TPLO produces predominantly positive long-term effects in most dogs, but it also produces a predictable set of changes that owners should understand and manage proactively.

Most of these effects are manageable with appropriate care. Knowing what to expect prevents owners from being surprised by normal post-TPLO findings and helps them recognize when a change requires veterinary attention.

Quick answer: The 13 key long-term effects of TPLO surgery: improved joint stability, progressive osteoarthritis, muscle atrophy, morning stiffness, cold weather sensitivity, scar tissue formation, patellar tendon thickening, permanent implant in situ, contralateral CCL rupture risk, late implant complications, behavioral changes from chronic pain, weight management challenges, and long-term monitoring requirements.

Key takeaways

• Improved joint stability is the intended and most common long-term effect: for 90 to 95% of dogs, TPLO eliminates CCL-related instability and restores near-normal function
• Progressive osteoarthritis develops in all CCL-affected stifles regardless of surgical technique: TPLO slows OA progression but does not stop it; long-term OA management is a universal requirement
• Muscle atrophy is common in the operated leg throughout recovery; the thigh may remain visibly smaller than the contralateral side for months if rehabilitation is inadequate
• Contralateral CCL rupture risk is high: SustainableVet.org confirms up to a 50% chance of tearing the opposite CCL within a few years; the same degenerative process affects both stifles
• The TPLO plate and screws are permanent in the vast majority of cases: removal is only performed when complications arise; routine plate removal is not standard practice
• Weight management is the most impactful long-term owner-controlled variable: excess weight accelerates OA progression; maintaining ideal body condition is the primary long-term prevention strategy

The 13 long-term effects

1. Improved joint stability and mobility

The primary intended effect. The osteotomy and plate fixation permanently change the tibial plateau geometry, eliminating the cranial tibial thrust that caused instability.

For 90 to 95% of dogs, this produces lasting functional improvement: return to normal gait, ability to run and play, and freedom from the pain of unstable joint loading.

SustainableVet.org confirms: over 90% of dogs regain full limb function within a year; with proper care, many dogs remain active for 8 to 10 years after surgery.

2. Progressive osteoarthritis

The most universal long-term challenge. CCL disease initiates an arthritis process in the stifle that continues regardless of surgical outcome.

TPLO reduces the rate of progression and the severity of clinical signs compared to other treatment options, but OA continues.

Clinical signs of progressing OA emerge gradually over months and years: stiffness after rest, reluctance to run, difficulty climbing, and behavioral changes associated with chronic low-grade pain.

Management: weight management, omega-3 fatty acids, glucosamine and chondroitin, NSAIDs for flares, hydrotherapy, physiotherapy.

3. Muscle atrophy and asymmetry

The operated leg loses muscle mass rapidly during the restriction period and slowly rebuilds during rehabilitation. Full recovery of muscle symmetry takes 4 to 6 months in most dogs.

In some dogs -- particularly those with inadequate rehabilitation or ongoing joint pain -- visible thigh circumference asymmetry persists long-term.

Vetplayas confirms: due to reduced use during recovery and altered movement patterns post-surgery, muscles around the operated leg may weaken and shrink.

4. Morning stiffness

Morning stiffness -- the dog rises from sleep stiffly and walks awkwardly for the first few minutes before loosening up -- is one of the most common long-term effects of post-TPLO OA.

It typically develops months to years after surgery and gradually worsens as the dog ages.

This stiffness should not be confused with acute lameness. It consistently improves within 5 to 10 minutes of movement.

If it does not improve, or if the dog refuses to bear weight on waking, contact your vet.

5. Cold weather sensitivity

Dogs with OA in the operated stifle commonly show increased stiffness and lameness during cold weather or when barometric pressure changes.

This reflects the sensitivity of arthritic joints to temperature and pressure changes -- the same phenomenon seen in human arthritis.

Management: NSAIDs or joint supplements maintained year-round; warming the dog's sleeping area; a brief gentle walk before expecting full function in cold conditions.

6. Scar tissue formation

The surgical dissection and bone healing produce scar tissue in and around the stifle. This fibrous tissue generally has a beneficial stabilizing effect, contributing to long-term joint stability.

In some dogs, however, periarticular fibrosis restricts range of motion and causes stiffness that persists long after bone healing is complete.

Regular low-impact exercise and physiotherapy help maintain range of motion and prevent excessive fibrous tissue restriction.

7. Patellar tendon thickening

Fibrous thickening of the patellar tendon is a recognized long-term change after TPLO. It is typically subclinical -- detected on palpation at follow-up examinations but not producing clinical lameness.

In a small number of dogs, it contributes to reduced range of motion.

8. Permanent implant in situ

The TPLO plate and screws are designed to remain in place for life. In the vast majority of dogs, the implant is never removed and causes no long-term problems.

SustainableVet.org confirms: these implants are meant to stay in place permanently. In rare cases, some dogs may develop infections around the implant or experience loosening of the hardware over time.

The plate is palpable under the skin on the medial tibial surface. This is normal and not a complication.

9. Contralateral CCL rupture

The degenerative process that caused one CCL to rupture typically affects both stifles.

SustainableVet.org confirms dogs have up to a 50% chance of tearing the CCL in the opposite knee within a few years.

RCVS confirms approximately 50% of dogs develop CCL disease in the other hind limb.

This is not a complication of TPLO -- it is the natural history of bilateral CCL disease.

Monitoring the contralateral stifle for early signs of instability, effusion, or lameness is appropriate in all TPLO dogs.

10. Late implant-associated complications

Implant-related complications -- loosening, late infection from hematogenous seeding, or implant irritation -- can occur years after the original surgery. These are uncommon but recognized long-term effects.

Signs: new lameness focused at the plate site, warmth or swelling over the plate, a new draining tract in previously healed skin. Any of these warrants prompt veterinary assessment.

11. Behavioral changes

Chronic joint pain from progressive OA, late meniscal injury, or implant irritation can produce subtle behavioral changes: reduced engagement in play, reluctance to walk, increased irritability, or reduced stair use.

These changes are often attributed to aging but may reflect treatable pain.

Annual or semi-annual pain assessments, including use of validated canine pain scales (Canine Brief Pain Inventory, Helsinki Chronic Pain Index), help detect behavioral pain signs before they become severe.

12. Weight management challenges

Activity restriction during recovery predisposes many dogs to weight gain. Excess weight gained during the 8 to 12 week restriction period is then carried on the healing joint for the following months.

Long-term obesity accelerates OA progression and is the most modifiable risk factor for long-term joint health.

Medcovet confirms: because activity is restricted, veterinary teams may recommend reducing food intake by about 30% during recovery to prevent weight gain and extra strain on the knee joint.

13. Long-term monitoring and supplement requirements

TPLO dogs benefit from long-term monitoring (every 6 to 12 months after full recovery) to assess:

• Arthritis progression radiographically and clinically
• Body condition score and weight
• Contralateral stifle stability
• Implant integrity (radiographs every 1 to 2 years in some protocols)

Joint supplements (omega-3 fatty acids at anti-inflammatory doses; glucosamine and chondroitin) and ongoing weight management are the primary preventive interventions for the long-term joint changes that TPLO does not prevent.

For the long-term outcomes guide, see long-term outcomes of TPLO surgery. For arthritis management, see arthritis after TPLO surgery in dogs.

For the signs that require attention, see signs of TPLO failure in dogs. For the failure rate overview, see TPLO failure rate in dogs.

Frequently asked questions

Will my dog develop arthritis even if the TPLO was successful?

Yes. All CCL-affected stifles develop progressive osteoarthritis regardless of surgical technique or outcome.

TPLO reduces the rate of progression and the severity of clinical signs compared to non-surgical management and lateral suture repair.

The goal of TPLO is not to prevent OA but to minimize it while restoring function.

How long will the TPLO plate last?

The plate is designed to be permanent. Published long-term follow-up data at 6.8 years shows 90.4% of dogs with good to excellent results -- with the plate in place.

Plate complications requiring removal occur in 3.5 to 7.5% of cases.

My dog had TPLO 2 years ago and is now limping. Is this related to the surgery?

Possibly. Two-year post-TPLO lameness most commonly results from progressive OA, late meniscal tear, late implant-associated infection (hematogenous seeding), or contralateral CCL disease.

A veterinary examination and radiographs of both stifles will identify the cause and guide treatment.

Does the opposite leg always need TPLO as well?

Not necessarily and not always at the same time. RCVS confirms approximately 50% of dogs develop CCL disease in the opposite hind limb.

When and whether the second stifle requires surgery depends on whether the second CCL has ruptured or become significantly unstable. Annual monitoring of the contralateral stifle is appropriate.

Can TPLO dogs still live active lives long-term?

Yes. Most do. SustainableVet.org confirms that with proper care, many dogs remain active for 8 to 10 years after surgery.

The keys are weight management, regular low-impact exercise, joint supplements, and addressing pain or complications promptly.

Resources

• SustainableVet. 13 Long-Term Effects of TPLO Surgery on Dogs. sustainablevet.org
• RCVS Canine Cruciate Registry. Tibial Plateau Levelling Osteotomy. rcvsknowledge.org
• TPLO Info. TPLO Literature and Studies. tploinfo.com
• SustainableVet. Long-Term Outcomes of TPLO Surgery. sustainablevet.org

Confinement after TPLO surgery is not optional. It is the primary structural safeguard preventing the plate from failing before the osteotomy heals.

A dog that is allowed to run, jump, or spin in the first 8 weeks risks plate displacement -- a complication that requires revision surgery and extends recovery significantly.

Effective confinement is a practical skill that owners can prepare for before surgery.

Quick answer: Confine in a crate large enough to stand, turn, and lie but not to pace. An exercise pen works for crate-resistant dogs. A baby-gated small room is a third option. Non-slip flooring is essential. Outdoor access requires a leash. Strict confinement continues for 6 to 8 weeks.

Key takeaways

• The crate is the gold standard confinement tool: limits jumping, spinning, and running that risk plate displacement; large enough to stand and turn but not to pace
• Non-slip flooring is required in all confinement spaces: slipping generates uncontrolled leg movements that stress the plate
• Leash on the dog at all times outside the crate: every unsupervised second without a leash risks slipping or running; a house leash gives immediate control
• Exercise pens (X-pens) are a practical alternative for crate-resistant dogs: more space than a crate while still preventing free access to the rest of the house
• The confinement protocol changes weekly: strict crate-only in weeks 1 to 2, then gradual expansion as bone healing is confirmed on radiographs
• Clean bedding weekly: dirty bedding harbors S. pseudintermedius; the incision is in close contact with bedding throughout recovery

Why confinement matters

The TPLO plate holds the rotated tibial plateau in position while new bone grows across the osteotomy. The plate is strong but not indestructible.

Bone is not fully consolidated across the osteotomy for 8 to 12 weeks.

During this healing period, a dog that runs, jumps onto a sofa, slips on hardwood flooring, or spins to chase another pet can apply forces to the plate that exceed its tolerance.

Plate bending, screw loosening, or osteotomy displacement are the results. Each requires revision surgery.

SustainableVet.org confirms: dogs typically need 6 to 8 weeks of restricted activity before returning to light exercise; strict confinement ensures the bone plate stabilizes and heals properly.

Option 1: the crate

Why crates work best

A crate completely controls the dog's environment. The dog cannot run to the door, jump on the sofa, or spin in excitement. Every movement is small, controlled, and low-impact.

SustainableVet.org confirms: a crate is one of the safest ways to confine a dog after TPLO surgery; crates help prevent jumping, running, or sudden twisting that can damage the healing leg.

Crate selection

Size: the crate must be large enough for the dog to stand fully, turn around, and lie in any direction comfortably. It should NOT be large enough for the dog to trot or run inside it -- an oversized crate allows the dog to generate enough speed within the crate to create impact when stopping.

Flooring: avoid wire-bottomed crates. The dog's leg can slip through wire flooring. Use solid-floored crates or add a mat over wire flooring.

Bedding: comfortable, non-slip bedding. Memory foam dog mats are excellent for TPLO dogs -- they cushion pressure points during long rest periods.

Location: place the crate in the main family living area, not in an isolated room. Isolation increases separation anxiety and whining. A dog that can see and hear the family is calmer and more able to rest.

TPLO Info confirms: dogs do not like dirty bedding, so wash crate items at least once a week.

Transitioning a crate-naive dog

If the dog has never been crated, introduce the crate before surgery:

• Place meals in the crate with the door open for several days before surgery
• Gradually extend time inside with the door closed, building from 10 minutes to 1 hour
• Never force the dog in or use the crate for punishment

A dog that enters the crate willingly before surgery recovers with significantly less confinement-related distress.

Option 2: the exercise pen (X-pen)

An X-pen is a freestanding modular fence creating a confined area larger than a crate. It can be configured in different shapes and sizes.

TPLO Info confirms: X-pens give enough room to move while keeping the dog in one place. Larger dogs may attempt to jump over the fence and require monitoring.

Advantages: more space than a crate, reducing frustration in dogs that do not tolerate crates; can be set up in any room.

Disadvantages: requires monitoring for jumping attempts; the dog can build more momentum in a larger space; not suitable for very large or athletic dogs who can clear the fence.

Height: use a 48-inch or taller X-pen for medium and large dogs; even a non-athletic dog may clear a 36-inch pen if motivated.

Flooring inside the X-pen: place yoga mats or a rubber-backed rug inside to cover hard flooring.

When to use an X-pen: recommended after the initial 2 weeks of strictest confinement, when the dog has established initial healing and the wound is closed. Not ideal for weeks 1 to 2.

Option 3: a baby-gated small room

A bathroom, laundry room, or small bedroom can serve as a recovery room when gated with a baby gate.

Dog Knee Injury confirms: prepare your home for post-surgery by setting up a recovery space with a comfortable dog bed, non-slip flooring, and a baby gate to create a barrier.

Requirements:

• Non-slip flooring throughout (add yoga mats or rugs)
• No furniture the dog can jump onto or off
• Accessible water and food bowls at floor level
• The gate must prevent the dog exiting unsupervised

Advantages: familiar environment, easy human access, more comfortable than a crate for larger dogs.

Disadvantages: more space means more opportunity for movement; the dog can circle and pace in a room, which a crate prevents; requires strict monitoring.

Outdoor access: leash only, no exceptions

Every outdoor bathroom trip requires a leash. No exceptions.

SustainableVet.org confirms: always use a leash when outside, even for bathroom breaks; open-door access to the yard allows a dog to run, chase, or slip before the owner can intervene.

Leash length: short -- no retractable leashes. The owner must be able to prevent sudden running immediately. A 4 to 6 foot leash is appropriate.

Bathroom trip duration: 5 minutes maximum in weeks 1 to 2. Gradual increase per the vet's protocol.

Wet weather: rain and wet grass introduce bacteria to the incision area and also create slipping hazard. Time trips to avoid heavy rain where possible; carry a dry towel.

Week-by-week confinement protocol

Weeks 0 to 2 (strictest):

• Crate at all times except supervised bathroom leash walks
• 5-minute walks, 3 to 5 times daily
• E-collar on at all times
• No access to any area without owner supervision

Weeks 2 to 6 (moderate):

• Crate or X-pen when unsupervised
• Supervised time in the confinement room with owner present
• Leash walks increasing gradually per vet's direction
• E-collar until incision fully confirmed healed at 2-week recheck

Weeks 6 to 12 (graduated relaxation):

• Confinement continues but may expand to a room-sized area under supervision
• Activity increases based on radiographic findings at 6-week recheck
• Off-leash access to the house (not yard) under close supervision for some dogs, vet-directed

After 12 weeks (post-clearance):

• Full activity restriction lifted after radiographic bone healing confirmation
• Progressive return to normal environment and activity
• Still avoid high-impact play until full muscle recovery at 4 to 6 months

For the full recovery timeline, see what to expect after TPLO surgery in dogs. For keeping a dog calm during confinement, see how to keep a dog calm after TPLO surgery.

For physical therapy timing, see when to start physical therapy after TPLO surgery. For infection prevention, see post-operative care mistakes that increase TPLO infection risk.

Frequently asked questions

My dog has never been in a crate. Can I start at surgery?

Yes, but start before surgery if possible -- even a few days of crate introduction before surgery significantly reduces post-operative confinement distress.

If you cannot prepare beforehand, introduce the crate gently in the first day or two at home, using meals and treats to create positive associations.

How do I know if the crate is the right size?

The dog should be able to stand with their head up, turn in a full circle, and lie in multiple positions without being cramped.

They should NOT be able to trot or run within the crate space. If in doubt, err toward smaller.

My dog cries in the crate for hours. Is the confinement causing psychological harm?

Extended, severe crate distress may indicate inadequate pain management (the dog is in pain, not just frustrated) or genuine severe separation anxiety. Contact your vet.

Trazodone and gabapentin can significantly reduce confinement distress. Do not abandon confinement -- the physical risk of uncontrolled activity is greater than the psychological discomfort of confinement.

Can my dog sleep in my bed during recovery?

No. Jumping off the bed -- even a single time -- can displace the plate.

The dog must sleep in the crate or on a floor-level dog bed in the recovery area throughout the restriction period.

Can I let my dog outside in a fenced yard for bathroom breaks without a leash?

No. Dogs routinely run, spin, and perform sudden movements in yards even when told to go to the bathroom.

A single run to chase a squirrel or greet someone at the fence is enough to cause plate failure before the osteotomy heals. Leash only, every time.

Resources

• SustainableVet. How to Confine Your Dog Post-TPLO Surgery. sustainablevet.org
• TPLO Info. How to Confine Your Dog Post-TPLO Surgery. tploinfo.com
• Dog Knee Injury. How to Confine Your Dog After TPLO Surgery. dogkneeinjury.com
• VCA Animal Hospitals. Tibial Plateau Leveling Osteotomy (TPLO) in Dogs. vcahospitals.com

"Failure rate" is used loosely when owners discuss TPLO, which can cause significant confusion. A complication is not the same as a failure.

Understanding what the published data actually shows and distinguishing minor complications from true surgical failures gives owners a much clearer picture of what to expect.

Quick answer: The overall TPLO complication rate is 10 to 34% across studies; most are minor. Major complications requiring reoperation occur in 2 to 7%. Infection is the most common major complication. Long-term good outcomes are reported in 90 to 93% of dogs.

Key takeaways

• Overall complication rate is 10 to 34% across published studies; most complications are minor and resolve without additional surgery
• Major complication rate requiring reoperation is 2 to 7%: a 1,000-dog study found 14.8% overall with 6.6% major complications
• SSI is the most common major complication: 2.9% to 25.9% across studies; giant breeds over 50 kg are at highest risk
• Small dogs under 15 kg have significantly lower complication rates: 4.44% in one 90-dog study, with no revisions
• Good to excellent long-term outcomes in 90 to 93% of dogs: the complication rate does not equal the failure rate
• Surgeon experience is the most modifiable risk factor: complication rates are consistently lower at high-volume specialty centers with board-certified surgeons

Defining "failure" vs. "complication"

This distinction is critical for interpreting the literature and for setting owner expectations accurately.

Complication: any deviation from the expected post-operative course. This includes minor findings like superficial wound dehiscence, mild swelling, or radiographic evidence of delayed osteotomy healing with no clinical signs. Many publications include these minor events in their complication rates.

Major complication: an event requiring additional surgical intervention or causing extended lameness. Major complications represent the subset of complications that meaningfully affect recovery and outcome.

Failure: the most restrictive definition surgery that did not achieve its goal of stifle stabilization, resulting in persistent instability and requiring revision with a different technique. True failure in this sense is uncommon after TPLO.

What published complication data shows

Overall complication rates

Vetamac confirms: complication rates following TPLO surgery range from 14% to 34%, with less than 10% of cases requiring a second surgery.

PMC (intraoperative bacterial culture study) confirms: the complication rate of TPLO varies between 10% and 34%, with 2 to 4% requiring surgical revision.

Today's Veterinary Practice reports a 14.8% complication rate in 1,000 TPLO patients (6.6% major — requiring repeat surgery or extended lameness), including 2.8% late meniscal injury and 6.6% infections.

Infection rates

Infection is the most common major complication and the one with the greatest variation by dog size and surgical setting.

PMC confirms: SSI rate after TPLO is reported to be 2.9% to 25.9% across studies, which is higher than other clean orthopedic surgeries (2.0 to 6.7%).

Surgical site infection rates of 21.3% to 25.9% have been reported specifically for giant-breed dogs weighing over 50 kg.

The implant removal rate due to infection is 3 to 7.4% per published literature (PMC PRP study; ResearchGate implant removal study).

Complication rates by dog size

Dog size is a consistent predictor of complication risk.

PLOS One retrospective (90 dogs under 15 kg): overall complication rate 4.44%, with no complications requiring surgical revision.

The study confirms: the complication rate in dogs under 15 kg is less than that historically reported in heavier dogs.

PubMed retrospective (small and medium dogs, 2.0 and 2.7 mm plates): overall complication rate 36%.

The most common complications were radiographic evidence of delayed healing (9%), patellar tendon thickening (8%), and tibial tuberosity fracture (6%). Only 7% of complications were major.

PLOS One confirms: the TPLO complication rates range from 10% to 34% and vary in severity from swelling and bruising to fractures and osteomyelitis.

Implant-related complications reportedly occur in under 10% of all TPLO procedures.

Long-term success rates

Complication rates must be interpreted alongside long-term success rates.

The retrospective cohort study comparing TPLO, Tightrope, and TTA found: function greater than 1 year after surgery was 93.1% for TPLO, 92.7% for Tightrope, and 89.2% for TTA.

SustainableVet.org confirms: good to excellent long-term outcomes are achieved in 90.4% of patients up to 6.8 years after TPLO surgery; 80 to 90% of owners are satisfied with their dog's long-term recovery.

A dog can have a complication even a significant one like an infection and still achieve a good long-term outcome after the complication is resolved.

The complication rate and the long-term success rate address different aspects of the outcome.

Factors that affect complication and failure rates

Surgeon experience and volume

This is the most consistently cited modifiable risk factor. High-volume specialty centers and board-certified surgeons consistently report lower complication rates than general practitioners performing occasional TPLO procedures.

Surgical efficiency, technique precision, and post-operative protocol standardization all contribute.

Dog size and body weight

Larger dogs generate higher joint forces, have larger dead space at the surgical site, and place more mechanical demand on the implant during healing.

These factors contribute to the higher complication rates seen in large and giant breeds.

Excessive tibial plateau angle (TPA)

Dogs with TPA above 35 degrees (excessive TPA, or eTPA) have higher complication rates.

Today's Veterinary Practice notes: owner-perceived outcome was superior for eTPA group dogs when TPLO resulted in TPA of 14 degrees or less compared to those with TPA greater than 14 degrees.

Postoperative complications were more common in dogs with eTPA.

Post-operative activity restriction compliance

Dogs that are over-active during recovery have higher rates of implant complications, seroma formation, and wound complications.

Strict adherence to the prescribed restriction protocol is the owner's primary contribution to reducing complication risk.

For the complications overview, see 15 common complications after TPLO surgery in dogs. For the infection signs guide, see TPLO plate infection signs and treatment.

For the long-term outcomes guide, see long-term outcomes of TPLO surgery. For the plate removal guide, see TPLO plate removal recovery guide.

Frequently asked questions

What is the TPLO failure rate?

Depends on how "failure" is defined. If failure means any complication: 10 to 34% across studies. If failure means major complications requiring surgery or causing extended lameness: 2 to 7%.

If failure means persistent instability requiring revision with a different technique: uncommon and not consistently reported across large series.

Is TPLO safe for large breed dogs?

Yes, but with a higher complication risk than small dogs. Vetamac confirms: for large breeds, TPLO is still the gold standard, providing better long-term stability than alternatives.

The higher complication rate in large dogs reflects the greater mechanical demands and surgical challenges, not a fundamental unsafety of the procedure.

What percentage of TPLO dogs need a second surgery?

Across published studies, 2 to 10% require a second surgical intervention. Most second surgeries address infection (requiring plate removal), late meniscal tears (requiring partial meniscectomy), or implant complications.

Does my dog's vet experience affect failure rate?

Yes, substantially. Surgeons performing fewer than a set number of TPLO procedures per year have higher complication rates than high-volume specialists.

This is one reason referral to a board-certified orthopedic surgeon (ACVS diplomate) is recommended for TPLO.

If my dog has a complication, does that mean the TPLO failed?

Not necessarily. Many dogs who develop complications including infections requiring plate removal still achieve good to excellent long-term function after the complication is resolved.

The complication rate and the long-term outcome are different measures.

Resources

• Today's Veterinary Practice. Canine Cranial Cruciate Disease: Evidence-Based Look at Current Treatment Modalities. todaysveterinarypractice.com
• PLOS One. Risk Factors for Short-Term Postoperative Complications in Dogs Weighing Less Than 15 kg. journals.plos.org
• PubMed. Short-Term Complications Associated With TPLO in Dogs Using 2.0 and 2.7 mm Plates. pubmed.ncbi.nlm.nih.gov
• PMC. Clinical Relevance of Positive Intraoperative Bacterial Culture in TPLO in Dogs. ncbi.nlm.nih.gov
• Vetamac. TPLO Surgery for Dogs: Success Rates and Alternative Options. vetamac.com

TPLO incision infection is one of the most common complications after surgery. Most incision infections are preventable with consistent owner-managed wound care, and most are treatable when caught early.

The window between a superficial incision infection (treatable with antibiotics) and a deep implant infection (requiring surgical intervention) is measured in days -- which is why daily inspection is not optional.

Quick answer: Normal TPLO incision healing shows mild redness fading from day 5, no discharge after day 3, and a clean approximated incision line. Infection signs: spreading redness, increasing warmth, cloudy or malodorous discharge, swelling not resolving, wound edges separating, or lameness worsening. Prevention centers on e-collar compliance, dryness, and daily inspection.

Key takeaways

• Licking is the most common preventable cause of TPLO incision infection: the oral cavity carries S. pseudintermedius that can inoculate the incision; e-collar compliance for 10 to 14 days is the most protective owner action
• The distinction between normal healing and early infection is trajectory-based: mild redness and clear serum discharge are normal for 2 to 3 days; anything worsening from day 5 onward warrants veterinary attention
• Infection signs requiring a same-day call: spreading redness, yellow or green discharge, malodorous discharge, wound dehiscence, or systemic signs alongside local wound changes
• Keeping the incision dry is the second most important prevention measure: bacteria proliferate in moist environments; no bathing or wet-grass walks until incision healing is confirmed by the vet
• Daily inspection at the same time each day creates a baseline: daily comparison of today to yesterday reveals whether the incision is improving or worsening
• Most superficial incision infections resolve with oral antibiotics if treated promptly: treatment escalates significantly if deep implant involvement occurs; early action prevents this escalation

Normal TPLO incision healing: what to expect

Understanding normal healing is the prerequisite for recognizing abnormal changes.

Days 1 to 3: acute inflammatory phase

Normal: the incision is red, mildly swollen, and warm. A small amount of clear to pale yellow serum may seep from the wound edges. The swelling may extend slightly beyond the incision line.

Context: this is the inflammatory phase -- the biological response to surgical trauma. It is expected and appropriate.

Days 3 to 5: peak swelling subsides

Normal: redness should be fading. Swelling should begin to reduce. Any discharge should have stopped by day 3. The incision line should be approximated (edges together and not gaping).

Days 5 to 10: healing consolidation

Normal: redness is minimal or absent. No discharge. The incision line is dry and the skin edges are growing together. The dog may experience some surface itching as new skin forms.

Suture/staple removal: typically at 10 to 14 days. The vet confirms incision healing before removal.

Day 14 onward

Normal: incision is healed, sutures removed, skin intact. Mild surface discoloration (pink to pale) is normal for several weeks. No further discharge.

Signs of TPLO incision infection

Spreading redness (most concerning early sign)

Normal healing produces redness confined to the incision line (typically 1 to 2 mm on each side).

Infection produces redness that spreads outward from the incision -- a widening halo of red skin extending beyond the original margins.

SustainableVet.org confirms: redness that worsens, especially with pain or heat, often accompanies infection. Contact your vet the same day if spreading redness is observed.

Warmth that is increasing rather than decreasing

Mild warmth is normal in the first 3 to 5 days.

Warmth that is increasing at day 7 or beyond -- when normal healing produces cooling -- indicates ongoing active inflammation, typically from infection.

Discharge type and timing

• Clear serum for 24 to 48 hours: normal
• Any discharge after day 3: concerning
• Cloudy, yellow, or green discharge at any stage: infection until proven otherwise
• Malodorous discharge: infection; contact vet immediately

SustainableVet.org confirms: inspect the incision daily for redness, swelling, or discharge; yellow or green discharge is not normal and needs immediate attention.

Wound dehiscence

The incision edges separate, exposing subcutaneous tissue or deeper structures. Most often caused by licking, but can occur from excessive activity, suture reaction, or infection undermining the tissue.

SustainableVet.org (complications article) confirms: if stitches are removed too soon or dehiscence occurs, a vet should assess the wound immediately.

Swelling that is not resolving

Expected swelling peaks at days 2 to 5 and consistently resolves after that.

Swelling that is the same or larger at day 7 as it was at day 3 is not following the expected trajectory.

Systemic signs alongside local changes

Fever (rectal temperature above 39.5 C / 103.1 F), lethargy, reduced appetite, or behavioral changes accompanied by any local wound sign constitute an emergency call. These suggest the infection is systemic.

SustainableVet.org (redness article) confirms: systemic signs including fever, lethargy, or loss of appetite along with redness indicate the infection may be spreading; contact your vet immediately.

Prevention: the actions that matter most

1. E-collar compliance without exception

The e-collar prevents the single most common preventable cause of TPLO incision infection: licking. Even one licking episode directly inoculates the wound with oral bacteria.

SustainableVet.org confirms: even brief periods of licking can introduce bacteria; an Elizabethan collar or medical pet shirt should be used at all times until the incision fully heals.

The e-collar must be worn:

• During sleep
• Unsupervised periods in the crate
• Whenever the dog is not under direct eye contact with the owner

If the dog can reach the incision with the collar on, the collar is the wrong size -- contact the vet for a larger size.

2. Keep the incision dry

Moisture promotes bacterial growth and skin maceration at the incision edges. No bathing or submerging the leg until the vet confirms healing at the 2-week recheck.

During wet weather, minimize wet-grass time on outdoor bathroom trips. Pat the leg dry immediately if it gets wet.

SustainableVet.org confirms: keep the incision clean and dry; avoiding moisture reduces infection risks.

3. Daily incision inspection

Inspect the incision at a consistent time each day. Compare today directly to yesterday. The trajectory (better, same, worse) is more diagnostically useful than any single observation.

Inspection takes 30 seconds. Pick a time (e.g., after the evening bathroom walk) and make it routine.

4. Do not clean with unapproved solutions

Unless instructed by your vet, do not apply hydrogen peroxide, alcohol, iodine, or other antiseptics to the incision. These can damage healing tissue and delay closure.

If cleaning is needed, use the vet-approved solution (typically dilute chlorhexidine or sterile saline).

5. Clean bedding weekly

Bedding in contact with the incision area accumulates skin bacteria. Wash crate bedding weekly in hot water.

6. Hand hygiene before touching the wound

Wash hands before any wound inspection or dressing change. Human skin also carries bacteria capable of contaminating an open or healing incision.

Treatment

Superficial infection (SSI-S): oral culture-directed antibiotics for 2 to 4 weeks; wound cleaning; continued e-collar compliance; wound recheck in 3 to 5 days to confirm response.

Progressing or deep infection: surgical debridement; deep culture; IV or long-course oral antibiotics; imaging to assess implant involvement.

Implant-associated infection: see the dedicated TPLO plate infection guide. Treatment typically includes plate removal once the osteotomy has healed.

For the infection signs guide, see earliest signs of TPLO infection. For the prevention mistakes guide, see post-operative care mistakes that increase TPLO infection risk.

For the staph infection guide, see staph infection after TPLO surgery. For the plate infection guide, see TPLO plate infection signs and treatment.

Frequently asked questions

My dog's incision looks red but the vet said it looks normal at the 2-week recheck. Should I still be worried?

If the vet examined the incision in person at 2 weeks and found it normal, trust that assessment. Post-recheck monitoring continues -- if the incision changes after the recheck, contact the vet.

A single normal exam does not guarantee no infection will develop later.

Can I tell the difference between a seroma and an infection at the incision?

Seromas are soft, fluctuant (fluid-filled), non-painful swellings without redness, warmth, or discharge. Infection produces warmth, redness, possible discharge, and pain. If you cannot clearly distinguish the two, contact your vet for assessment.

The incision looked fine yesterday but today there is yellow discharge. What do I do?

Call your vet the same day. Yellow discharge at any point after the first 2 to 3 days is concerning. Do not wait to see if it resolves.

Keep the e-collar on and do not apply any home remedies to the wound before the vet advises.

My dog keeps trying to lick the incision even with the e-collar. What else can I try?

Ensure the collar is the correct size -- most dogs can reach their hind legs with a too-small collar.

A longer cone, a recovery suit (medical pet shirt), or a contact bandage over the incision site (applied by your vet) can supplement the collar.

Ask your vet about trazodone or gabapentin if anxiety is driving the licking behavior.

Does the incision need to be cleaned every day?

In most cases, no. Daily cleaning is not required and may introduce contamination or irritate healing tissue. Daily inspection is required.

Clean only if the vet specifically instructs it and with the approved solution only.

Resources

• SustainableVet. TPLO Incision Infection: Symptoms and Prevention. sustainablevet.org
• SustainableVet. Earliest Signs of TPLO Infection. sustainablevet.org
• SustainableVet. TPLO Plate Infection Signs and Treatment. sustainablevet.org
• VCA Animal Hospitals. Tibial Plateau Leveling Osteotomy (TPLO) in Dogs. vcahospitals.com

Staphylococcus species are the most common cause of surgical site infections (SSI) after TPLO surgery in dogs.

The primary culprit is Staphylococcus pseudintermedius -- a bacterium that normally lives on the skin, nares, and perianal area of healthy dogs.

Understanding why this organism is so prevalent, how it produces infection, and what makes methicillin-resistant strains particularly challenging is essential for owners of TPLO dogs and the veterinary professionals treating them.

Quick answer: S. pseudintermedius is the most common cause of post-TPLO infection. MRSP accounted for 28% of infections in a 659-TPLO study. Signs include redness, swelling, warmth, and discharge -- or only lameness regression and plate-site swelling for deep implant infections. Culture and sensitivity testing is required; empirical treatment risks selecting for further resistance.

Key takeaways

• S. pseudintermedius is the most frequently identified pathogen in TPLO infections: a normal skin commensal in dogs; the PMC 769-TPLO study identified it in 37 of 65 SSI cases
• MRSP accounted for 28% of infections in a 659-TPLO study: a high proportion of resistant organisms in a single surgical population; MRSP does not respond to many first-line antibiotics
• Biofilm formation on the TPLO plate makes staph infections difficult to treat: once established on the metal plate, bacteria are protected from antibiotics; deep implant infections often require plate removal
• Signs of staph infection range from visible wound changes to none: superficial infections produce redness, warmth, and discharge; implant infections may show only lameness regression and plate-site swelling
• Diagnosis requires bacterial culture and sensitivity testing: MRSP cannot be diagnosed visually; empirical antibiotic treatment without culture risks selecting for further resistance
• Pre-operative MRSP carriage significantly increases SSI risk: preoperative MRSP colonization is an independent risk factor; dogs with known carriage require enhanced perioperative protocol

Why S. pseudintermedius is so prevalent in TPLO SSI

It is a normal resident of dog skin

S. pseudintermedius colonizes the skin, nares, and perianal area of most dogs as part of their normal flora. It is present on the surgical preparation area even after antiseptic skin preparation.

The preparation reduces the bacterial load but does not sterilize the skin.

SustainableVet.org confirms: S. pseudintermedius is naturally found on a dog's skin; in healthy dogs it rarely causes issues, but after TPLO surgery it can infect the surgical incision and implants.

The TPLO plate provides a preferred colonization surface

Metal implants dramatically lower the minimum infective dose -- the number of bacteria required to establish infection. On a plate surface, S. pseudintermedius can form biofilm with far fewer organisms than required to infect soft tissue alone.

SustainableVet.org confirms: TPLO surgeries are particularly prone to infection because of the metal implants, which provide a surface for bacteria to stick to and form biofilms.

Licking introduces oral cavity organisms to the incision

The oral cavity of dogs is also colonized with S. pseudintermedius. When a dog licks the incision, it introduces additional bacteria directly to the wound.

This is the most common mechanism of avoidable post-TPLO SSI.

ResearchGate MRSA TPLO case report confirms: the dog licked the surgical site, causing dehiscence, and MRSA was detected from the purulent discharge. This underscores the critical importance of e-collar compliance.

MRSP: the resistant strain that complicates treatment

MRSP (methicillin-resistant Staphylococcus pseudintermedius) is resistant to beta-lactam antibiotics via the mecA gene -- the same mechanism as MRSA in humans. Cephalexin, amoxicillin-clavulanate, and most penicillins are ineffective.

Why MRSP is a particular challenge in TPLO

Most perioperative antibiotic protocols use cefazolin (a cephalosporin). MRSP is resistant to cephalosporins by definition.

If a dog unknowingly colonized with MRSP receives cefazolin prophylaxis, the MRSP is not suppressed. If it reaches the plate, it establishes infection against which standard first-line antibiotics are ineffective.

SustainableVet.org confirms: MRSP has developed resistance to many commonly used antibiotics, making infections harder to treat and increasing the risk of complications.

MRSP incidence in TPLO infections

ResearchGate TPLO MRSA/MRSP study (659 TPLO procedures, SSI rate 11%): MRSP accounted for 20 of 71 infections (28%). This is a high proportion of resistant organisms in a post-surgical population.

Antibiotic options for MRSP

First-line options for susceptible S. pseudintermedius (cephalexin, amoxicillin-clavulanate) do not work for MRSP. Culture and sensitivity testing is required to identify effective agents. Common options based on sensitivity results include:

• Chloramphenicol: effective against many MRSP; requires bone marrow monitoring
• Clindamycin: effective if sensitivity confirmed; not all MRSP strains
• Doxycycline: bacteriostatic; used for some superficial MRSP infections
• Rifampin (rifampicin): excellent biofilm penetration; always combined with another agent to prevent resistance; used for implant-associated MRSP
• Vancomycin: last resort; the MRSA TPLO case report describes a rifampin-vancomycin combination resolving MRSA infection that persisted despite implant removal and vancomycin alone

SustainableVet.org confirms: one of the biggest challenges in treating staph infections after TPLO is the presence of multidrug-resistant bacteria, particularly MRSP; this strain has developed resistance to many commonly used antibiotics.

Signs of post-TPLO staph infection

Superficial incisional infection (SSI-S)

• Redness spreading beyond the incision line (after day 5)
• Warmth at the incision site increasing rather than decreasing
• Swelling that is not resolving or is increasing
• Discharge: cloudy, yellow, green, or malodorous from the incision
• Wound edges that are not healing or are separating

Deep implant-associated infection (SSI-D)

• New or worsening lameness after a period of improvement
• Swelling over the plate site (not necessarily at the incision)
• Warmth specifically at the plate site on palpation
• A draining tract opening near but not at the incision (typically weeks to months post-surgery)
• No discharge from the original incision despite significant clinical signs

SustainableVet.org confirms: signs of infection include redness, swelling, warmth around the incision, pus-like discharge, an unpleasant odor, and increased pain or tenderness.

Diagnosis

Wound swab culture: taken from discharge at the incision or from the draining tract. Provides the organism identification and sensitivity profile.

Deep tissue culture: more accurate than wound swabs because it avoids surface contamination. Obtained at surgery (arthrotomy or plate removal).

Plate surface culture: the most sensitive diagnostic for implant-associated infection. Obtained when the plate is removed.

Imaging: radiographs assess peri-implant bone changes (radiolucent halos, periosteal reaction); advanced imaging (CT) may be used for complex deep infections.

The PMC 769-TPLO study confirmed: bacterial culture was positive in 72% of samples submitted when SSI was first suspected.

Treatment

Superficial infection: culture-directed oral antibiotics for 2 to 4 weeks; wound cleaning; e-collar compliance to prevent licking; local wound care.

Deep implant-associated infection: surgical debridement (lavage and debridement of the plate site); culture; culture-directed antibiotics for 4 to 8 weeks; plate retention if the osteotomy is not yet healed (with the understanding that complete resolution may require later plate removal); plate removal once the osteotomy has healed.

MRSP-specific: culture results guide antibiotic selection. Rifampin combinations are used for biofilm-associated implant infections. Veterinary infectious disease consultation is appropriate for complex MRSP cases.

For the infection prevention guide, see how can TPLO infections be prevented post-operatively?. For MRSP specifically, see can MRSP or MRSA occur after TPLO surgery?.

For the SSI rate data, see how common are infections after TPLO surgery?. For the antibiotic guide, see antibiotics commonly used for TPLO infections.

Frequently asked questions

My dog had a culture and it came back as S. pseudintermedius. Is that MRSP?

Not necessarily. S. pseudintermedius can be methicillin-susceptible (MSSP) or methicillin-resistant (MRSP). The sensitivity panel on the culture report will indicate whether the organism is susceptible to cephalexin and other beta-lactam antibiotics.

If susceptible, it is MSSP and responds to standard first-line drugs. If resistant to cephalosporins, it is MRSP and requires second-line agents.

Can I prevent staph infection after TPLO?

Licking prevention (e-collar compliance for 10 to 14 days) is the single most impactful owner-controlled prevention measure. Licking is the most common avoidable cause of post-TPLO SSI.

Wound dryness, clean bedding, limited environmental contamination, and daily wound inspection are additional preventive measures.

My dog finished the antibiotic course but the discharge came back. What does that mean?

Recurrence after antibiotic completion most commonly indicates biofilm-associated implant infection that was suppressed but not eradicated by antibiotics. Plate removal is likely needed for definitive resolution.

Contact your vet immediately -- do not wait to see if it resolves again.

Can my dog spread MRSP to other dogs or people?

MRSP is primarily a veterinary pathogen. It is less commonly transmitted to humans than MRSA, but zoonotic transmission has been documented.

Standard hygiene measures (hand washing after wound care, gloves for wound dressing changes, avoiding face contact with the infected wound) are appropriate precautions during treatment.

How long does it take to clear a deep staph infection after TPLO?

Deep implant-associated infections typically require 4 to 8 weeks of culture-directed antibiotics plus plate removal once the osteotomy is healed.

MRSP infections that involve biofilm and require rifampin combinations may take 3 to 6 months of total treatment. Osteomyelitis extends this further.

Long courses are necessary because biofilm-associated bacteria are protected from antibiotics and resistant populations can regrow when treatment stops.

Resources

• PMC. Surgical Site Infection After 769 TPLOs. pmc.ncbi.nlm.nih.gov
• ResearchGate. Treatment of MRSA Infection Following TPLO in a Dog. researchgate.net
• SustainableVet. Staph Infection After TPLO Surgery. sustainablevet.org
• SustainableVet. Is Staph the Most Common Infection After TPLO Surgery? sustainablevet.org

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