First off, you're welcome to ask me anything, anytime. I'm happy to help! Trust me when I say that you've done plenty to warrant the simple exchange of information. Aside from that, it's my pleasure to offer this kind of help. It's why I do what I do, and teaching is my favorite part of my job. :)
As far as cruciates go, the TPLO is the new-and-best being offered by the veterinary surgery folks. Tibial Plateau Leveling Osteotomy. There is a *ton* of physics involved, but the basic idea is that by changing the geometry of the knee joint, the abnormal motion allowed by the torn ligament is eliminated, which spares the cartilage in the joint and is a permanent fix to the destructive physical forces that result from a damaged cruciate ligament. That said, there is *NO* sure way to fix the inflammation and subsequent degradation of the cartilage in the joint once a ligament tear has started. We have many ways to slow and limit these inflammatory changes (special foods, non-steroidal anti-inflammatories), so most dogs do very very well for a long time. A great deal of the longterm success depends upon how quickly the problem is fixed -- the sooner the better.
The TPLO includes a bone being deliberately cut, moved slightly, and then fixed in place with a big custom metal bone plate that stays in place for good. Technically, it's a very cool surgery, and you have to take a special course to learn to do it. You definitely want a board-certified surgeon to do this, IMHO, which means (usually) a specialty referral. I'm sure some private-practice vets are certified to do this surgery, but that's not the same as being a board-certified veterinary surgeon. Go with what feels right and comfortable in that respect.
The alternative to the TPLO surgery is a procedure developed by Dr. Gretchen Flo and assoc., in the 70's, at Michigan State University. I had Dr. Flo as a prof when I was in school. She just retired in 2003. Amazing woman, for sure. :) Her procedure is called the MRIT (Modified Retinacular Imbrication Technique). The basic idea here is that heavy nylon suture line is used on the outside of the joint to act as a substitue for the torn cruciate ligament. The joint capsule is toughened up by the irritation of the nylon suture as well, providing stability in the joint. Results are generally good overall.
The TPLO folks say that the MRIT is 'doomed to fail' because the suture stretches over time, as does the joint capsule, which allows for abnormal motion of the knee joint and further damage and irritation.
The MRIT was 'the way you fix a torn cruciate' for about 25 years. The TPLO is the 'next step' in what to do, but there aren't any 10+ year followups on the TPLO to say that it's the cat's meow just yet. I worked for a vet in Florida who did TPLOs, and his patients did -very well-.
Re: Ask Away! :)berbalangApril 7 2006, 21:23:20 UTC
Oh man, I do believe 'T's told me about the Infamous Dr. Flo. Talk about a taskmaster!! Sheesh.
I am thinking I'll go for the TPLO and move out my out-of-debt deadline by a little. I'm already busting my hump, I can do it for a while longer if it means she'll have the quality of life she deserves. The specialist Dr. Freyman works with is certified for the procedure and apparently does little else; two or more surgeries at the Factoria clinic alone. Sounds like he knows his stuff.
Can't do anything 'til the LEFT leg's better, anyhow, so we'll take it...*sigh*..one step at a time. Unavoidable pun.
*hugstight* Thank you very much for being such a willing ear. You and 'T are a PAIR of princes.
Re: Ask Away! :)otterdocApril 7 2006, 23:27:25 UTC
Again, it's truly my pleasure to help out however I can. :) Keep me posted, and best of luck with the surgery and mending that poor accident-crunched leg.
As far as cruciates go, the TPLO is the new-and-best being offered by the veterinary surgery folks. Tibial Plateau Leveling Osteotomy. There is a *ton* of physics involved, but the basic idea is that by changing the geometry of the knee joint, the abnormal motion allowed by the torn ligament is eliminated, which spares the cartilage in the joint and is a permanent fix to the destructive physical forces that result from a damaged cruciate ligament. That said, there is *NO* sure way to fix the inflammation and subsequent degradation of the cartilage in the joint once a ligament tear has started. We have many ways to slow and limit these inflammatory changes (special foods, non-steroidal anti-inflammatories), so most dogs do very very well for a long time. A great deal of the longterm success depends upon how quickly the problem is fixed -- the sooner the better.
The TPLO includes a bone being deliberately cut, moved slightly, and then fixed in place with a big custom metal bone plate that stays in place for good. Technically, it's a very cool surgery, and you have to take a special course to learn to do it. You definitely want a board-certified surgeon to do this, IMHO, which means (usually) a specialty referral. I'm sure some private-practice vets are certified to do this surgery, but that's not the same as being a board-certified veterinary surgeon. Go with what feels right and comfortable in that respect.
The alternative to the TPLO surgery is a procedure developed by Dr. Gretchen Flo and assoc., in the 70's, at Michigan State University. I had Dr. Flo as a prof when I was in school. She just retired in 2003. Amazing woman, for sure. :) Her procedure is called the MRIT (Modified Retinacular Imbrication Technique). The basic idea here is that heavy nylon suture line is used on the outside of the joint to act as a substitue for the torn cruciate ligament. The joint capsule is toughened up by the irritation of the nylon suture as well, providing stability in the joint. Results are generally good overall.
The TPLO folks say that the MRIT is 'doomed to fail' because the suture stretches over time, as does the joint capsule, which allows for abnormal motion of the knee joint and further damage and irritation.
The MRIT was 'the way you fix a torn cruciate' for about 25 years. The TPLO is the 'next step' in what to do, but there aren't any 10+ year followups on the TPLO to say that it's the cat's meow just yet. I worked for a vet in Florida who did TPLOs, and his patients did -very well-.
I say if you can afford the TPLO, go for it. :)
Here are a couple of informative links:
http://wilsonvethospital.com/index.php?page=orthopedics
http://members.cox.net/uck9s/cruciate.htm
You've got our number, too, so if you want to call and go over this stuff on the phone at some point, please just let me know!
-M.
Reply
I am thinking I'll go for the TPLO and move out my out-of-debt deadline by a little. I'm already busting my hump, I can do it for a while longer if it means she'll have the quality of life she deserves. The specialist Dr. Freyman works with is certified for the procedure and apparently does little else; two or more surgeries at the Factoria clinic alone. Sounds like he knows his stuff.
Can't do anything 'til the LEFT leg's better, anyhow, so we'll take it...*sigh*..one step at a time. Unavoidable pun.
*hugstight* Thank you very much for being such a willing ear. You and 'T are a PAIR of princes.
Reply
Keep me posted, and best of luck with the surgery and mending that poor accident-crunched leg.
-M.
Reply
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