Maddie's TPLO surgery
click on any image below for a larger version.
 

We adopted Maddie from a local rescue organization in August of 2000. She had been found by the sheriff’s department wandering the streets in a "not so friendly" part of town and was brought to the shelter a day or two before we got her. We had Maddie checked out by our vet and she was described as a happy healthy four month old lab-mix puppy.

Less than a week later Maddie was hospitalized with a severe viral infection. It was not Parvo, but had similar symptoms and was never identified. She spent almost a week in the hospital and then another couple of weeks recuperating at home with us. All of this trauma bonded Maddie very close to our family, including our two cats. Maddie grew to be a happy, loyal, and loving housedog. She still had a few fears and quirks but fit very well with our family. She was a normal playful puppy.

 

At one year old, Maddie was starting to have trouble sitting up straight. She would throw her back legs out to the side and sit on her hips. She also seemed to have some difficulty on long walks. She would get tired very easily. We took her to the vet who said that she could possibly have hip dysplasia but nothing could be certain without x-rays. She suggested waiting to see how Maddie’s development continued. At this same time, we lost one of our precious cats to diabetes and liver disease. Within a short time the second cat went into kidney failure. (We think it was related to the loss of his lifelong friend.) Needless to say, Maddie’s “problem” was moved to the back burner. It took another year to regulate the cat’s kidney issue. With the help of two kittens to cheer him up, he seemed to be on track to recover.

At two year’s old, Maddie was very happy with the addition of two kittens who would play all day and snuggle her at night. Maddie  had always hated being outside by herself. She would have preferred to be an indoor only dog. Her displeasure with the outside seemed to be increasing and she was showing signs of stiffness and less activity. After playing with another dog, Maddie would actually drag her back legs and have difficulty getting up and down until she rested for a day. These symptoms increased and Maddie was spending more and more time inactive, resting on her bed. Throughout all of this, Maddie was happy and playful in spurts.

In July of 2002, at age 2 ½ and 80 pounds, we returned to the vet with Maddie’s symptoms. Maddie was prescribed Rimadyl and scheduled for x-rays. Maddie’s x-rays showed that it was her knees not her hips that were the problem. At this point we needed to see an orthopedic specialist. In November, the specialist determined torn cruxiate ligaments in both knees and recommended TPLO surgery as soon as possible.

 

After learning about the cost ($2600 per knee) and the rehabilitation time (16 weeks per knee), we determined that we were unable to do it at the time so we took the opportunity to get a second opinion.  In February, I took Maddie to UC Davis Veterinary Hospital. The orthopedic specialist and his resident agreed that TPLO was the best procedure to repair the damage done to Maddie’s knees. Again they stressed that there was increasing damage done daily to the meniscus and the surgery should be done as soon as possible. Maddie was developing severe arthritis. We switched from Rimadyl to Deramaxx as an anti-inflammatory because it seemed to be easier on her stomach.

We decided to schedule the first surgery for June. There are not a lot of qualified doctors to do this surgery and we felt lucky to have a qualified doctor in town.  In May, I called the veterinary hospital to set the surgery date. I was upset to hear that the surgeon was leaving the practice and there was not a replacement to do the surgery. I started searching for other options and found that there would be a 2 month wait to get back into UC Davis. This would not leave us able to complete the rehabilitation time before summer vacation ended and I had to go back to teaching. Short of hiring someone to sit with the dog and take her to the bathroom when needed, this was not an option. We were extremely lucky that the surgeon was able to make arrangements to go ahead and do Maddie’s surgeries. However, she would not be available for any follow-up or emergencies. We would have other veterinarians for this purpose. I would have preferred to work solely with one doctor but it seemed that we had no options to keep to our time frame.

 

The First Surgery

In June 2003, Maddie underwent TPLO surgery on her right knee. The surgery took about 3-4 hours and the surgeon said that everything went well. We took Maddie home after only one night in the hospital. Her right leg was wrapped from her toes to her thigh with a bandage that was like a soft cast. Maddie was able to put weight on her leg and could limp around. We were surprised and pleased that she had only minor difficulties with squatting to go to the bathroom. She had no need for a sling to hold her up and didn’t have any of the other bathroom issues we had read about on other web sites. She was very needy the first few days and wanted to go outside almost once an hour to try to go to the bathroom. (I attribute this to stomach upset from the anesthesia and getting used to the antibiotics.) She was on Dermaxx and antibiotics as well as Glucosamine supplements. Tylenol with codeine was prescribed as needed for pain.

The first two weeks she tried to do as many “normal activities” as possible. We were worried that she was too active and had to create activities to entertain her and keep her still. She alternated days of really wanting to be active and wandering around the family room with days of just wanting to sleep at my feet. If I left the room, she would pace until I returned. The goal was to keep her rested and as inactive as possible. Maddie never whined or showed any signs of acute pain. She did not take the pain medication. We did notice some very deep red bruising on her thigh. The vet assured us that this was normal. The surgery is very invasive and the bruising will spread throughout the entire leg.

On day 15, Maddie had the bandages and sutures removed. The doctor said that everything looked good and she was on track for recovery. She didn’t seem to have any interest in the suture area and hadn’t licked at all at the bandaged leg, so we were hoping to only use an e-collar when she was left alone or at night. The very next day she had rubbed open the whole suture area and was bleeding and oozing from her wounds. A trip to the emergency room later, they cleaned her up and put her back on antibiotics. The doctor also suggested Benadryl to help with the itchy skin near the suture site. The shaved hair was growing back and her skin was really dry. I gave her the Benadryl that night and immediately had zombie-dog. She was awake and resting but not moving. We also decided upon her wearing the e-collar all the time for at least a week. Again, Maddie alternated moments of activity with hours of deep sleep. She began having obvious muscle spasms in her right leg. They would stop as soon as I put my hand on her leg. This of course was causing her distress and she would only rest if she was near me. There were a few days of her pacing again if I left the room.

 

At 4 weeks, Maddie was walking almost normally. She did however seem to develop some ear difficulties as long as she was wearing the e-collar. I wiped out her ears every day. The suture line healed and we could finally remove the e-collar. Her ears got better within a few days. Maddie was still restricted to one room and only going outside on leash to go to the bathroom. Maddie however felt as if she should be able to return to all of her normal activities. It was getting hard to keep her quiet and confined. But, we didn't want to take any chances with her healing.

We felt that this was the time to move on to the surgery on her left knee. We found out in the middle of week five that the surgeon that we had been counting on would not be able to return to the veterinary practice to perform the second surgery. We had to find a new doctor! We felt that we really were pushed by our timeline to have the worst part of the procedures done while I was home on summer vacation. Maddie was really hurting on her left because she had been favoring her right. And now we were starting over. I got recommendations from a couple of different veterinarians. I was lucky to talk to our original veterinarian about the credentials (and personalities) of a few doctors in the area that were qualified to do the surgery.

In week 6, we had an appointment with a new surgeon. He looked over the right leg and agreed that she was making very good progress. He looked at the left leg and agreed that she was really bad off on that leg and needed surgery as soon as possible and lucky for Maddie, he had an opening that afternoon. Maddie had also developed a rash on her right leg and stomach. (We never did figure out where it came from).

Maddie's Left Leg

The fourth week of July Maddie had TPLO surgery on her left knee. Again, she spent one night in the hospital. I picked her up the next afternoon. This surgeon did not use any bandaging and we noticed that this incision was a lot shorter and all stitches were internal dissolving stitches. Maddie came out of the back room at the vet's walking on all four legs. Within ten minutes, Maddie was holding her left leg up and doing a three legged hop to get around. I think that the bandaging on the other leg had prevented her from doing this hop after the first surgery. The doctor seemed to think that this was normal so we didn't make a big deal of it. Without bandaging, we also got to see the extent of the swelling. Her whole leg was swollen with the majority of the swelling residing at the ankle and for the first week and a half she continued to hold the leg up as she walked. Maddie had been switched to Baytril as an antibiotic and Torbutrol for pain. This doctor decided to keep her off the Deramaxx for a while so that Maddie would have better knowledge of her limits. He felt that the Deramaxx masked the pain and would make her feel like she could do too much too soon. She took the Torbutrol the first three days and slept a lot.

Week 7 (Right) Week 1 (Left)

The swelling went down except at the suture sight. She walked on all four feet when on the carpet or the grass. However, she held her left leg bowed in as she walked. She seemed to be better about resting and keeping herself inactive. We went through a few nylabones and tennis balls but she spent most of the first week after the second surgery sleeping.

 
 
Photo pages - click below for more images.

 

Week 1:
Day 2 after surgery - the first day home
Day 4 after surgery - Some bruising has developed above the bandage
Day 6 after surgery - the bruising has gotten larger but does not appear to be as dark red

Week 2:
Days 7-14 - relaxing at home

Week 3:
Day 15 - the bandages come off

Week 4:
Week 4 - the lampshade goes on

Week 6:
Week 6 - Day 2 after second surgery