Age alone does not disqualify a dog from TPLO surgery.

The decision for an older or senior dog depends on overall health status, concurrent conditions, quality of life goals, and individual assessment -- not a chronological cutoff.

Many senior dogs benefit substantially from TPLO, while some older dogs are better managed conservatively. Understanding how to approach this decision is essential.

Quick answer: TPLO is viable for most older dogs with CCL rupture who are medically suitable for anesthesia. Published data estimates 85 to 90% of senior dogs regain near-normal or improved limb function. Age increases anesthetic risk and slows recovery -- manageable factors, not contraindications. Pre-surgical bloodwork and cardiac evaluation reduce risk.

Key takeaways

• Age alone is not a contraindication for TPLO: a comprehensive veterinary assessment is essential; the decision is based on health status, not chronological age
• 85 to 90% of senior dogs regain near-normal or improved limb function: comparable to the 90 to 95% general TPLO population; older dogs achieve similar success with appropriate post-operative care
• The primary risk factors for senior dogs are anesthetic risk and comorbidities: older dogs are more likely to have heart disease, kidney disease, or arthritis complicating anesthesia; pre-surgical screening manages these risks
• Recovery takes longer in older dogs: senior dogs need a longer recovery with extra monitoring and rehabilitation; timelines should be extended and expectations adjusted
• Conservative management is appropriate for some older dogs: very elderly dogs with limited activity needs, multiple health concerns, or advanced concurrent arthritis may benefit more from conservative management
• The quality of life cost of not operating is significant: untreated CCL rupture means chronic joint pain, progressive arthritis, and severe mobility impairment; TPLO offers a better quality of remaining life for many senior dogs

What changes with age in TPLO candidates

Anesthetic risk

General anesthesia in older dogs carries higher risk than in young adults. The primary reasons:

Cardiovascular function: cardiac output typically decreases with age. Dogs with occult cardiomyopathy, valve disease, or arrhythmias have reduced ability to compensate for the cardiovascular demands of general anesthesia. Pre-surgical cardiac evaluation (auscultation, chest radiographs, echocardiography if indicated) identifies and quantifies this risk.

Renal function: anesthesia and NSAIDs both affect renal perfusion. Dogs with reduced GFR are at risk for acute kidney injury. Pre-surgical blood chemistry (BUN, creatinine, SDMA) establishes baseline renal function and guides anesthetic protocol choices.

Hepatic function: the liver metabolizes most anesthetic agents. Hepatic insufficiency prolongs drug effect and increases toxicity risk. Pre-surgical liver enzyme panel and bile acids test if enzymes are elevated.

Thermoregulation: older dogs lose body heat more quickly during anesthesia. Active warming protocols (circulating warm water blankets, warm IV fluids, warm recovery environment) are particularly important.

Healing and regeneration

Bone healing takes longer in older dogs. The osteotomy that consolidates in 8 weeks in a 3-year-old Labrador may take 10 to 14 weeks in a 10-year-old dog.

Radiographic confirmation of healing before lifting restrictions is therefore even more critical in senior dogs.

Muscle rebuilding is also slower. Full muscle recovery may take 6 to 9 months rather than 4 to 6 months in older dogs.

Pre-existing arthritis

Most older dogs with CCL disease have concurrent arthritis in the affected stifle at the time of presentation.

This does not prevent TPLO from providing benefit, but it affects the baseline from which the dog recovers.

Upland Animal Hospital confirms: dogs with advanced degenerative joint disease may not be ideal candidates; existing joint damage could limit improvement in mobility.

The realistic expectation is not a return to young-dog mobility, but elimination of instability pain and slowing of further arthritis progression -- both of which meaningfully improve quality of life.

Pre-surgical assessment for older dogs

The pre-surgical workup for a senior dog should include:

Complete blood count: rule out anemia, infection, and thrombocytopenia.

Blood chemistry panel: kidney function (BUN, creatinine, SDMA), liver function (ALT, ALP, GGT), albumin, glucose.

Urinalysis: assess renal concentrating ability and rule out urinary tract infection (a source of bacteremia that can seed the implant).

Chest radiographs: assess cardiac silhouette and pulmonary fields for occult cardiac disease or pulmonary abnormalities.

Electrocardiography: if cardiac auscultation reveals arrhythmia or murmur.

Echocardiography: if the cardiac evaluation suggests significant structural disease; quantifies severity and guides anesthetic protocol.

Blood pressure: hypertension is common in older dogs and affects anesthetic management.

Companion Animal Hospital confirms: older patients are more likely to have heart disease, kidney problems, or arthritis complicating anesthesia and recovery. Each patient is evaluated thoroughly to weigh complications against expected benefits.

When TPLO is appropriate for older dogs

TPLO is generally appropriate when:

• Pre-surgical assessment confirms the dog is medically suitable for general anesthesia
• The dog has a good quality of life before the CCL rupture
• The owner is committed to the post-operative care demands
• Life expectancy is at least 1 to 2 years (enough time to benefit from the recovery period)
• Pain from CCL instability is significantly reducing the dog's quality of life

SustainableVet.org confirms: 85 to 90% of senior dogs regain near-normal or improved limb function. Older dogs achieve similar success rates when conditions like arthritis are managed well.

When conservative management may be more appropriate

Conservative management (strict rest, NSAIDs, physical therapy, weight management) may be more appropriate when:

• The dog has severe concurrent cardiac, renal, or hepatic disease that significantly elevates anesthetic mortality risk
• Pre-existing arthritis is so advanced that functional improvement from TPLO is unlikely
• The dog has very limited mobility needs (sedentary older dog in minimal pain before the CCL event)
• Life expectancy is significantly limited by a concurrent condition

Chewy confirms: TPLO can be performed in dogs of any age, but your veterinarian will consider overall health in senior dogs.

Upland Animal Hospital confirms: very elderly dogs might benefit more from conservative management if they have limited activity needs and multiple health concerns.

Adjusting expectations and the recovery plan for older dogs

For older dogs undergoing TPLO:

• The restriction period is the same (8 to 12 weeks) but radiographic healing may take longer; follow-up imaging should be extended if healing is not confirmed at the standard 6 and 12 week timepoints
• Recovery plans should include additional physiotherapy support, hydrotherapy, and pain management beyond the standard protocol
• Concurrent arthritis management (joint supplements, periodic NSAIDs, hydrotherapy) continues long-term after recovery
• Body condition monitoring is critical -- older dogs are more likely to gain weight during restriction

SustainableVet.org confirms: senior dogs need a longer recovery with extra monitoring and rehabilitation. Physical therapy helps, but patience and adjusted expectations are essential.

For the surgery overview, see what is TPLO surgery in dogs?. For recovery, see post-surgery recovery after TPLO in dogs. For long-term outcomes, see long-term outcomes of TPLO surgery.

For anesthesia protocol, see TPLO anesthesia protocol in dogs.

Frequently asked questions

My dog is 11 years old with a torn CCL. Should I get TPLO?

Age 11 is not a contraindication. The decision depends on your dog's overall health. Schedule a thorough pre-surgical assessment including bloodwork, urinalysis, and chest radiographs.

If your dog is medically suitable for anesthesia and has a reasonable life expectancy, TPLO will likely provide a better quality of remaining life than conservative management of an unstable stifle.

Does TPLO take longer to heal in older dogs?

Yes. Bone healing in older dogs typically takes 2 to 4 weeks longer than in young adults.

Muscle recovery also takes longer -- expect 6 to 9 months rather than 4 to 6 months. Radiographic follow-up should reflect this extended timeline.

Is the anesthetic risk for TPLO too high in senior dogs?

This depends entirely on the individual dog's health status. Pre-surgical assessment quantifies anesthetic risk. Many senior dogs in good health tolerate TPLO anesthesia well.

Dogs with significant cardiac or renal disease have elevated risk that must be weighed against the benefit of surgical stabilization. There is no population-level answer -- only individual assessments.

Can conservative management work for an older dog with CCL rupture?

For some older dogs, yes.

For most medium and large dogs over 15 kg with complete CCL rupture, conservative management does not restore normal joint stability, and chronic pain with progressive OA is the expected outcome.

Whether conservative management is appropriate depends on the dog's baseline activity level, severity of rupture, concurrent health status, and owner goals.

What is the recovery quality like for older dogs after TPLO?

With appropriate rehabilitation and arthritis management, most older dogs achieve meaningful improvement in mobility and pain control after TPLO.

The realistic goal is not the function of a young adult dog but rather elimination of the pain of joint instability and a return to comfortable daily activity.

SustainableVet.org confirms: when combined with weight management and physical therapy, TPLO offers lasting relief, often keeping dogs active well into their senior years.

Resources

• SustainableVet. TPLO Surgery for Older Dogs. sustainablevet.org
• Companion Animal Hospital Maize. Senior Dogs and TPLO. maizevet.com
• Upland Animal Hospital. What Is TPLO Surgery in Dogs? uplandanimalhospital.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org

TPLO surgery requires general anesthesia that is tailored to the individual patient. For most healthy adult dogs, TPLO anesthesia is straightforward and low-risk.

For older dogs, obese dogs, or those with concurrent medical conditions, the anesthetic plan requires additional planning.

Understanding what the protocol involves helps owners know what to expect and how to prepare their dog.

Quick answer: TPLO anesthesia includes a preoperative blood panel; premedication with an opioid and sedative; induction with propofol or alfaxalone; maintenance with isoflurane or sevoflurane; continuous monitoring; and multimodal pain management including NSAIDs, nerve blocks (sciatic/femoral or epidural), and post-operative opioids.

Key takeaways

• Preoperative blood work is standard for all TPLO patients: CBC and biochemistry identify organ dysfunction and conditions that increase anesthetic risk
• TPLO anesthesia is multimodal: combining opioids, NSAIDs, nerve blocks, and inhalant anesthetic reduces total drug doses and improves pain control
• Nerve blocks are now standard in TPLO anesthesia: femoral and sciatic blocks with bupivacaine reduce post-operative opioid requirements
• A published feasibility study achieved total opioid-free post-operative analgesia in TPLO dogs using nerve blocks, ketamine, isoflurane, and meloxicam
• Epidural analgesia reduces post-operative opioid requirements by 36% compared to no epidural, per PMC study data
• Food is withheld 8 to 12 hours before surgery to reduce aspiration risk; water restriction is typically shorter

Pre-anesthetic assessment

Every dog undergoing TPLO is evaluated before anesthesia to identify risk factors and optimize the anesthetic plan.

Physical examination: body weight, cardiovascular and respiratory status, mucous membrane color and capillary refill, hydration status, and assessment of concurrent conditions.

Blood work: complete blood count (CBC) detects anaemia, infection, and platelet abnormalities. Biochemistry panel assesses kidney function (creatinine, BUN), liver function (ALT, ALP, bilirubin), blood glucose, and electrolytes. These results determine anesthetic drug selection and guide fluid therapy.

ASA classification: anesthesiologists use the American Society of Anesthesiologists (ASA) physical status classification (1 to 5) to communicate overall health status. Most TPLO patients are ASA class 1 (healthy) or 2 (mild systemic disease). Dogs with significant cardiac, renal, or hepatic disease may be ASA 3 or higher and require additional monitoring or modified protocols.

Premedication

Premedication is given 20 to 40 minutes before induction.

It serves to calm the dog, reduce anxiety, provide early analgesia (preemptive analgesia), reduce the amount of induction and maintenance agent required, and make induction smoother.

Opioids (most common premedication component for TPLO):

• Hydromorphone: commonly used as a premedication; the PubMed perioperative analgesia study used hydromorphone plus acepromazine as premedication in all 56 TPLO dogs
• Methadone: provides both opioid analgesia and NMDA receptor antagonism; commonly used as a premedication in many European centres
• Morphine: used in some protocols, particularly when combined with epidural administration

Sedatives:

• Acepromazine: a phenothiazine tranquilizer that provides reliable sedation; use is reduced in patients with cardiovascular compromise due to vasodilatory effects
• Medetomidine or dexmedetomidine: alpha-2 agonists providing sedation, analgesia, and muscle relaxation; used in the opioid-free feasibility protocol (PMC 2024)
• Midazolam: benzodiazepine used particularly in geriatric or debilitated dogs for its minimal cardiovascular effects

Anesthetic induction

Induction agents produce rapid unconsciousness, allowing placement of an endotracheal tube for airway control.

Propofol: the most commonly used induction agent in healthy dogs. Provides smooth, rapid induction with a short duration, making induction-to-intubation management easy.

Alfaxalone: a neuroactive steroid with a similar profile to propofol. Used in some protocols as an alternative, particularly in smaller dogs or where propofol is not available.

Ketamine + midazolam: used in some protocols as an alternative induction combination, particularly when some degree of analgesia is desired at induction. Also used in opioid-sparing protocols.

Intraoperative maintenance

Inhalant anesthetics (isoflurane or sevoflurane) are delivered via endotracheal tube to maintain unconsciousness throughout the surgery.

Isoflurane is the most widely used agent in veterinary anaesthesia for TPLO. Sevoflurane provides faster recovery but is more expensive. Both are effective.

IV constant rate infusions (CRI) during surgery augment inhalant anesthesia and reduce inhalant requirements:

• Ketamine CRI: used in opioid-sparing protocols; the PMC feasibility study used ketamine CRI at 0.6 mg/kg/h throughout surgery
• Morphine-lidocaine-ketamine (MLK CRI): a well-established combination providing balanced intraoperative analgesia with reduced inhalant requirements
• Fentanyl CRI: an opioid CRI providing titratable intraoperative analgesia

Regional analgesia (nerve blocks)

Nerve blocks have become a key component of TPLO anesthesia because they provide superior post-operative pain control compared to systemic opioids alone.

Femoral and sciatic nerve blocks (FSNB): block the main sensory nerves to the stifle joint and hind limb. Performed before surgery with bupivacaine. PMC research comparing nerve blockade approaches for TPLO confirms that femoral and sciatic nerve blocks provide superior postoperative analgesia compared to IV CRI alone.

Lumbosacral epidural: injection of morphine and bupivacaine into the epidural space. PMC data (epidural + liposomal bupivacaine study) found epidural analgesia produced 36% fewer post-operative opioid injections compared to no epidural.

Intra-articular injection: bupivacaine injected directly into the stifle joint before or after surgery. Used as an alternative or supplement to nerve blocks in some protocols.

Intraoperative monitoring

Standard TPLO monitoring includes:

• ECG: continuous heart rate and rhythm monitoring
• Pulse oximetry (SpO2): peripheral oxygen saturation
• Capnography (end-tidal CO2): assesses ventilation adequacy; dogs are often placed on mechanical ventilation during TPLO
• Blood pressure: direct arterial or indirect Doppler/oscillometric
• Temperature: hypothermia is a common complication of long anesthetic events; warming devices are used routinely
• Depth of anesthesia assessment: clinical signs including eye position, jaw tone, and response to surgical stimulation

Post-operative pain management

TPLO is a significant orthopedic procedure and post-operative pain management directly affects recovery quality and rate of return to function.

NSAIDs: meloxicam or carprofen are administered in the peri-operative period and continued at home for 7 to 14 days minimum. The PMC opioid-free protocol administered meloxicam 0.2 mg/kg IV intraoperatively.

Opioids: hydromorphone or buprenorphine for 24 to 48 hours post-operatively, reducing as the nerve block wears off and NSAID analgesia covers the residual pain.

Gabapentin: increasingly prescribed for the first 1 to 2 weeks post-operatively to address neuropathic pain components associated with the surgical trauma and healing nerve tissues.

For the full recovery guide and what to expect after waking up, see what to expect after TPLO surgery in dogs.

For the leg shaking guide that often relates to anesthetic recovery, see dog leg shaking after TPLO surgery.

For the incontinence guide related to catheterization and anesthesia effects, see dog incontinence after TPLO surgery. For the post-surgical pain guide, see dog whining after TPLO surgery: causes and care.

Frequently asked questions

Is TPLO anesthesia safe for dogs?

For healthy adult dogs, TPLO anesthesia is considered low-risk. The most significant risks involve cardiovascular depression from the anesthetic agents and hypothermia during the procedure.

These are managed through continuous monitoring and supportive care. Pre-anesthetic blood work identifies dogs with conditions that increase risk.

How long is the dog under anesthesia for TPLO?

Total anesthesia time typically ranges from 1.5 to 2.5 hours for a standard TPLO, depending on the surgeon's experience and any complications.

Dogs are usually extubated within 15 to 30 minutes of the end of surgery as they recover consciousness.

What happens if my dog is in pain when it wakes up from TPLO?

Post-operative pain assessment is performed by the veterinary team as the dog recovers. Rescue analgesia (additional opioid doses) is given if pain scores exceed defined thresholds.

The goal of the multimodal protocol is to prevent pain peaks rather than treat pain after it occurs.

Contact the surgical team if your dog appears to be in significant pain after discharge.

My dog is older. Is anesthesia more dangerous?

Age increases anesthetic risk because older dogs are more likely to have subclinical cardiac, renal, or hepatic disease, slower drug metabolism, and reduced physiological reserve.

Thorough pre-anesthetic bloodwork and cardiac assessment (chest X-ray, echocardiogram in selected cases) helps quantify risk. The anesthetic team adjusts protocols for older patients with reduced drug doses and enhanced monitoring.

What does fasting before TPLO mean?

Food is typically withheld for 8 to 12 hours before anesthesia to reduce the risk of vomiting and aspiration during induction or recovery.

Water restriction is typically shorter often until the night before or only 2 to 4 hours before surgery.

Follow your surgeon's specific instructions, which are tailored to your dog's size and health status.

Resources

• PMC. Postoperative Opioid-Free Analgesia in Dogs Undergoing TPLO: A Feasibility Study. pmc.ncbi.nlm.nih.gov
• PMC. Incidence of Postoperative Opioids in TPLO Dogs After Liposomal Bupivacaine With or Without Morphine Epidural. ncbi.nlm.nih.gov
• PubMed. Comparison of Perioperative Analgesic Protocols for Dogs Undergoing TPLO. pubmed.ncbi.nlm.nih.gov
• PMC. Effects of Saphenous and Sciatic Nerve Blocks, Lumbosacral Epidural or MLK CRI on Postoperative Pain in TPLO Dogs. pmc.ncbi.nlm.nih.gov
• VCA Animal Hospitals. Tibial Plateau Leveling Osteotomy (TPLO) in Dogs. vcahospitals.com

If your dog has been diagnosed with a torn cranial cruciate ligament, you have likely encountered the acronym TPLO possibly before you knew what it meant or why it was being recommended.

TPLO is the most commonly performed CCL surgery in the US. Understanding what the acronym means helps demystify why the surgery works the way it does.

Quick answer: TPLO stands for Tibial Plateau Leveling Osteotomy: Tibial (shin bone), Plateau (upper surface forming the knee), Leveling (making the plateau closer to horizontal), Osteotomy (controlled bone cut). The surgery stabilizes the knee by rotating the tibia, making the CCL biomechanically unnecessary.

Key takeaways

• T = Tibial: the tibia, the shin bone below the knee (stifle) joint
• P = Plateau: the upper tibial surface forming the knee joint; in dogs it has a significant slope called the tibial plateau angle
• L = Leveling: reducing the tibial plateau angle to closer to parallel with the ground, changing joint biomechanics
• O = Osteotomy: a controlled surgical bone cut that allows the tibial segment to be repositioned and fixed
• TPLO does not repair the torn CCL: it changes joint geometry so the ligament becomes biomechanically unnecessary
• TPLO was first described in the early 1980s by Dr. Barclay Slocum and is now the most reliable procedure for CCL disease in dogs

Breaking down each word

T Tibial

The tibia is the main weight-bearing bone of the lower leg, running from the knee (stifle) joint to the ankle (tarsus).

In dogs, the tibia is not perfectly vertical it angles slightly forward relative to the femur above it. This angle contributes to the mechanical forces that act on the stifle during weight-bearing.

Veterinary Partner (VIN) explains: tibial refers to the shin bone.

P Plateau

The tibial plateau is the upper, relatively flat surface of the tibia that contacts the bottom of the femur to form the stifle joint.

Unlike in humans, where the tibial plateau is nearly horizontal, in dogs it has a significant slope the tibial plateau angle (TPA).

A steeper TPA creates more cranial tibial thrust during weight-bearing, which is the force that normally the CCL resists.

Veterinary Partner (VIN) defines it as: the upper surface of the shin bone; the bottom of the knee joint.

L Leveling

Leveling refers to the goal of the surgery: reducing the tibial plateau angle to approximately 5 degrees, making it closer to parallel with the ground.

When the tibial plateau is leveled, the femur no longer tends to slide forward relative to the tibia during weight-bearing the cranial tibial thrust is neutralized.

This is why a functioning CCL is no longer required after TPLO.

Veterinary Partner (VIN) defines it as: making the plateau more parallel to the ground.

O Osteotomy

An osteotomy is a controlled surgical cut through a bone a deliberate, planned fracture performed under anesthesia to allow repositioning of a bone segment.

TPLO involves a curved osteotomy through the proximal tibia, creating a segment that is rotated to the new angle and fixed with a bone plate and screws during healing.

Veterinary Partner (VIN) defines it as: a bone-cutting procedure like a controlled fracture of the bone.

Why TPLO was developed

Before TPLO, the dominant approach to CCL repair was extracapsular stabilization placing sutures outside the joint to mimic the CCL's function.

While effective in small dogs, this approach was unreliable in large, active dogs because the suture material eventually stretched or failed, and the joint depended on periarticular scar tissue for long-term stability.

Veterinary Specialty Center explains: TPLO changes the biomechanics of the knee so the joint can remain stable without relying on the damaged CCL.

Instead of replacing the torn ligament, it changes the mechanics of the knee entirely.

DVM360 confirms: TPLO alters the mechanical forces acting on the stifle, rendering the cranial cruciate ligament unnecessary.

Dr. Barclay Slocum first described TPLO in the early 1980s.

Veterinary Partner (VIN) notes that much research has been done since to refine the technique, and it has emerged as the most reliable technique for CCL disease management in dogs.

How TPLO differs from human ACL surgery

This is one of the most common points of confusion for owners.

In humans, ACL surgery typically involves replacing the torn ligament with a graft (taken from the patient's hamstring, patellar tendon, or a donor).

The new ligament is reconstructed to restore normal joint function.

TPLO does not reconstruct the CCL. It bypasses the need for a functioning CCL entirely by changing joint geometry.

Veterinary Specialty Center confirms: in people, ACL surgery replaces the torn ligament; in dogs, TPLO changes knee mechanics so the joint functions without the CCL.

This is why dogs cannot "re-tear" their CCL after TPLO there is no ligament replacement to fail. The stability provided by TPLO is structural and permanent.

What TPLO treats and who it is for

TPLO is used to treat cranial cruciate ligament (CCL) rupture the canine equivalent of the human ACL.

CCL rupture is the most common cause of hind limb lameness in dogs and costs US dog owners over $1 billion annually.

The ACVS recommends TPLO as the most commonly performed procedure for dogs over 60 lbs. It is also recommended for smaller dogs where long-term mechanical stability and minimal arthritis progression are priorities.

For the surgical causes guide, see what causes TPLO surgery to be needed in dogs. For the full surgical overview, see what is TPLO surgery in dogs?.

For the pros and cons of the procedure, see TPLO surgery pros and cons for dogs.

Frequently asked questions

Does TPLO stand for the same thing in all dogs?

Yes. The acronym and the procedure are the same regardless of breed, size, or the specific implant system used (Arthrex or Synthes).

The variation between cases is in the amount of tibial rotation required (based on the individual TPA), the plate size selected, and the post-operative protocol.

Is TPLO the same as TTA?

No. TTA (Tibial Tuberosity Advancement) is a different procedure with a similar goal both change knee biomechanics rather than replacing the CCL.

TTA advances the tibial tuberosity cranially rather than rotating the tibial plateau. They achieve knee stabilization through different geometric approaches.

Why is it called leveling if the bone is rotated?

The rotation of the tibial bone segment achieves the leveling.

When the proximal tibial segment is rotated, the angle of the tibial plateau changes it becomes less sloped, i.e., more level relative to the ground.

The procedure is named for the result (leveling) rather than the method (rotation).

Was TPLO invented for dogs?

Yes. TPLO was developed specifically for veterinary use in dogs in the early 1980s by Dr. Barclay Slocum.

It was developed because the canine stifle's anatomy and biomechanics differ significantly from the human knee particularly the steep tibial plateau angle that is uniquely problematic in dogs.

Why is TPLO preferred over other CCL surgeries for large dogs?

Large, active dogs generate higher joint forces than small dogs.

Extracapsular repair (lateral suture) provides stability through scar tissue formation adequate for small dogs but inadequate for the forces generated by large, active breeds.

TPLO provides bone-based mechanical stability that is not dependent on scar tissue, making it more durable and reliable for larger patients.

Resources

• Veterinary Partner (VIN). TPLO Surgery. veterinarypartner.vin.com
• VCA Animal Hospitals. Tibial Plateau Leveling Osteotomy (TPLO). vcahospitals.com
• DVM360. Understanding Tibial Plateau Leveling Osteotomies in Dogs. dvm360.com
• Veterinary Specialty Center. TPLO Surgery for Dogs. vetspecialty.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org

Bilateral CCL (cranial cruciate ligament) disease -- affecting both stifle joints -- is common in dogs.

Midvalley Animal Clinic confirms 30 to 40% of dogs with unilateral CCL rupture will eventually develop rupture of the contralateral CCL.

When both stifles are significantly affected, the decision between simultaneous bilateral TPLO and staged TPLO is one of the most important surgical planning discussions an owner will have.

Quick answer: Simultaneous bilateral TPLO operates on both stifles in one anesthetic event, offering a single recovery period and lower total cost. Staged TPLO operates on one leg at a time, reducing anesthetic risk. Simultaneous is preferred for healthy, large dogs with both stifles unstable. Staged is preferred for older, smaller, or compromised dogs.

Key takeaways

• 30 to 40% of dogs with unilateral CCL disease develop contralateral CCL rupture: bilateral TPLO may be planned proactively at presentation or urgently when the second CCL ruptures during recovery
• Simultaneous bilateral TPLO offers a single anesthetic event and shorter overall recovery: both knees heal together; total cost is lower than two staged surgeries
• Staged bilateral TPLO reduces surgical risk: each surgery is shorter; the dog has one functional leg during recovery; preferred for older or medically compromised dogs
• The critical challenge of simultaneous bilateral TPLO is recovery: with both rear legs restricted, owners must provide intensive physical support (slings) for the first 2 to 3 weeks
• PubMed research (176 bilateral TPLO cases) found no significant difference in overall complication rates between simultaneous and staged approaches in appropriately selected patients
• Large dogs with strong front limbs handle simultaneous TPLO better: smaller or weaker dogs benefit from the staged approach due to greater difficulty bearing weight on two compromised rear legs

Why bilateral CCL disease is common

CCL disease in dogs is degenerative, not purely traumatic.

The same factors that caused one CCL to rupture -- degenerative fiber changes, abnormal tibial plateau angle, breed predisposition, obesity, and mechanical overload -- are typically present in both stifles.

When a dog ruptures one CCL, it often shifts weight onto the contralateral leg, increasing the load on the already-compromised contralateral CCL. This accelerates degeneration and the timeline to rupture.

The clinical implication: even when only one stifle is symptomatic at presentation, the surgeon will typically assess both stifles.

Pre-operative radiographs of both stifles help determine whether the contralateral joint shows early instability, effusion, or an elevated TPA that warrants planning for bilateral surgery.

Simultaneous bilateral TPLO

Overview

Both stifles are operated on during a single general anesthetic event. The dog is positioned, the first TPLO is performed, the dog is repositioned, and the second TPLO is performed.

Total surgical time is approximately 3 to 4 hours.

Advantages

Single anesthetic event: the dog is exposed to general anesthesia once rather than twice. Each anesthetic event carries inherent risk; eliminating one event reduces cumulative anesthetic risk.

Faster total recovery: both legs heal simultaneously. Rather than 8 to 12 weeks of restriction for the first leg, then a second 8 to 12 week restriction for the second leg, the dog completes one restriction period covering both.

SustainableVet.org confirms: when both knees are corrected in a single surgery, the dog undergoes just one healing phase rather than two separate ones, returning to normal activity sooner.

Lower total cost: while the simultaneous surgery costs more than a single TPLO, it is less than two completely separate procedures with individual hospitalization, anesthesia fees, and post-operative care expenses.

SustainableVet.org confirms: simultaneous TPLO often reduces overall costs by avoiding duplicate anesthesia, hospitalization, and post-operative care fees.

Risks and challenges

Both rear legs are compromised simultaneously: the dog cannot transfer weight to a strong rear leg during the recovery period. All rear-limb support requires either front-limb loading (difficult for large breeds) or active owner assistance via sling.

Increased owner demand: SustainableVet.org confirms post-surgical care is more challenging because the dog cannot rely on a strong leg for support, requiring owners to provide intensive assistance.

Longer anesthetic duration: total surgical time of 3 to 4 hours for bilateral vs. 1.5 to 2 hours for unilateral increases the physiological burden of anesthesia and surgery.

Potentially higher complication rate in some populations: the PubMed 176-case study compared simultaneous and staged TPLO complications and found no significant overall difference, but the study population was highly selected.

Staged bilateral TPLO

Overview

The more significantly affected stifle is operated on first. After a full recovery (typically 8 to 12 weeks until bone healing is confirmed), the second stifle is operated on.

Advantages

Reduced surgical risk per event: each procedure is a standard unilateral TPLO, carrying the same risk profile as any single TPLO.

One functional rear leg during recovery: the dog can weight-bear on the unoperated leg immediately after the first surgery. This simplifies nursing care significantly and allows most dogs to stand and toilet independently.

Better option for older or compromised dogs: SustainableVet.org confirms older dogs or those with other health issues benefit from a staged approach to reduce surgical risk. Dogs with cardiac, renal, hepatic, or respiratory disease may not tolerate a 3 to 4 hour bilateral procedure safely.

Disadvantages

Two separate anesthetic events: two exposures to general anesthesia over a 3 to 6 month period.

Longer total recovery timeline: the dog may not reach full bilateral function for 6 to 9 months or longer from the date of the first surgery.

Higher total cost: two separate surgeries, two hospitalizations, two sets of post-operative medications and supplies.

Risk of contralateral rupture during the first recovery: the contralateral leg bears additional load during the first recovery period, accelerating degeneration. In some dogs, the second CCL ruptures acutely during the first recovery -- this forces an emergency decision about timing of the second surgery.

Which approach is right for a given dog?

Generally prefer simultaneous bilateral TPLO when:

• Both stifles are confirmed significantly unstable at presentation
• The dog is young, healthy, and large with strong front limb musculature
• The owner is able to provide intensive physical support during the bilateral recovery period
• The surgeon is experienced with bilateral TPLO technique
• Financial considerations favor the single-event approach

Generally prefer staged bilateral TPLO when:

• Only one stifle is currently significantly symptomatic (the second may be monitored and staged only if it progresses)
• The dog is older, small, or has significant concurrent health conditions
• The owner's ability to provide intensive bilateral recovery support is limited
• The anesthetic risk for a prolonged bilateral procedure is elevated

SustainableVet.org confirms: large dogs with strong front limbs may handle simultaneous TPLO better, while smaller or weaker dogs may benefit from a staged approach.

Bilateral TPLO recovery: what to expect

Simultaneous recovery

Weeks 1 to 2: the most demanding period. Both rear legs are compromised. The dog requires a sling for all mobility. Bathroom trips require active owner support.

Crate rest at all other times.

Weeks 2 to 6: gradual improvement. Both legs begin partial weight bearing. Sling use may reduce but is still needed for most dogs on stairs or uneven surfaces.

Weeks 6 to 12: radiographic assessment of both osteotomies. Activity increases based on healing of both legs.

Key equipment for bilateral TPLO recovery

• Lifting harness or rear-end sling (essential, not optional)
• Non-slip mats throughout the house
• Ramps for car access (no jumping in or out)
• Low dog beds at floor level

For the standard TPLO recovery timeline, see what to expect after TPLO surgery in dogs. For confinement advice, see how to confine your dog after TPLO surgery.

For post-op tips, see 10 essential TPLO recovery tips for pet owners. For the cost guide, see TPLO surgery cost in dogs.

Frequently asked questions

How will I know if my dog needs bilateral TPLO?

Your vet will assess both stifles during the physical examination.

Signs that the contralateral stifle is also affected include drawer sign or tibial thrust on the second side, joint effusion on radiographs, or intermittent lameness on both rear legs.

Both stifles are typically radiographed at the pre-operative planning visit.

Can the second CCL rupture while my dog is recovering from the first TPLO?

Yes. This is one of the main risks of staged TPLO. The unoperated leg bears more weight during recovery, accelerating degeneration.

If the second CCL ruptures acutely, the dog becomes bilateral suddenly and the timing of the second surgery must be reassessed with your vet.

Is bilateral TPLO safe for large breeds?

Yes, when appropriately selected. Large dogs with good front limb strength typically handle the bilateral recovery better than small dogs.

The challenge is the nursing care requirement, which is significant regardless of size. Ensure you have the physical ability to support a large dog in a sling before committing to simultaneous surgery.

My dog needs bilateral TPLO but I can only afford one surgery now. What should I do?

This is a common situation. Staged TPLO is appropriate and legitimate. Operate on the more severely affected stifle first and monitor the second closely.

Discuss weight management and controlled activity to reduce load on the second stifle during the first recovery. Plan financially for the second surgery.

Do both TPLO plates stay in permanently?

Yes, unless a complication (infection, implant failure) necessitates removal.

If both plates require removal, it can be done as a single procedure or staged, depending on the reason for removal and the healing status of each osteotomy.

Resources

• SustainableVet. Bilateral TPLO Surgery. sustainablevet.org
• PubMed. Comparison of Intra- and Postoperative Complications Between Bilateral Simultaneous and Staged TPLO. pubmed.ncbi.nlm.nih.gov
• Midvalley Animal Clinic. Pre-Op Instructions for TPLO. midvalleyanimalclinic.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org

Some degree of lameness after TPLO surgery is expected. The surgery involves a bone cut and plate fixation, and the dog's leg needs weeks to heal.

The clinical challenge for owners is distinguishing between normal post-surgical lameness (which requires patience) and lameness that indicates a complication (which requires prompt veterinary attention).

The answer depends heavily on timing, trajectory, and accompanying signs.

Quick answer: Normal post-TPLO lameness should show consistent week-over-week improvement. The most common pathological causes are: surgical site infection, late meniscal tear, implant loosening, muscle atrophy, delayed bone healing, and progressive osteoarthritis. The key signal is trajectory reversal -- lameness worsening after improvement or failing to improve for 2 or more weeks.

Key takeaways

• Some lameness is normal throughout the first 8 to 12 weeks of TPLO recovery: mild limping that improves gradually over 6 to 12 weeks is typical; the key variable is trajectory
• Trajectory reversal is the key warning sign: lameness that worsens after improvement, or fails to improve for 2 or more consecutive weeks, warrants veterinary evaluation before the next appointment
• Late meniscal tear is a recognized cause of sudden lameness regression: recurrence of lameness after initial resolution can indicate meniscal injury; it occurs in 2 to 22% of TPLO cases
• Muscle atrophy is a commonly underappreciated cause of persistent lameness: the affected leg loses muscle mass during restriction; inadequate rehabilitation leaves an asymmetric gait
• Progressive osteoarthritis is the most common cause of chronic mild lameness starting months after surgery; TPLO slows but does not stop this process
• Implant failure and infection must be ruled out for lameness that is worsening or not responding to conservative management; radiographs and culture are required for diagnosis

Normal post-surgical lameness: what to expect

Week 1 to 2

Most dogs are significantly lame in the first 1 to 2 weeks. They may toe-touch only or hold the leg off the ground entirely.

This is the acute post-surgical inflammatory phase combined with the effects of anesthesia wearing off.

SustainableVet.org confirms: some lameness is expected after TPLO surgery, especially in the first few weeks; normal recovery lameness is mild limping that improves gradually over 6 to 12 weeks.

Week 2 to 6

Consistent improvement should be visible week over week. By week 4, most dogs should be bearing significant weight on the operated leg during slow walking.

Three-legged walking during activity is still common but should be decreasing.

Week 6 to 12

Most dogs should be consistently weight-bearing on the operated leg. By week 12, most are nearly normal for household activities.

Radiographic confirmation of bone healing at weeks 6 to 8 and 12 guides when activity can increase.

Pathological causes of post-TPLO lameness

1. Surgical site infection (SSI)

Timing: most commonly weeks 1 to 4, but can occur at any stage (including months later for deep implant-associated infections).

Mechanism: bacterial contamination of the incision or implant causes inflammation and pain at the plate site, which produces or worsens lameness.

Signs accompanying lameness: redness, warmth, swelling, or discharge at the incision or plate site.

Action required: same-day veterinary contact for any infection signs alongside lameness.

2. Late meniscal tear

Timing: typically weeks 4 to 12 post-surgery, though it can occur months later.

Mechanism: the meniscus, which may have been structurally weakened before surgery or had a small tear not detected at surgery, fails under load during the recovery period.

Signs accompanying lameness: audible or palpable meniscal click; pain on stifle manipulation; sudden lameness regression in a dog that had been improving.

Animal Outpatient Surgery confirms: if lameness resolves after TPLO and recurs at a later time, this can be an indication of meniscal injury.

Action required: veterinary evaluation within 24 to 48 hours; arthroscopy or arthrotomy for diagnosis and partial meniscectomy for treatment.

3. Implant loosening or failure

Timing: most common in the first 6 to 12 weeks when the osteotomy is still healing and the plate bears the full load. Can also occur later from chronic infection or late trauma.

Mechanism: excessive activity before the osteotomy heals applies forces that exceed the plate's tolerance; screws pull out or the plate bends.

Signs accompanying lameness: sudden severe lameness; pain at the plate site; sometimes audible clicking or grinding; radiographic evidence of screw loosening or plate migration.

SustainableVet.org confirms: signs of implant failure include ongoing limping, pain, swelling around the implant site, and unusual clicking or grinding sounds from the joint.

Action required: same-day emergency veterinary contact for sudden severe lameness; radiographs urgently required.

4. Muscle atrophy and weakness

Timing: most prominent from weeks 4 to 12; persists for months if rehabilitation is inadequate.

Mechanism: during activity restriction, the operated leg muscles (quadriceps, hamstrings, hip extensors) atrophy rapidly. Asymmetric muscle mass leads to asymmetric weight distribution and abnormal gait patterns that present as persistent limping.

Vetplayas confirms: limited mobility during recovery leads to muscle loss and decreased strength. This imbalance results in abnormal gait patterns and subsequent limping.

Signs: visible muscle asymmetry (operated thigh smaller than opposite); lameness that worsens with activity and improves with rest; no accompanying warmth, redness, or plate-site changes.

Action required: rehabilitation assessment; physiotherapy to rebuild muscle mass.

5. Delayed bone healing

Timing: identified at the 6 to 8 week radiographic assessment.

Mechanism: the osteotomy is not showing expected callus formation and cortical bridging. Common causes include infection, excessive activity, poor blood supply, or systemic factors (NSAIDs at high dose for extended periods, nutritional deficiencies).

Signs: persistent lameness at a level that does not match the expected trajectory; confirmed radiographically.

Action required: veterinary investigation for underlying cause; extended activity restriction; sometimes additional diagnostics (culture to rule out occult infection).

6. Delayed union or non-union

Timing: identified at 12+ weeks when bone healing should be complete.

Mechanism: the osteotomy fails to heal. The plate is subject to continued cyclic loading without the protection of consolidated bone, increasing implant failure risk.

Action required: specialist reassessment; may require bone grafting, implant revision, or extended medical management.

7. Progressive osteoarthritis

Timing: typically becomes clinically apparent after 6 to 12 months.

Mechanism: CCL disease initiates an irreversible arthritis process in the stifle. TPLO reduces but does not eliminate arthritis progression. Over months and years, arthritis produces chronic mild lameness, particularly after rest and exercise.

Signs: stiffness that improves with movement; lameness worse in cold weather or after long periods of rest; gradual worsening over months; bilateral involvement common.

SustainableVet.org (failure symptoms article) confirms: limping 2 years post-TPLO may result from arthritis, implant irritation, meniscal damage, or muscle atrophy.

Action required: long-term management (joint supplements, weight management, NSAIDs for flares, hydrotherapy, physiotherapy).

8. Contralateral CCL rupture

Timing: any time during or after recovery from the first TPLO.

Mechanism: the contralateral CCL, subject to the same degenerative process and bearing extra load during recovery, may rupture. The dog appears to start limping on the opposite leg.

Signs: what appears to be recovery from one side suddenly accompanied by new lameness on the opposite side; the dog may be lame on a different leg or bilateral.

Action required: veterinary evaluation; bilateral CCL disease may require staged or simultaneous bilateral TPLO.

How to assess the trajectory at home

Create a simple weekly log: note the leg-use pattern (full bearing, toe-touching, three-legged) and the dog's willingness to walk at each prescribed walk time.

Compare week 4 to week 3, week 6 to week 5. If the pattern is consistently improving, continue the protocol. If it is static or worsening, contact your vet.

For the lameness guide, see lameness after TPLO surgery in dogs. For the TPLO failure signs guide, see signs of TPLO failure in dogs and when to see a vet.

For the meniscal tear guide, see dog meniscus tear after TPLO surgery. For the infection guide, see earliest signs of TPLO infection.

Frequently asked questions

My dog was progressing well at week 4 but is limping more at week 5. What do I do?

A single week of regression after a period of progress is not necessarily pathological -- increased activity, weather changes, or an off day can cause temporary setbacks.

But if the worsening persists for 2 weeks, or is accompanied by any infection signs, contact your vet.

Monitor closely and reduce activity to the week 2 level for 24 to 48 hours to see if the leg settles.

My dog is still limping 4 months after TPLO surgery. Is this normal?

Mild residual lameness can persist to 4 months, particularly in older dogs or those with significant muscle atrophy.

However, lameness at 4 months that is not showing week-over-week improvement warrants a veterinary assessment.

A radiograph will confirm bone healing status; physical examination will assess muscle mass and stifle range of motion.

My dog is limping on the opposite leg during TPLO recovery. What does that mean?

This raises concern for contralateral CCL disease. The opposite leg is bearing extra load during recovery and may have already been compromised.

A new limp on the opposite leg during recovery warrants veterinary evaluation, including assessment and radiographs of the contralateral stifle.

Can physiotherapy reduce long-term limping?

Yes, significantly. Rebuilding the atrophied quadriceps and hip extensor muscles through controlled hydrotherapy, cavaletti exercises, and progressive strength work reduces the compensatory gait patterns that produce chronic post-TPLO lameness.

Weight management is equally important -- every additional kilogram of body weight increases stifle load.

When is limping after TPLO an emergency?

Sudden complete non-weight bearing (holding the leg entirely off the ground) after a period of normal improvement is an emergency call. Same-day emergency veterinary contact is appropriate for this presentation.

Gradual worsening that does not resolve within 24 to 48 hours is a next-day call.

Resources

• SustainableVet. Common Causes of Limping in Dogs Post-TPLO Surgery. sustainablevet.org
• Animal Outpatient Surgery. What Are the Most Common Complications of TPLO Surgery in Dogs? animaloutpatientsurgery.com
• SustainableVet. Lameness After TPLO Surgery in Dogs. sustainablevet.org
• Laveen Vet Center. Dog Limping 1 Year After TPLO Surgery. laveenvetcenter.com

Some degree of fluid accumulation after TPLO surgery is normal and expected.

The surgery involves cutting and rotating the tibia a significant tissue injury that triggers an inflammatory response, part of which is fluid production.

The question is not whether fluid will appear, but whether the fluid you are seeing is a normal healing response or a sign of something that needs attention.

Quick answer: Fluid buildup after TPLO is usually a seroma — clear serum under the skin that is not an infection. Small seromas resolve in 1 to 3 weeks with rest. Call your vet if swelling is hot, rapidly growing, producing discharge, or accompanied by fever.

Key takeaways

• Seroma is the most common fluid buildup after TPLO: clear serum under the skin, not an infection, resolving with rest in 1 to 3 weeks
• Small seromas are managed with rest: the body reabsorbs the fluid naturally; no intervention is needed for most small seromas
• Large or persistent seromas may require needle aspiration: this must be done under sterile veterinary conditions; never drain at home
• Ankle swelling at 3 to 5 days post-surgery is normal: gravity pulls post-surgical fluid downward to the ankle; TPLO Info confirms this is routine
• Warning signs requiring vet contact: rapidly increasing swelling, warmth, redness, pus, foul odor, fever, or lethargy
• Activity restriction is the most important prevention: excessive movement is the leading cause of seroma formation after TPLO

What is fluid buildup after TPLO surgery?

Fluid buildup after TPLO surgery typically takes one of two forms: seroma or post-surgical edema.

A seroma is a collection of serum the clear, protein-rich fluid component of blood that leaks from disrupted blood vessels and lymphatic channels during surgery.

It pools in the dead space beneath the skin at the surgical site. Seromas feel soft, fluctuant (squishy), and are usually not warm or painful when small. They are not infections.

Post-surgical edema is broader tissue swelling caused by the inflammatory response to surgery.

This is expected in the first few days after any major orthopedic procedure and typically peaks at 48 to 72 hours before gradually resolving.

Both are distinct from hematoma (a collection of blood) and from infectious fluid (which appears purulent, has an odor, and accompanies systemic illness signs).

Why fluid builds up after TPLO

TPLO surgery creates significant soft tissue disruption.

The curved osteotomy cut, muscle retraction, and plate placement create dead space under the skin.

Fluid accumulates in this space before the tissues close together during healing.

Key contributing factors:

Excessive activity after surgery: the most preventable cause. Every time the operated leg moves beyond gentle weight-bearing, tissue planes are disrupted and more serum leaks into the dead space. TPLO Info confirms that the most common post-surgical cause of seroma is excessive movement of the knee.

Surgical technique: a longer or more complex procedure increases tissue disruption and the resulting dead space. Most surgeons use subcutaneous sutures and tissue closure techniques to minimize this, but some seroma formation remains common even with optimal technique.

Dog size and body composition: larger dogs and those with more subcutaneous fat tend to have more dead space at the osteotomy site and are more prone to seroma formation.

Licking or chewing at the incision: disrupts the healing wound edges and can introduce bacteria into a seroma, converting a benign fluid collection into an infected abscess. The E-collar must remain on at all times.

Normal vs. abnormal fluid buildup: how to tell the difference

Treatment options

Observation and strict rest: for small seromas (under 2 to 3 cm), the standard approach is to enforce activity restriction and allow the body to reabsorb the fluid. Small seromas typically resolve within 1 to 3 weeks. Cold compresses in the first few days reduce new inflammation.

Needle aspiration: large or uncomfortable seromas may be drained by your veterinarian using a sterile needle and syringe. This is a simple outpatient procedure but must be performed aseptically to avoid introducing infection. Never drain a seroma at home.

Compression bandaging: gentle compressive bandaging reduces the dead space available for fluid accumulation and can help prevent reformation after aspiration. This is typically applied by the veterinarian.

Surgical drain placement: if fluid continues to accumulate despite aspiration, a closed suction drain can be placed temporarily. This is rarely needed but is an option for persistent, large seromas.

Antibiotics: only if bacterial infection is confirmed or strongly suspected. Most seromas do not require antibiotics. Prescribing antibiotics for a non-infected seroma is not appropriate and contributes to antimicrobial resistance.

When to contact your veterinarian

Contact your vet promptly if you notice any of the following:

• Swelling that is rapidly increasing in size, especially in the first week
• The swollen area becomes warm, red, or painful to touch
• Any discharge, pus, or unusual odor from the incision or the swollen area
• Your dog develops fever, lethargy, loss of appetite, or stops bearing weight
• The seroma persists beyond 3 to 4 weeks without improvement

For the related article on incision site complications, see seroma in dogs after TPLO surgery. For the full complications overview, see 15 common complications after TPLO surgery in dogs.

For incision infection specifics, see TPLO incision infection symptoms and prevention.

Frequently asked questions

Is it normal to have a lump under the TPLO incision?

Yes, in most cases. A soft, non-painful lump that develops within the first 1 to 2 weeks under the TPLO incision is typically a seroma.

As long as it is not hot, rapidly growing, or producing discharge, it is usually a benign post-operative finding. Monitor it daily and report any changes to your vet.

How long does post-TPLO swelling last?

Most post-surgical edema resolves within 3 to 7 days as the acute inflammatory phase subsides.

Seromas take longer typically 1 to 3 weeks for small ones, and potentially 4 to 6 weeks for larger ones if they reform after aspiration.

Can I massage the fluid away?

Gentle massage around (not directly over) the incision can encourage local circulation, but vigorous massage of a seroma risks rupturing it and introducing bacteria.

TPLO Info notes that ankle swelling that develops 3 to 5 days post-surgery can be massaged and iced. For the surgical site itself, follow your vet's specific guidance.

What happens if a seroma is left untreated?

Most small seromas reabsorb on their own without problems.

A larger seroma that is not treated may persist for weeks or months, become uncomfortable due to pressure, or rarely become infected if bacteria enter through the overlying skin.

Monitoring and reporting changes to your vet is the key strategy.

Can my dog's activity level cause more fluid to build up?

Yes. Excessive activity is the most preventable cause of seroma formation and recurrence after aspiration. Every unnecessary movement of the operated leg disrupts healing tissue planes and drives more fluid production.

Strict confinement and leash-only activity are essential.

Resources

• TPLO Info. Recovery FAQs. tploinfo.com
• Vetplayas. Understanding Swelling After TPLO Surgery. vetplayas.com
• VCA Animal Hospitals. Seroma in Dogs. vcahospitals.com
• ACVS. Cranial Cruciate Ligament Disease. acvs.org