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TTO Surgery with Laser – Rave

Rave had the Triple Tibial Osteotomy (TTO) surgery with Stage 9 laser option. The TTO with lazer is a less invasive procedure, and there will be less scar tissue as a result. Rave was an excellent candidate for this type of procedure as she had no cartilage damage.

Rave gets her staples out tomorrow morning. The TTO (with lazer) was done 2 weeks ago and she is doing well. She came home with barely any swelling. I periodically grip wrapped gel ice packs on over the first 2-3 days. By the 3rd or 4th day she was allowed to go for brief 5 minute walks in addition to potty breaks, with icing the leg afterward. By last Friday she was feeling so good she wanted to play. She tried, I stopped it. I am pleased with the proceedure, and am very pleased with her progress.

Triple Tibial Osteotomy SurgeryThe total cost of Raven’s TTA includes level IX laser surgery, all radiography, and pain patches (2 fentanyl), and post op antibiotics was $3,800.

There was no notable swelling upon discharge. Her gait and stance were near normal. I was to check her incision daily. She could be on lead active and was crated only at night, so she wouldn’t be tempted to jump on my bed. We were allowed 5-10 minute walks after the first 3 days. No running, swimming, jumping, or strenuous activity for 2 weeks after the surgery.

Later this month, Rave begin physical therapy following the TTO. I am hopeful of her regaining some of the beautiful musculature she has been blessed with.

Post TTO X Rays (click to view larger image)

Post Surgery TTO XrayDog TTO Xray

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21 Responses to TTO Surgery with Laser – Rave

  1. Jana Rade July 8, 2011 at 8:38 pm #

    This is the first time I hearing a TTO testimony! When I first learned about this surgery I felt it was a great hybrid between the TPLO and TTA. If I had to choose, that’s the one I pick.

    I’m very happy Rave is recovering so amazingly well and fast.

  2. Lucy July 10, 2011 at 5:23 am #

    There are 3 cuts in to the tibia the one you can see best(x-ray)is the V which is braced open and awaiting bone growth to fill in. The other two cuts are like a backwards L on the inside (2nd view is from the back of the leg). It provides better stabilization.

    At three weeks was doing 2-3, 15-30 minute walks a day. At the vet’s recommendation we also began a standing up or rearing up on her hind legs. Now at 3.5 weeks, she is getting the “bounce” back in her step and we can do figure 8′s. She wanted to trot today and yesterday. I am yet reluctant to let her go that far.

    We start physio at http://www.AnimalPTCenter on the 19th. I am looking forward to it. They have pools and underwater treadmills (resistance). I have every confidence she can be at or near 100% 6 at months. Rave loves being an athlete. I want to give that back to her, if I can.

    Does she still limp? Yes, primarily after she’s been lying down. During ther walks the limp is bearly perceptable. When she is tired, she does a bit of the toe touching stance. No surprise. We’re certainly not there yet, but I am so pleased.

    Hopefully never, but yes this is the surgery I would choose… again.

    • Jana Rade July 10, 2011 at 11:00 am #

      Yes, I am familiar with the procedure, just haven’t heard a real life story of a dog that had it done :-) I’m very happy he’s doing so well!

      Physical therapy is great, and also very important, in fact, it can make or break the success of any surgery.

      Yes, I’m not surprised there is still some limp, particularly after rest. There is a lot to heal in there.

      We are happy with the results of the extracapsular repair we chose, but the recovery certainly wasn’t this fast :-)

  3. Lucy July 12, 2011 at 2:52 am #

    Rave is the only dog I know personally to have the TTO. I expect there will be others at the Performance Therapy Center.

  4. Lucy July 19, 2011 at 6:59 pm #

    Today was Rave’s first physical therapy day. We had a brand new x-ray to take with us. Well, let me backtrack a bit. Over the weekend she was 3 legging it. I took her in to her vet Monday. All is well. We just over did things. Her x-ray shows excellent bone regrowth in the “V”.

    The PT recommendations include a 2x/day “therapy walk” of 5 minutes, massage therapy, medication: Tramidol 2x/daily, and light weight shifting to the rt, when eating or looking out a window.

    We go back in 2 weeks. We discussed the underwater treadmill, and eventually swimming in addition to a number of other possibilities and options.

  5. Jana Rade July 19, 2011 at 8:31 pm #

    It’s easy to overdo, glad that’s all that was. Hydrotherapy is great, if you have the option.

  6. Lucy July 20, 2011 at 4:55 am #

    Planning on it. She had her in the chamber so she could investigate. Then took her out for the tank to fill. She was totally inconcerned with the noises and watched the water rise, thru the glass.

    Rave found teh life vests by the pool fairly interesting. But we’re getting ahead of ourselves. We have a way to go just yet.

    Jana, without looking back and my memory is awful these days, you did physio with your dog, I believe? Were you able to use hydrotherapy? It seems like it would be such an enormous boost to rebuilding (or even conditioning for conformation) muscle and function.

  7. Jana Rade July 20, 2011 at 11:10 am #

    Yes, hydrotherapy is a great boost to both muscle mass and range of motion. It gives a lot of exercise without taxing the joint. It’s so great that we still go in on maintenance basis (as with Jasmine every time we stopped she managed to pull a muscle)

    The combination of warmth, buoyancy and resistance does great things for the muscles and for the joint.

  8. Lucy August 3, 2011 at 2:51 am #

    Rave had PT yesterday. She is doing very well. Her thigh circumference and knee mobility are improving. We have a list of about 10 interesting activities, choose 2/day: I think *tug will be her favorite! The idea is to have her walk backward about 5′(3-4x), if that is one of our choices for the day. The agility ladder has been resurected for her to walk over, placed flat on the ground. She can walk over low poles braced up on dented soda cans. The pause table can be low, low on the ground. We can do wide figure 8′s, tho I imagine the right will be harder for her. There is a sit to stand exercise (hips squarely under). The 2 she will like least are the square stance weight shift and me lifting the left leg for a few seconds. She can venture out onto new surfaces besides firm ground: sand, ineven ground, small inclines of 50′, wading in water. The walks(2-3)can extend in length and massages remain daily, of course.

    She had a laser treatment and did the underwater treadmill. She REALLY likes that! ;) We’ll be doing it weekly for 10 weeks.

    I think, this is where pain management is so important. The more pain free, the more correct the walk. The less significant the limp, the more of the “right” muscles are put into play.

  9. Jana Rade August 3, 2011 at 5:30 am #

    great stuff. yes, that’s where pain management is important, for proper use of the limb

  10. Lucy August 10, 2011 at 6:30 am #

    Rave had her weekly PT session. She kept trying to drown the “man” floaty toy! She put her full face underwater to hold him under. What a hoot! Then she’d try to paw him under on her “break” when the treadmill stops.

    Things are much more interesting for her, now that she is 8 weeks post op. We have an ever expanding list of extra things to do. Her favorite is “tug” with the idea of walking/pulling backwards for 5′ (5-7x). She loves wading in the river or at the lake, and she loves walking in the sand and the stony creek bed… uphill. We are having a ball!

  11. Andrew August 15, 2011 at 7:18 am #

    Lucy,

    I am interested to know where you live. I’ve been researching this new procedure and it seems like there are few vets currently offering this choice in the United States. My dog recently had a TTA, so I’ve developed an interest in the trends with this stuff.

    Hope Rave has a successful recovery!

  12. Lucy August 23, 2011 at 1:21 pm #

    Hi Andrew! I live in Binghanton, NY. The vet office is just up the road in Chenango Bridge. It’s a 10 minute drive to Chenango Animal Hospital. Dr S. has been doing the TTO’s fow 3-4 years now with notable success.

    I am also about an hout from Ithaca, and Cornell University and Colonial Veterinary. They have the specialized equipment needed for the TPLO’s had that been my choice.

    I opted for the less invasive TTO, as it statistically seems to have an equal long term outcome. My agility vet friends agree it is the proceedure they would have done for their own dogs should the unfortunate need arise.

    Let me know what your research turns up. I know I am extremely fortunate to have both a vet who’s experienced and talented with this procedure. AND… I have an excellent PT center not too far away! Bless you both Lin and Mark!

  13. Lucy September 15, 2011 at 5:24 am #

    Well, here we are at 12 weeks! Raven is looking very muscular and fit. Of course, *I* can still see a difference, but to the general public? The right looks like the left. There is still more than 1″ difference.
    However… she is up to 30 minutes on the underwater treadmill once a week. And she is now cleared for trotting on lead a bit. WOOHOO! At home, I am still doing the daily deep tissue massage. I feel like I am running a rehab facility. She can walk probably 1.5 miles in a day with some intermittent trotting allowed. We go wading and she uses ALL surfaces such as sand, and moderate inclines.
    I am so happy. She is coming along so well. I can’t say enough in favor of
    building those muscles back. Imagine how much that alone deminishes the chance of injuring the other side! And… I want my dog(s) to be able to rejoin the agility world to whatever degree then are capable of, even if it is only classes and demos. Raven thinks agility is great fun. Eventually, I want her to have that back in her life, probably more for her than for me. I don’t actually care if she ever competes. I don’t need the titles. However it is something not only she enjoys, but I enjoy doing with her.

  14. Jana Rade September 15, 2011 at 10:26 am #

    So glad to hear! Great news for Raven! 1″ isn’t really that much of a difference! Yay Raven.

  15. Lucy October 15, 2011 at 2:12 am #

    Well here we are at 18 weeks post op.  PT wise:  We have done 10 weekly sessions of the underwater treadmill and are now at a crossroads.  She could swim.  She could do another series in the treadmill and share the last few with Stetson so they end at the same time… then begin swimming.  Or, I can work a prescribed program at home.

    Her surgical musculature is very, very close to that of the other leg.  So we have the freedom to pick and choose, now.  For now, I am keeping the Tuesday appointment, and we’ll discuss the options before I decide which best suits.

    Decisions, decisions… ;)

  16. Jana Rade October 15, 2011 at 11:59 am #

    Not a bad crossroad to be at :-) The only downside of the underwater treadmill is the cost and time invested. No downside for the dog, only upside. I’d say, if you can afford it, keep at it. The treadmill certainly offers benefits that cannot be duplicated.

  17. Lucy October 31, 2011 at 7:53 am #

    Raven is signed up for an additional 4 treadmill sessions. She love. love, loves being off lead up at the lake. She has a good recal, and tends to stay within a couple hundred yards.

    The lake was very, v-e-r-y COLD today!! Some snow remains on the ground. What wasn’t covered with snow was icy and frosted. Brrrrr!! Of course Raven would stay there all day with me if I let her. She’ll be 20 weeks post op, Tuesday.

    When Stetson (11 weeks) gets really good on his long line at Otsiningo Park (by the river), I may take them to Cole Park (the lake) together. The earlier I go the more deserted it is. But… he needs that improved long line manageability! He’s a work in progress.

  18. Lucy December 15, 2011 at 4:31 am #

    WOOHOO!! Raven is considered recovered based on thigh measurements: She is fully equal ar the top and lacks a scant 1/4″ in the middle, but that will fill in. I am so excited! Finally, she can run. All those trips to the lake, off lead, and controlled…. finally paid off. And, as predicted, “safely” took 6 months.

    Lin, our PT has designed a 12 step program for dogs re-entering agility. Any soreness or difficulty, we are to go back to the previous weeks tasks. We have a very important and specific *warm up and *cool down routine to follow.

    Week 1: for example allows her to do 4 straight jumps at 4″, four repitions (2x wk). Week 2: 5 jumps, 5 reps. Week 3, 6 jumps, 6 reps, and increase the height to 8″. Later a pause table is added, then a straight tunnel,

    By week 5 we can add a teeter at a low setting, and do 8 jumps in a row. We can do straight “courses” at 3-4 courses per session, 4 times a week. By week 6 we can curve the tunnel and increase the jumps to 12″ with wide turns after 2 jumps. Week 7 add the dog walk, increase to 10 jumps with wide turns after 4, the rest… straight.

    Week 9 increase jumps to 16″, doing 12 jumps, turns after all jumps. Week 10 A-frame at low height, raise to competition level at week 11. Week 11 jumps at 20″, 3 dyas later run a full course. Week 12, ready to compete!

    This is paraphrased and adjusted for Raven, which I certainly appreciate! Thank you Lin! We look forward to being back!

  19. Lucy May 11, 2012 at 2:36 am #

    Update:  We finished Lin’s “12 step” reintegration to agility some time ago.  We have been busy moving forward.  Raven is doing VERY well.  Her thigh measurements are 100% equal, and she has her muscular rump bach.  You don’t know how pretty that is until you’ve seen it lopsided for 6 months.  It is such a pleasure to be doing agility once again with her!  Nice to have my dog back!!
    To those of you considering TTO, I cannot recommend it highly enough.  I have had 2 (Rave and Stetson) who underwent this surgery after being out in my fenced and muddy yard (2011 flood) yard for potty and came in with torn curtiates.  Both are now recovered.  PT is available in our area and we did it! 

  20. Lucy March 28, 2014 at 3:01 am #

    UPDATE:

    Well :) Rave’s original TTO has been 3+ years now! This was a most successful surgery and I am thrilled!! I’ve had two dogs (flood of 2011 injuries) with this procedure. Both have excellent results and time bears this out. They are highly athletic dogs. Both do and have done agility, tho at 9.5 Rave is semi retired doing agility demos.

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