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How Common Are Infections After TPLO Surgery?

How Common Are Infections After TPLO Surgery?

Infection

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Owners

Learn how common infections are after TPLO surgery in dogs, typical infection rates, risk factors, early warning signs, and prevention steps.

By 

Sustainable Vet Group

Updated on

August 3, 2026

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This article is for informational purposes only and is not a substitute for professional veterinary advice. Every case is unique, so always consult your veterinarian for guidance specific to your pet.

This content is intended for veterinary professionals for educational purposes. It does not replace clinical judgment or tailored advice. Always rely on your training, expertise, and the specific context of your patients.

How Common Are Infections After TPLO Surgery?

TPLO has a higher surgical site infection (SSI) rate than most other sterile elective orthopedic procedures in dogs.

Published literature reports rates ranging from 2.9% to 17.3%, with the wide range reflecting differences in study populations, SSI definitions, and follow-up duration.

Understanding where this rate comes from -- and what drives it -- helps owners and clinicians put the risk in appropriate context.

 

Quick answer: Published TPLO SSI rates range from 2.9% to 17.3%. The PMC 769-TPLO study found 8.5%, higher than expected for sterile orthopedic surgery. Key drivers are the metal implant, S. pseudintermedius on dog skin, and thin tibial coverage. Implant removal occurs in 3.5% to 7.5% of cases.

 

Key takeaways

  • TPLO SSI rates range from 2.9% to 17.3%: the PMC 769-TPLO study found 8.5%; Clinician's Brief notes the range extends to 1.3% to 25.6% by SSI definition
  • TPLO has a higher SSI rate than other sterile orthopedic procedures: the implant, S. pseudintermedius-colonized skin, and thin tibial coverage all contribute
  • Implant removal due to infection occurs in 3.5% to 7.5% of TPLO procedures: 37.5% of dogs with SSI require plate removal per ResearchGate implant removal data
  • German Shepherd dogs and dogs with previous contralateral TPLO are at significantly higher risk: OR 4.41 and 2.01 respectively per the PMC study
  • Higher body weight and longer anesthesia time are independent SSI risk factors: confirmed in multiple published studies
  • Surgeon experience, meniscectomy, and surgical duration significantly affect SSI risk beyond the baseline population rate

Why TPLO has a higher SSI rate than other orthopedic surgeries

Several TPLO-specific factors elevate SSI risk above the baseline for clean orthopedic procedures:

Metal implant presence

Metal implants dramatically lower the minimum infective dose. In the presence of a plate, a bacterial challenge that the immune system would clear in soft tissue surgery is sufficient to establish infection. The PMC 769-TPLO study confirms TPLO SSI rates are considered higher than expected in comparison to other sterile elective orthopedic procedures.

Proximity to skin flora

S. pseudintermedius colonizes the skin, nares, and perianal area of most dogs.

The proximal tibia -- where the TPLO plate sits -- is covered by a thin layer of subcutaneous tissue and skin.

The surgical skin preparation reduces but does not eliminate this commensal flora. Bacteria from the perioperative skin surface can reach the plate during or immediately after surgery.

Thin soft tissue coverage

The medial aspect of the proximal tibia has minimal soft tissue overlying the plate.

This thin coverage makes the plate site more susceptible to contamination from wound licking, minor trauma, and environmental bacteria than a plate site covered by substantial muscle and subcutaneous tissue.

Oscillating saw contamination

The TPLO osteotomy uses an oscillating saw that generates heat and aerosolized bone debris.

This creates a microscopically disrupted tissue zone around the osteotomy that may be more susceptible to bacterial colonization than undisturbed tissue.

What published data shows

The PMC 769-TPLO study (2005 to 2015)

627 dogs, 769 TPLO procedures. SSI rate: 8.5% (n=65). Major SSI (requiring additional surgical treatment): 6.8% of procedures, representing 80% of SSI cases.

The study confirms: reported incidence of SSI ranges from 2.9% to 17.3% and is considered higher than expected in comparison to other sterile elective orthopedic procedures.

Clinician's Brief TPLO complications review

Confirmed range: 1.3% to 25.6%, with the wide range secondary to variable SSI definitions and methodology.

ResearchGate TPLO implant removal study

Overall SSI rate in the cohort: 8.2%, consistent with previous studies reporting SSI rates of 3% to 15.8%. Implant removal rate due to infection: 3.5% to 7.5% of TPLO procedures.

JAVMA silver-coated implant study (2024)

Confirms previous studies reported infection rates ranging from 3% to 15.8% for TPLO.

Retrospective study -- factors associated with TPLO SSI (PubMed, 2018)

German Shepherd Dogs, meniscectomy, and attending surgeons having performed 20 or fewer procedures were independently associated with increased SSI risk on multivariable analysis.

Why rates vary so widely across studies

The 2.9% to 17.3% range is real but partly reflects methodological differences rather than true variation in underlying SSI risk:

SSI definition: studies using strict definitions (CDC criteria requiring clinical signs plus positive culture) produce lower rates than studies that include any post-operative wound complication as an SSI.

Follow-up duration: studies with short follow-up capture only early superficial infections; longer follow-up captures delayed implant-associated infections that appear weeks to months later.

Population characteristics: studies from referral centers (larger breeds, more complex cases) typically report higher rates than general practice studies.

Antibiotic protocols: differences in perioperative prophylaxis and the use or non-use of post-operative antibiotics affect reported rates.

Surgeon experience: less experienced surgeons have longer procedure times and potentially less sterile field control, both of which increase SSI risk.

Risk factors that increase individual SSI probability

Breed

German Shepherd Dogs: OR 4.41 (PMC 769-TPLO study). Bulldogs: OR 11.1 for SSI in MRSP-carrier Bulldogs (PubMed MRSP-TPLO study). These are among the highest documented breed-specific risk factors in the literature.

Body weight

Higher body weight is an independent SSI risk factor. The silver-coated TPLO implant study confirmed a significant association between higher body weight and SSI (P=0.037).

ResearchGate TPLO data noted SSI rates up to 21% to 28% in some large-breed populations.

Anesthesia/surgery duration

Longer anesthesia time is an independent SSI risk factor (silver-coated implant study, P=0.003). Longer procedures mean more time for surgical field contamination and tissue drying.

MRSP carriage

Pre-operative MRSP carriage increases SSI risk OR 6.72 (PubMed 549-dog MRSP study). Dogs with pre-operative MRSP on their skin are at significantly higher SSI risk than non-carriers.

Concurrent skin conditions

The retrospective SSI factors study found that dogs with dermatitis at the surgical site had SSI rates of 16.7%; dogs with dermatitis elsewhere had 10.2% SSI rates.

Meniscectomy

Performing concurrent meniscectomy (removal of the meniscus) was independently associated with increased SSI risk in the retrospective PubMed study. Meniscectomy extends procedure time and adds another tissue trauma variable.

Surgeon experience

Surgeons having performed 20 or fewer TPLO procedures were independently associated with higher SSI risk. This reflects the learning curve for TPLO and the importance of surgical volume for infection prevention.

For the bacteria guide, see what bacteria cause TPLO infections?. For the prevention guide, see how can TPLO infections be prevented post-operatively?.

For the MRSP risk guide, see can MRSP or MRSA occur after TPLO surgery?. For the long-term outcomes guide, see long-term outcomes after TPLO infection.

Frequently asked questions

Is a 3% to 10% infection rate high for a surgery?

Compared to many sterile orthopedic procedures in humans and dogs, yes. The PMC 769-TPLO study explicitly notes that TPLO SSI rates are higher than expected for sterile elective orthopedic surgery.

The reasons are the implant, the skin flora composition, and the anatomy -- not a failure of surgical standards.

My dog's surgeon has a low infection rate. Is that meaningful?

Yes. Surgeon experience is an independent risk factor -- surgeons who have performed more than 20 TPLO procedures have lower SSI rates in published data.

High-volume TPLO surgeons at referral centers have better infection control metrics than early-career surgeons.

Does the breed of my dog matter for infection risk?

Significantly. German Shepherds have 4.41 times higher SSI risk. Bulldogs have elevated risk due to MRSP carriage. Crossbreed dogs have lower risk than purebred dogs per the PubMed LOAD SSI study.

If your dog is a high-risk breed, discuss with your surgeon what additional precautions are appropriate.

Is a TPLO infection always serious?

Not necessarily. The published literature confirms that most dogs with TPLO SSI achieve long-term functional outcomes equivalent to non-infected dogs when treated appropriately.

SSI is a complication, not a catastrophe, when managed promptly.

Can I reduce my dog's individual SSI risk?

Yes -- through strict post-operative care compliance. E-collar compliance, wound dryness, activity restriction, environmental hygiene, and daily wound inspection are the owner-controlled variables.

The published risk factors that are owner-modifiable post-operatively are primarily wound management behaviors.

Resources

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Step #1

Getting Ready

Ensuring a clean surgical field starts with proper skin preparation. This video demonstrates the best practices for:

  • Shaving the patient – Achieving a close, even shave while minimizing skin irritation
  • The Dirty Scrub – The initial skin prep step to remove surface debris and reduce bacterial load before the sterile scrub.

Following these techniques helps reduce infection risk and improve surgical outcomes. Watch the video to see how it’s done effectively!

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Many surgeons are shocked to find out that their patients are not protected from biofilms and resistant bacteria when they use saline and post-op antibiotics.

That’s Where Simini Comes In.

Why leave these risks and unmanaged?  Just apply Simini Protect Lavage for one minute. Biofilms and resistant bacteria can be removed, and you can reduce two significant sources of infection.

Step #3

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Preventing surgical infections is critical for patient safety and successful outcomes. This course covers:

  • Aseptic techniques – Best practices to maintain a sterile field.
  • ​Skin prep & draping – Proper methods to minimize contamination.
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