Wednesday, December 26, 2012

A Mastiffs Journey through Cranial Cruciate Ligament Surgery

In the Beginning...

Well in less than 24 hours Brinkley will get dropped off for her TPLO surgery.  I have deliberated back and forth, back and forth on whether to do the TPLO surgery or the Tightrope surgery on her and I have decided that I think the TPLO will yield the best results for the long term for her.  This was not an easy decision for me, so I hope by documenting her surgery and recovery I can maybe help someone else out down the road to make their decision a little easier. 
Flashback to where this all started…. Brinkley is a 175lb female English Mastiff who just turned 2 years old in October.  She is very high energy for a Mastiff and that is one of the reason’s I think her ligament tore. She first tweaked her knee a few months ago.  Nothing severe, just a little limp for one or two steps when she first got up after she played too hard or ran or walked too far.  In an effort to help her heal up we put her on house arrest and restricted any roughhousing indefinitely.  It seemed to be going well and the last month or so she seemed to be doing fine…. Then her knee went out completely on December 12th.  We got home from work, both dogs went out in the backyard and 3 minutes later I heard a yelp. I ran outside to see what was wrong and she was not using it at all and was barely even toe tapping it.  She was in obvious distress, so we brought her in and crated her so she couldn’t move it to much and I gave her a Deramaxx I had left over from Boone’s neuter.  The next morning I was off to the emergency unit at the University of Missouri to confirm my suspicions, a torn Cranial Cruciate Ligament.  They gave me Tramadol and Rimadyl to get her through until she could have surgery, but the earliest open appointment they had was January 23rd.  Although they are one of the top orthopedic surgery vet groups in the Midwest, I was worried that in compensating for the injured leg she would blow the other knee out if we waited 2 months, so I called around and was able to get an appointment at Midwest Veterinary Referral Center in St. Louis a specialist group that only focuses on surgery, oncology and other specialized canine treatments.  They got her in the three days later and we scheduled a surgery appointment for December 27th…. tomorrow.
Now, back to the present…. Brinkley gets dropped off in the morning.  Since the tear I have dropped around 10lbs off of her (she is as skinny as I ever would want her to get now) in an effort to take some stress off the leg during recovery.  She was prescribed 150mg of Rimadyl 2 x per day and 150mg of Tramadol 3 x per day. For the first week and a half I gave it to her, but have since weaned her off as she really doesn’t seem to need it.  I have had her on Glucosamine/Chondroitin as well as Fish Oil supplements since she was a puppy also, something the vet was pleased to hear and said she should be on for the rest of her life to lubricate the joint. She limps much less now that when she initially tore it, making me wonder if it is only a partial tear.  Only the pre-op x-ray will tell though.
I weighed the pro’s and con’s of the surgery options and I’ll share with you how I decided on the surgery I did. There are four surgical options for dogs with CCL injuries; traditional Extracapsular Ligament Surgery (sometimes referred to as the fishing line surgery), Tibial Tuberosity Advancement (TTA) surgery, Tibial Plateau Leveling Osteomy (TPLO) and the Tightrope surgery. With a dog like Brinkley the only real options for surgery are the TPLO or the Tightrope.  The Extracapsular and the TTA surgery were out of the question.  That left me to choose between the TPLO and the Tightrope surgery. Below are the things I considered while trying to come to my decision.
TPLO Pro’s – (1) longest term option, once it’s done it never has to be done again, (2) veterinarian doing the surgery uses a new type of TPLO plate that screws into the bone, making less room for ‘wiggle’ while the bone heals (3) metal plate can be removed once the leg is 100% healed (http://www.tploanswers.com/Pages/default.aspx)
TPLO Con’s – (1) some people think the metal plate used to hold the bone together while it heals can cause cancer later in the dogs life, (2) the bone itself is cut and repositioned, making it a more intensive surgery and (3) a more intensive recovery time (4) if the surgery fails there is nothing else that can really be done.
Tightrope Pro’s – (1) no bone cutting, less intensive surgery resulting in (2) a less intensive recovery time and (3) if the surgery fails you can always go back and do the TPLO surgery at a later time.
Tightrope Con’s – (1) tape they use to ‘replace’ the ligament can give out overtime and the surgery will need to be repeated possibly resulting in (2) arthritis in the meantime, (3) the tape they use is also a wonderful place for bacteria to harbor and grow once the surgery is done, sometime making it necessary to remove the tape yielding the surgery as a failure, (4) the holes that are drilled through the bone that the tape runs through can wallow out over time making the surgery less effective and arthritis to proliferate faster.
As I said above, I decided on the TPLO surgery after reading MANY hours worth of personal stories about both procedures (success and failures) and by considering the recommendations and personal experiences of many other Mastiff owners who have gone through similar circumstances. I will have to say that I do LOVE the vet that I have chosen to do the surgery.  Orthopedic surgeries are her specialty and she not only attended the University and interned under Dr. Jimmy Cook (the inventor of the Tightrope surgery), she is also accredited by the American College of Veterinary Surgeons. I hope we made the right choice. 

Here is a video of Brinkley Pre-TPLO.  You can see why she most likely isn't a good candidate for the Tightrope surgery.  Even injured she still is as rambunctious as ever.

video
 
Read about the rest of Brinkley's journey here:
Makin'Mischief Mastiff Collar... Plus Brinkley Day 11 TPLO Update
PassiveRange of Motion Exercises in Post TPLO Mastiff

7 comments:

  1. Best to you and your pup. Thanks for all the details.

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  2. Wow...Thank you so much for posting this. My boy (20 month old Mastiff) started with a slight limp and toe touching a couple of weeks ago and since it has not any better after being on serious "house arrest" my fear is that he may be needing the same. We have a vet appointment scheduled so I will know soon. I'm so glad your girl is doing well, she is beautiful :) Thank you again. Your research was very, very helpful!

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    1. I'm so glad it helped Carol! It was so hard to find any information on Mastiffs and CCL surgeries, so my goal in doing this was to help others incase they were looking for the same info. I can tell you I have since found out from a very knowledgeable group (the orthodog group on Yahoo) that no one on there that has done the tightrope surgery is happy with it. It always ends up causing additional issues and fails more often than not. Please keep me updated with your pups diagnosis and progress.

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    2. I had never heard of the tightrope, but after reading your post about it I knew that would not be my choice. Also, I had not even thought of weight loss in all of this! My boy is not fat, but having him loose a few pounds to help him out in all of this is a great idea. I'll give you a follow up when I find out....fingers crossed! I am petrified when these big guys have to go under anesthesia.

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  3. I have a 3 yo female mastiff weighing in at 161 lbs w/poss cruciate ligament tear. Xray shows inflammation and dr believes possible tear but not sure how much of a tear. I hate to go through surgery w/o any definites but her symptoms leave dr to believe it's this. I'm reading up on any info I can find and found vet should be board certified ACVS. There are none in our area. We live in central PA. The vet/surgeon we met said she would def do the TTA which you totally don't agree with and I would like to know why? Please respond to this blog. Thanks.

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    1. Because the TPLO surgery has been around for so long it's a tried and true method. If you find a board certified surgeon who does these on a regular basis you are only strengthenig the chances everything goes smoothly. I had Brinkley diagnosed at the University of Missouri (world renowned for thier orthopedic sugery unit) and the surgery itself done at a orthopedic referral veterinarian. Both told me straight up that if it were their dog TPLO would be the way they would go. I also ran the decision by numerous peers in the Mastiff world and TPLO was the unanimous suggestion. I really have nothing against the TTA surgery, however it's a new enough surgery I don't want to risk it. If the surgeon you chose is more comfortable with that surgery then I wouldn't force them to do the TPLO if they don't do it very often, that's asking for problems. Let me check on some resources for you, I know several people in eastern OH that have had orthopedic surgeries done on their Mastiffs, I'll see if I can get some vet names for you to check out. If you chose to proceed with the vet you are currently using I would ask if she has ever (and how often) performed the TTA on a giant breed (not a lab or german shephard, a true giant breed). If she has never done one or only 1 or 2 I would find a vet with more experience just to be safe.

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  4. Hi there I have a 220lbs male mastiff Zeus. He is on his 2nd week of recovery from the TPLO surgery. I am noticing that he had a build up on the top of his knee when he stands up, not sure if it is fluids or this is normal? any thoughts

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