How much will a TPLO surgery for my dog cost?  How much should I expect to spend on a TPLO repair?

TPLO, also known as Tibial Plateau Leveling Osteotomy, is a CCL repair technique through which the veterinary surgeon alters the head of the tibia and plates it to create a new joint angle.  Simply put – your veterinarian will re-invent your dog’s injured knee joint to provide increased stability through changing the way the top and bottom of the leg meet at the knee joint.  This is the most invasive, and requires the most surgical skill, of all the surgical cranial cruciate ligament repair options; it is also the most expensive.  In this article we will break down an actual TPLO cost estimate and explore the cost of choosing this type of CCL repair surgery for your dog.

Below is the estimate I received for my dog to undergo TPLO surgery. 

A few things to note before going into the details of the invoice:

1)  My dog in an American Bulldog weighing roughly 90 pounds (normal weight), and is 5 years old.

2)  He is in good health with no pre-existing conditions that would complicate anesthesia or surgery.

3)  This estimate, although some of the information has been blacked out to protect privacy, is from a speciality veterinary clinic with veterinary surgeons who specialize in cranial cruciate ligament repair surgeries in dogs.

4)  I live in Southern California, and this estimate is from a veterinary office in that area.

Here is the estimate I received for a TPLO CCL repair.  The low end of the estimate was $3,892.79 and the high end of the estimate was $4,03.58 for TPLO surgery.

I will go line by line to go over the charges included in the cost of TPLO surgery.  For smaller animals some of the values will be less, and accordingly for larger dogs.  Hopefully this invoice will give you a basic picture of what you can expect to pay for a TPLO, and where all of the money goes.

EST TPLO Surgery Med/Large – $0 – Just tells us what type of estimate we are looking at.

CBC and Chemistry Profile – $163.80 – Basic blood panel the veterinarian will want to run prior to surgery to determine if you dog is fit to be put under anesthesia and to rule out any other complications.  One way we could have saved money here was to have our dog’s regular vet perform this blood panel at a lower price than to have it done at the speciality clinic.

Radiograph, 2 Views – $224.70 – This is the x-rays that need to be performed prior to the TPLO so the surgeon is able to properly manipulate the tibia during surgery to create the desired angles.  These will need to be performed somewhere prior to TPLO, and some veterinarians will want to do the xrays themselves.

Radiology Interpretation – $45.68 – Fee charged for processing and reading the x-ray.

Catheterization, Intravenous – $94.00 – This fee is for the placement and maintainence of an IV catheter while your dog is undergoing and recovering from TPLO surgery.  Your dog will be given IV fluids and possibly medications through this catheter during the duration of surgery and post operative hospitalization.

Epidural Injection – $86.52 – Local anesthetic (pain relieving medication) will be injected into the lumbosacral (in the spine) space of your dog prior to surgery.  Depending on what types of medication(s) your veterinarian uses this can help to alleviate pain after surgery, and desensitize the effected site during surgery.

Surgery Room Use – $113.82 – Fee for using the Operating Room space to perform the TPLO.

TPLO Inhalant Anesthesia – $306.34 – Cost of putting your dog under gas anesthesia for the time required to perform the TPLO procedure.  This is used in conjunction with the epidural anesthesia.

Surgical Anesthesia Level 1 – $294.00 – Fee for dog to be put under anesthesia and monitored during TPLO surgery.

Surgical Supplies, Orthopedic – $358.05 – Cost for instruments to be used during surgery; this does not include the cost of the actual TPLO implant.

TPLO Surgical Implants, Med/Large – $358.05 – Cost of TPLO implant plates to be placed on the bone during surgery.

TPLO Surgeons Fee – $974.40 – Price veterinary surgeon charges to perform TPLO operation.

Radiograph, Post Op – $192.52 – Cost of x-ray to be taken following surgery to check placement of implant and knee joint angles.

Elective Ortho Hospitalization, General – $138.92 – Cost of overnight hospital stay following TPLO repair surgery.

Fluids – IV, Inital 24 Hours – $0-$190.31 – This would depend on whether or not your dog was being cared for at the hospital post operatively, and how much fluids your pet required.

Misc. Medications, Orthopedic - $450 – This includes prescription medications given to your pet post operatively and those sent home with you during the post operative period.  They would include a sedative (Acepromazine), pain relief (Tramadol), anti inflammatory (Rimadyl), and an antibiotic(Cephalexin), and possibly other medications at your veterinarian’s discretion.

Fentanyl, 75 mcg patch – $65 – Pain relief patch that will be placed in your pet to control post operative discomfort.

Buster Collar, Clear – $25.26 – Collar to be placed on your dog during the post operative period to prevent them from ripping out their stitches or injuring the surgical site.

Included:  X-ray at 8 weeks to check the post operative recovery and  misc. sedative (not sure if this is sedative used during the surgery itself or the sedative medication to take home with you following TPLO surgery).

Also included are all of the post operative recheck visits, but be aware that if you pet develops any complications related to the surgery you will be required to pay for any additional expenses incurred.

What is the Actual Cost of TPLO Surgery? is a post from: Dog Knee Injury

In the house, we are still struggling a bit to accommodate his needs. Someone still sleeps downstairs in the living room with him because I just know he would try and get on the bed if we let him upstairs. We have taken the ugly Rubbermaid totes off the couch and let him climb up there if he wants to (as the vet said we could), which does make him pretty happy. Still leash walking in the yard, which is no fun for any of us.

Beau at Three and Four Weeks Post Op CCL Repair is a post from: Dog Knee Injury

This week we have seen a big improvement in Beau’s ease in getting around. In fact, he thinks he’s superdog! He clearly isn’t feeling much pain, so we have eased off on the Tramadol, but continue to give him the Metacam and the Acepromozine for sedation. The most difficult part of the week is getting him to just lay around. We’ve invented some little games to keep him busy but still – such as a toy we have that has stuffed, squeaky squirrels hidden in a stuffed tree and he has to work to get them all out. To up that game a bit, we hide a small cookie at the bottom. When he’s really full of himself, a small rawhide chewie settles him down a bit – but they sure don’t last very long. He’s never done well with the big rawhide bones – loves them, but his gums start too bleed. We have some very thick sweet potato chewies that do last longer, but they are expensive.

At the end of the week, Beau had a check up and got his sutures removed. His leg is getting a bit of hair back and the twelve inch incision looks very good. We were very lucky that Beau did not mess with his incision. I was ready with a pair of old boxers and a T shirt, to cover and distract, but they turned out to be unnecessary. The vet was pleased with his progress and indicating we were now entering the physical rehabilitation period. The idea is to build his muscle back up without over stressing the knee joints/ligaments. Her recommendations for the next month:

1. Swim Therapy. The vet hospital has a separate facility with hydrotherapy pool and trainer and is always pushing this. We did this a few years a go when we were first told Beau had hip dysplasia but it’s just too expensive to do it on a regular basis. I’m sure it’s wonderful, but we just couldn’t do that his entire life. However, a limited post op period is doable. We told the vet we could either do it one time a week for a longer period of weeks or two times a week for a shorter period of weeks. She preferred the longer period of weeks, so we’ll be taking him one a week for ten weeks. We do have our own pool that Beau swims in (it’s in ground, so it’s easy for him to get in and out) but we live in Ohio, so this isn’t an option until summer!

2. Stairs. Beau is now to be encouraged to do stairs either once a day for ten minutes or twice a day for five minutes. This is somewhat of a relief to me, since I’m worried that he’ll try this anyway. We’ll still have to keep the stairs blocked off most of the time, however, because the vet doesn’t want him just following us up and down the stairs all day long.

3. Walking on inclines. We are to take him on walks of initially five minutes, increasing an additional five minutes each week to an area with small inclines and zig-zag walk him up and down the inclines. This could have been challenging – Ohio is pretty flat! – but we live a street away from a golf course. We can drive there, get on the path, and walk him up and down the hills. The vet suggested these walks 3 times a week for now.

Beau’s Story – Two Weeks Post Op CCL Repair is a post from: Dog Knee Injury

Overall, this has been a good week and not as terrible as I imagined. By the third day, he no longer dragged his toes and was actually putting some pressure on the leg. We applied a cold compress to ice his knee area four and five times a day, but are not doing any passive range of motion exercises yet. He is able to lay himself down much more easily. His incision is healing nicely, he is leaving it alone so far.

However, we did have one mild setback. On the fourth day post op, I noticed his ankle was slightly swollen and bruised. By the end of the day, it was very swollen. We were worried he’d somehow managed to sprain it, but a check in with the vet indicated that he had edema, a fluid build up just like a pregnant woman in her ninth month! The treatment for this was massaging around the fluid areas and cold compresses on the area. The edema was resolved in just a couple of days. Throughout the week, we continued to sedate him with the Acepromozine and relieve pain with Metacam and Tramadol. Due to the edema, we also added an antibiotic since the fluid would be a breading ground for infection. These medicines, combined with the thyroid medicine he has been taking for some time, take some work to keep straight. I hate giving him so many drugs and can’t wait to be done with that part.

We are also learning that Beau is not going to be a good patient when it comes to following doctor’s orders. He desperately wants on the couch and succeeded one time when someone forgot to put back the big blockades we have rigged. Although he “never” goes upstairs unless we do, he tried when we weren’t looking…. so now that is blocked off too. He made it up the first three steps before my husband caught him and scooped all 79 lbs of him off the step. When the Acepromozine wears off, he’s ready to be in full blast mode. What are we going to do when he starts feeling better?

Beau’s CCL Repair – One Week Post Op is a post from: Dog Knee Injury

My husband and I modified our work schedules somewhat so that someone could be home with Beau at all times for the first week. Today was my turn. In the morning, I took the bandage off as instructed and was very happy to find that the vet technician had done a great job in ensuring that the gauze underneath would not stick. It was an easy removal and his incision was not bleeding or oozing. I was surprised at just how long the incision was though! Must be twelve inches long! At that point, Beau had I called the vet’s office to give them a report, as requested, and the rest of the day went well. Beau was alert, but wasn’t interested in trying to walk around much. A few trips outside and then he was lying down again. I had a harder time keeping myself in one place so that he wouldn’t want to follow me! At least I had a good book to read.

Beau – One Day Post CCL Repair Surgery is a post from: Dog Knee Injury

I dropped Beau off at the vet’s at 7:30 am and went on to work, warning all my co-workers to expect a basket case in the office that day. By 8:30, I had a call from the vet’s office. I started panicking, but it turned out that they just had a question about when he’d received his last dose of Metacam. The technician told me he was fine – so fine that he wouldn’t go to sleep with the pre-anesthesia like a good boy should! We decided he was looking for cheese – that’s what he usually gets when he goes to the vet.

The morning passed slowly, but by 12:30 I had a call that the surgery had gone well, Beau was in recovery, just waking up, and we arranged to pick him up at 4:30 that day. Leaving him overnight was an option, but because the office was not staffed at night, we felt that it was best to just take him home. The vet agreed and encouraged us to do so.

Upon arriving at the vet’s office, we had some much welcomed good news! The meniscus had not been damaged. And the CCL had only partially torn. He had still needed the surgery to repair the tear, but this could only be good news for his recovery and long term prognosis. Our wallet fared slightly better than the estimates as well. The total cost of the surgery and take home medicines was approximately $1,500. (This does not include the initial x-rays and exam.) Of course, seeing Beau again was the best part! He hobbled and he was a bit groggy, but he was glad to see us! He’d been shaved more than I had anticipated and he wore a purple polka dot bandage, but he was managing to “walk” which I hadn’t expected. His “walk” has his bad leg either slightly lifted or with an awkward (and rather eerie) toe dragging gait. We lifted him into the car and took him home. Once home, I did have the foresight to make sure he stopped on the grass to relieve himself so that he wouldn’t need to go outside again for awhile.

The evening was fairly uneventful. Beau had trouble getting in the lying down position, but he managed after a time – perhaps as much as 15 minutes. We gave him a little food, administered his pain medication on schedule and tried to ensure that he was as comfortable as possible. One odd thing was that he didn’t really sleep, his eyes were open and just staring ahead. But since he otherwise seemed okay, we let him be. He became restless around 2:00 am, and we took him outside, re-dosed him and tried to settle him down. Once again, he had some trouble figuring out how to lie down and he was also disappointed that the couch access had been blocked, but eventually he opted for his own bed that we had brought down from upstairs. I believe he actually slept much better than we did that night.

Beau’s Day and Night of CCL Surgery is a post from: Dog Knee Injury

To prevent further injury, we needed to keep Beau quiet. No running, no jumping and lots of rest. We were given Metacam for pain and Acepromozin as a sedative. It just about killed me to see my happy, active dog so sleepy – even though I knew it was for his own good. And in between doses, he was all fired up! I learned quickly that keeping him quiet was going to be big challenge. He wasn’t limping much anymore, and I’m sure he’d forgotten all about it. As a dog who has probably had some minor pain with his hips for many years, I think Beau is tough and just pushes through.

Because Beau would be favoring the leg and losing muscle tone, our vet suggested that we perform a Passive Range of Motion (PROM) exercise by gently bicycling his leg. We performed the exercise three times a day, followed by a massage on the rear back muscles and cold compresses to the knee area. Beau didn’t mind the massage or the icing, but he was definitely not crazy about the PROM exercise! We learned to do this exercise when the sedative was at its peak.

The three week waiting period also gave us time to figure out how to prepare the house for the months of recovery. We bought remnant carpeting to cover hardwood floor areas and we borrowed a gate to block off certain other areas. Stairs would not be permitted for some time, so we prepared to sleep in the living room with Beau. (Our thirteen year old son quickly volunteered for this duty, but I’m insisting that he take this job only on non-school nights!) We live in Ohio, and that means the months of December, January and February will be filled with snow and ice. With mandated leash walking, I wonder which one of us will be in for knee surgery next?! Time to load up on pet safe ice melter. We had some good ideas and some ideas that weren’t workable, but the upside of delaying the surgery was having the time to think the options through and prepare. And I, the neat freak, also used the time to adjust to the fact that my house would not be in order again for several months!

Preparing Beau for CCL Repair Surgery is a post from: Dog Knee Injury

Our dog Beau is a seven year old Golden Retriever and master of the household! He’s friendly, fun, energetic and spoiled! Unfortunately, we learned early in his first year that he also has hip dysplasia. Until now, this has not stopped him from having an active, doggy life. However, in late November we noticed some on again, off again limping and after a few days of this, we took him to the vet to check it out.
After an exam and x-rays (done under sedation) the bad news turned out to be a ruptured cranial cruciate ligament. Our vet said that this is a common injury in dogs, particularly large breeds and particularly dogs with hip dysplasia who tend to alter their gait and put added stress on the knee ligaments. While humans tend to tear these ligaments in sporting activities (the football player who misses the season due to a torn ACL), dogs put much more stress on their knees (stifles) and are more prone to rupturing these ligaments over time, without a significant trauma. We were presented with the following options for Beau:

1. No surgery. Treat with rest, physical therapy, pain and anti-inflammatory medications. Our vet did not feel that the ligament in a dog this size would heal on its own, however, and indicated that the likely outcome would be abnormal wear and tear leading to arthritis which would continue to worsen over time, becoming chronic and debilitating.

2. TPLO surgery (Tibial Plateau Leveling Osteotomy). This is a surgical procedure in which the head of the tibia is surgically altered and plated to create a new joint angle. A new angle is created in the stifle to prevent the femur from sliding off of the tibia. This surgery would need to be performed by an orthopedic veterinary surgeon and would be very expensive. We were never actually given an estimate for this surgery, but my research puts the cost in the $3,000 – $4,000 range. Our vet indicated that this procedure is considered by some to be the gold standard in treatment. However, due to it high cost and invasiveness, she did not recommend it for a seven year old dog.

3. Traditional Repair surgery (Extracapsular Imbrication). This procedure uses a strong leader line placed within the knee to provide stabilization. As it was explained to us, the downside of this procedure is that the line will eventually break and it is impossible to say when. It could be that the line lasts five years, or it might only last two months. With a large dog like Beau, our vet didn’t feel this was our best option.

4. Modified Traditional Repair surgery. This is the same procedure as in number 3 above, except that the dog’s own muscle is used to provide the stabilization, which is much stronger. As the area heals, it heals around this graft of muscle and further increases the knee stabilization. The cost of this surgery, as well as the surgery in 3 above, depended in part on whether or not the meniscus was damaged. The meniscus is the pad between the bones of the joint – a shock absorber. Estimates for this surgery were from $1,700-$1,900. Our vet recommended this option, which would be performed in their offices by a different veterinarian with extensive experience in this procedure.

To be honest, we didn’t give option 1 too much consideration. Neither my husband nor I could bear the thought of our middle aged (but not old), active dog declining early in such a painful manner. On the other hand, TPLO surgery was simply too expensive for us to consider and our veterinarian seemed to think this surgery would be warranted for a young dog, but not a seven year old dog. Option 3 seemed too risky and also was not recommended by our vet for a dog of Beau’s size. Thus, we elected for the Modified Traditional Repair using the dog’s own muscle to stabilize the knee. I was unable to find much information on this modified type of repair on-line, but it may be that there is a particular name for it which I was not searching under. I did see information on the Tightrope repair surgery, but our veterinarian felt that this was not in favor currently. One very sober fact: the vet told us that 40% of dogs that rupture the CCL eventually rupture the CCL in the other leg. Whatever choice we made, we best be prepared to make it again.
Unfortunately, we learned the next day that the veterinarian who was to perform the surgery was out of town for several weeks. The surgery was scheduled for December 8^th and our job was to keep Beau quiet and calm until then!

Our Dog Beau and His CCL Injury is a post from: Dog Knee Injury

Prices for veterinary surgery vary greatly depending on where you are located no matter whether you choose TTA, TPLO, TR, or a lateral suture method.  The prices can also fluctuate due to the availability of a certain procedure, number of surgeons performing the surgery, and the size of your dog. A number of veterinary practices will include a number of weeks of post-op physical therapy, including hydrotherapy, as part of a package price for the surgery. It is important when comparing prices to understand what is included in the quoted price, so you are able to compare apples to apples.  Taking these factors into consideration can help to explain the wide variance in prices presently for the Tightrope (TR) CCL repair surgery.

We would expect TR costs to be substantially lower than TPLO or TTA, but slightly higher than a conventional Lateral Suture Surgery (extracapsular imbrication, traditional repair).  Reported Tight Rope costs have ranged from $700 to $2500, and seem to depend mostly on geographic location and type of facility where the surgery was performed.  At a private practice in North Dakota an owner paid $1108 for everything, which included exam, diagnostics, anesthesia, scope, surgery, FiberTape implant, post operative monitoring, bandages, and medications (TPLO was $1900 at the same practice). At one major US state university vet facility, the total bill for TR done by top ortho surgeons including was in the $2200-2500 range.

The materials used in TR are a lot less expensive than those used in TPLO/TTA, and the surgery itself is a lot less complex. A typical TPLO procedure takes about one hour, whereas TR is completed in about 20 minutes. Less time under anesthesia, less surgical time, a simpler procedure, and fewer materials should translate into a lower cost for dog owners. I expect in the future we will see the prices for Tightrope repair somewhere in the $1000 range as more veterinarians become trained and proficient in this technique.

Remember, when looking for a veterinary surgeon, a higher price does not necessarily mean a better surgeon or superior procedure.

Below is the invoice for an estimate I received when contemplating Tightrope repair for my dog.  The low end of the estimate was $3,551.16 and the high end of the estimate was $3,635.94 for Tight rope surgery.

A few things to note before going into the details of the invoice:

1)  My dog in an American Bulldog weighing roughly 90 pounds (normal weight), and is 5 years old.

2)  He is in good health with no pre-existing conditions that would complicate anesthesia or surgery.

3)  This estimate, although some of the information has been blacked out to protect privacy, is from a speciality veterinary clinic with veterinary surgeons who specialize in cranial cruciate ligament repair surgeries in dogs.

4)  I live in Southern California, and this estimate is from a veterinary office in that area.

I will go line by line to go over the charges included in the cost of Tightrope surgery.  For smaller animals some of the values will be less, and accordingly for larger dogs.  Hopefully this invoice will give you a basic picture of what you can expect to pay for a Tight rope repair, and where all of the money goes.

EST Tightrope Procedure – $0 – Placeholder to tell us what type of estimate we are looking at.

CBC and Chemistry Profile – $163.80 – Blood panel including complete blood count and general chemistry to make sure your dog is healthy enough to tolerate anesthesia and the TR procedure.

Radiograph, 2 Views – $224.70 – X-rays needed prior to surgery to both confirm diagnosis of torn CCL (rule out other possible causes of lameness), and to act as a guide for the veterinary surgeon during the procedure.

Radiology Interpretation – $45.68 – Cost to have a veterinary professional examine and read the x-rays.

Catheterization, Intravenous – $94.00 – An IV will be placed in your dog’s vein through which your pet will receive medication and fluids during and immediately following surgery.

Surgery Room Use – $113.82 – Fee associated with use of the operating room for the duration of time required to perform the Tightrope surgery (this value is significantly more for a TPLO).

Isoflurane Gas Anesthesia, Initial 15 Min – $117.88 – Cost for the anesthetic gas used to put your dog under anesthesia during the procedure.

Isoflurane Gas, Additional – $168.60 for 60 minutes and $252.90 for 90 minutes – Cost for additional quantities of anesthetic gas depending on how long the ccl repair takes.

Tightrope Standard – $470. 00 – Cost of Tightrope surgery related supplies, this is mostly the cost of the Fiber Tape.

Surgical Anesthesia, Level I – $294.00 – Cost associated with keeping your dog under anesthesia during surgery and providing medications/monitoring.

Surgical Supplies, Orthopedic – $268.54 – Fee for use of general surgical supplies used during Tightrope repair (scalpel, drapes, cautery tools, etc.), this does not include the cost of the actual Tightrope Fibertape material.

Surgeons Fee 2 – $960.75 – Price the surgeon charges to perform Tightrope repair surgery.

Elective Ortho Hospitalization, General – $138.92 – Fee to have your dog kept in the veterinary hospital overnight following the CCL surgery with monitoring.

Misc. Medications, Surgical – $400.00 – This includes prescription medications given to your pet post operatively and those sent home with you during the post operative period.  They would include a sedative (Acepromazine), pain relief (Tramadol), anti inflammatory (Rimadyl), and an antibiotic(Cephalexin), and possibly other medications at your veterinarian’s discretion.

Fentanyl 75 mcg patch – $65.00 – Pain relief patch that will be placed in your pet to control post operative discomfort.

Buster Collar 25 cm, Clear – $23.86 – Collar to be placed on your dog during the post operative period to prevent them from ripping out their stitches or injuring the surgical site.

Also included are all of the post operative recheck visits, but be aware that if you pet develops any complications related to the surgery you will be required to pay for any additional expenses incurred.

What Does TightRope Surgery Cost? is a post from: Dog Knee Injury

The newest surgical technique to repair torn cranial cruciate ligaments in dogs is the tightrope procedure.  Tightrope CCL is an extracapsular technique which uses lateral suture stabilization in conjunction with a virtually indestructible material called FiberTape for knee joint stabilization.  The Fiber Tape is placed in the dog’s knee through a few small incisions, mostly done arthroscopically, which create tunnels through the bone, and is considered to be one of the least invasive surgical approaches to canine cruciate injury repair. 

Unfortunately, not every dog is a good candidate for the tightrope procedure.  Below you will find some general criteria that excludes certain dogs from tightrope surgery.  Remember – This list is in no way conclusive or exhaustive, your veterinarian will take into consideration many factors including your dog’s age, weight, health history, onset of injury, and physical conformation when making a treatment recommendation for your pet.

Who is not a Candidate for Tightrope CCL Repair?

1)  Dogs weighing less than 30-40 pounds.

2)  Dogs (and people) that cannot follow a physical rehabilitation protocol after surgery.

3)  Canines with limb deformities of any kind.

4)  Dogs with a steep tibial plateau, usually an angle of more than 30 degrees.

Is My Dog a Candidate for Tightrope Surgery? is a post from: Dog Knee Injury