidates — include Labrador Retrievers, Golden Retrievers, Rottweilers, Boxers, Bulldogs, Mastiffs, and Newfoundlands.

Pre-Surgical Assessment

Orthopaedic Examination

The diagnosis of CCL rupture is confirmed by detecting cranial drawer movement — abnormal forward movement of the tibia relative to the femur — and a positive tibial compression test. Sedation is often required for accurate assessment in a painful, tense patient.

Radiography

X-rays of the affected stifle confirm the diagnosis, assess the degree of existing osteoarthritis, measure the tibial plateau angle, and allow surgical planning. Chest X-rays may be taken to assess anaesthetic risk in older dogs.

Bloodwork

Pre-anaesthetic bloodwork assesses organ function and is recommended for all dogs undergoing general anaesthesia — particularly important in older patients.

Referral

TPLO is a specialist orthopaedic procedure. In most cases, dogs are referred to a veterinary surgeon with orthopaedic training or a specialist referral centre for the procedure itself. Your primary care veterinarian — including Walker Lake Veterinary Centre — manages the diagnostic workup, referral, and post-operative care.

TPLO Recovery — What to Expect

TPLO recovery requires a significant commitment from the owner. Strict adherence to the post-operative protocol is one of the most important factors in achieving a good outcome.

Immediate Post-Operative Period (Days 1–5)

Your dog returns home the day of or the day after surgery with:

• A bandaged limb for the first 24 to 48 hours
• Prescription pain medication — typically NSAIDs and additional pain relief for the first 1 to 2 weeks
• Antibiotics for the first 1 to 2 weeks
• An Elizabethan collar — essential to prevent licking at the incision
• Detailed written aftercare instructions

Expect your dog to be significantly lame for the first week — this is normal. The bone has been cut and needs to heal. Most dogs begin toe-touching within a few days and gradually increase weight bearing over the following weeks.

Weeks 1 to 4 — Strict Rest

• Strict confinement — crate rest or a small room with no access to stairs, furniture, or slippery surfaces
• Leash walks only — 5 minutes, 3 times daily initially, increasing gradually as directed
• No running, jumping, playing, or off-lead activity under any circumstances
• E-collar at all times except under direct supervision
• Incision check — monitor daily for swelling, redness, or discharge
• Suture removal at 10 to 14 days post-surgery
  

Weeks 4 to 8 — Controlled Exercise

A follow-up appointment with repeat X-rays at 6 to 8 weeks confirms bone healing. If healing is progressing well, controlled exercise is gradually increased:

• Leash walks increasing to 10 to 15 minutes, 3 times daily
• Short, gentle inclines on lead
• Continued avoidance of high-impact activity
• Introduction of physiotherapy exercises as directed

Weeks 8 to 16 — Progressive Return to Normal

As bone healing consolidates, activity gradually returns toward normal. Most dogs are walking well and showing good function by 12 to 16 weeks. Full return to high-impact activity — running, jumping, playing — is typically permitted at 4 to 6 months post-surgery once complete bone healing is confirmed on X-ray.

Long-Term Recovery

Most dogs achieve excellent functional recovery after TPLO — returning to full activity with minimal or no ongoing lameness. However, because CCL rupture causes joint damage before and during surgery, all dogs develop some degree of osteoarthritis in the affected stifle over time. Long-term management may include joint supplements, weight management, and periodic pain medication during flare-ups.

Studies consistently show that approximately 85 to 95% of dogs return to normal or near-normal function after TPLO. Outcomes are significantly better than leaving the condition untreated — dogs with untreated CCL rupture develop rapidly progressive, painful osteoarthritis.

Potential Complications

While TPLO has a high success rate, all surgical procedures carry risks. Potential complications include:

• Infection — deep surgical site infection is the most serious complication, occurring in approximately 2 to 5% of cases
• Implant failure — the bone plate or screws may fail if the bone does not heal adequately or if activity restrictions are not followed
• Meniscal injury — the medial meniscus can tear at the time of CCL rupture or later during recovery (late meniscal tear)
• Delayed bone healing — uncommon but may require additional treatment
• Patellar tendon complications — rare but possible
  

Strict adherence to exercise restriction during recovery is one of the most important factors in avoiding implant failure and other mechanical complications.

Supporting Your Dog’s Recovery

Home Environment Modifications

• Remove access to stairs — use baby gates
• Cover slippery floors with non-slip mats or yoga mats
• Provide a comfortable, supportive orthopedic bed at floor level
• Use a ramp or steps to help with any necessary height changes
• Consider a sling or support harness for assistance with rising in the early weeks
  

Physiotherapy

Physiotherapy significantly improves recovery speed and functional outcome after TPLO. A structured programme of passive range of motion exercises, controlled weight bearing exercises, and proprioceptive training begins in the first weeks and progresses as healing allows. Hydrotherapy — particularly underwater treadmill — is one of the most valuable rehabilitation tools for post-TPLO dogs.

Pain Management

Adequate pain control is essential throughout recovery — a dog in pain will not use the limb appropriately, which slows muscle recovery. Follow the prescribed pain medication schedule precisely and contact your veterinarian if your dog appears to be in significant discomfort despite medication.

If your dog is limping on a hind leg or has been diagnosed with CCL rupture, book an assessment at Walker Lake Veterinary Centre. We can confirm the diagnosis, discuss surgical options, and coordinate referral. Call (587) 786-6771 or book online. Located at 5109 22 Avenue SW, Southwest Edmonton.

Book an Appointment at Walker Lake Veterinary Centre

Walker Lake Veterinary Centre provides orthopaedic assessment, CCL rupture diagnosis, pre-surgical workup, and post-operative care coordination for dogs across Walker Lake, Summerside, Ellerslie, Heritage Valley, and Southwest Edmonton.

Call us at (587) 786-6771 or book online. We are located at 5109 22 Avenue SW, Edmonton.

Clinic hours:

• Monday, Tuesday & Thursday: 9:00 AM – 7:00 PM
• Wednesday & Friday: 9:00 AM – 6:00 PM
• Saturday: 9:00 AM – 3:00 PM
• Sunday: Closed

Frequently Asked Questions

How long does TPLO surgery take?

The surgical procedure itself typically takes 60 to 90 minutes per stifle. Your dog will be at the surgical facility for most of the day — arriving in the morning for pre-operative preparation and returning home the same evening or the following day.

Is TPLO the only option for a torn cruciate ligament?

No. Other surgical options include extracapsular repair and TTTA. Non-surgical management — strict rest, pain medication, and physiotherapy — may be considered for small dogs under 10kg, but outcomes are generally inferior to surgical treatment in medium and large breeds. Discuss the options with your veterinarian and the referring surgeon based on your dog’s size, age, and activity level.

Will my dog need TPLO on the other leg too?

Possibly. As discussed, 40 to 60% of dogs rupture the opposite CCL within 1 to 2 years of the first. This is not a consequence of the surgery — it reflects the bilateral degenerative nature of the condition. Your veterinarian will monitor the opposite stifle and advise if surgical intervention becomes necessary.

My dog seems to be using the leg well before the follow-up appointment — can I let them exercise more?

No. A dog that appears to be walking well at 4 to 6 weeks post-surgery has not yet achieved full bone healing — the osteotomy site is still consolidating. Premature return to high-impact activity is one of the most common causes of implant failure and surgical complications. Follow the prescribed activity restrictions precisely regardless of how well your dog appears to be doing.

What happens if CCL rupture is left untreated?

Without surgical stabilisation, the unstable stifle joint develops rapidly progressive and painful osteoarthritis. Most dogs with untreated CCL rupture remain lame long-term, develop significant muscle wasting, and experience chronic pain. Surgical treatment — even when performed months after the initial injury — typically produces significantly better long-term outcomes than conservative management in medium to large breed dogs.