TTA Surgery

[Eventaholic]

Hey All. Look surgeries. My four year old mixed large breed (85lb) is going in for his first knee in a couple of weeks, with plans for the second knee when he’s ready.

He is genuinely the sweetest creature on earth and until recently has been VERY active with lots of hiking and swimming and chasing birds on the beach. He was never a competitive anything and certainly isn’t going to be, and as much as he has earned his couch potato awards, he much prefers to be on the go (go go!) and then couch potatoing when he’s truly tired. We started noticing some stiffness and gimpyness on and off about a year ago, at the time living outside on a mountainside farming all day. We then lived in a second-story apartment about a year, and during that time his lameness became more obvious but still very on and off. I lost the coin toss with my partner and we had his hips X rayed first, which looked great- vet wasn’t a big fan of how his knees were in person, I didn’t say I told you so, and we had his knees X rayed and shared with the local knee people. In the spring we found a single-story home far from town and saw a pretty notable difference when we eliminated the very steep stairs required for any in/out, and being able to go outside so much more (doesn’t need supervision outside and opening the slider takes literally a second). We saw a specialist and he concluded that TTA surgery for both knees is our best bet.

I’m very anxious about recovery. Our house has a very open floorplan and there are multiple beds- though he strongly prefers the couch and the human bed, and small enough that he’s never too far from the water bowl. I mostly work from home but he’ll be home for maybe 6 hours 1-3 days a week, I should be able to make lighter schedules immediately after surgery. Especially because he will be going back in for the second knee at some point (I’m not sure this is something we want to do mid-winter in VT? Best to wait until spring?) I want to make sure we do everything possible to support good healing. I got him a pair of BoT dog boots because I LOVE all my BoT stuff as does the horse (who is currently recovering from colic surgery :lol:), we’ll see if he wears them! ha. At the moment he eats TOTW dry food, gets salmon oil, and Dasuquin w msm.

We’ll happily take good thoughts for the handsome devil.

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[S1969]

Just have time for a quick response - my (now deceased) dog had a TTA quite a number of years ago but the recovery wasn’t bad at all. He had previously had a medial collateral ligament repaired, and that was difficult - it was very painful and needed a lot of PT to keep it mobile. We expected a similar recovery with the TTA but it wasn’t that way at all - he practically jumped out of the car when we got home and felt really good.

We put a crate in every room we were in for any length of time so he would be with us; and spent a lot of time in the bedroom with carpeting so that he could be loose (under supervision) instead of the living room with hardwood floors. I slept on a mattress on the floor with him for about 6 weeks so that he could still sleep “in bed” but not jump up and down from the real bed. Overall it was pretty easy.

[Where_sMyWhite]

I had a Bouvier who had a TTA in one “knee”. Recovery is key in allowing the bone to set properly but I much prefer the TTA vs the TPLO procedure. And yes, TTA they do feel good so restraint is key. Crate, walk, no running up stairs, no jumping on beds… the payoff with a good solid 6-8 week post surgical recovery will be worth it. My vet told is that the dogs with post surgical “issues” were usually the ones where the owner didn’t follow directions during the post-surgical recovery period.

If you work from home, put a crate in your home office. He can be with you without you having to worry about what he’s doing every minute

IMO, worth it. My girl had it at about age 4 and went another 6+ years with no issues in the other leg and no apparent side effects.

[DogIsMyCopilot]

First I need to say that I ADORE your dog. He looks like a spitting image of my first dog (except mine was brindle).

My female also went through TTA surgery on both knees. I don’t want to scare you, so take it as only one of many experiences, but it was an absolute nightmare.
In short, even after two years of conservative treatment (careful exercise, physiotherapy, anti-inflammatories, antibiotics, etc), the right side never healed properly and when we saw bone lysis around the the implant we decided to get it removed (by a different surgeon).
Unfortunately, it turned out that the surgeon who did the TTA did a botch job: the knee angles of my dog were too steep for TTA to begin with, implants were too small for the size of dog, they were implanted crooked, and he accidentally nicked the right femur when he made the bone cut, which left massive inflammation in the bone that ultimately led to decalcification in the condyle of the femur.
To add insult to injury, the vet who removed the implants found that my dog was misdiagnosed from the start, the cruciate was intact. It turned out that the lameness issues were caused by completely unrelated problems.
Needless to say we were pretty shocked. Mind you, my dog had been seen by THREE board certified veterinary surgeons pre-surgery, and none of them diagnosed her properly.

TTA is a little bit less invasive that TPLO/TTO, but it has basically two big downsides: the knee angle of the dog cannot be too steep (it is impossible to correct a very steep knee angle by TTA); and in the case of complications, the implant cannot be removed as easily as plates/screws from a TPLO.
I think one of the problems is that TTA is still not a very well established surgery in North America, since the procedure was developed in Switzerland (Vet Faculty at the University of Zurich) and only few vets who perform the surgery in North America have had formal training overseas. Also, many vets that do the surgical aftercare have virtually no experience with TTAs, so problems get spotted late.
Also, in the course of this whole mess I have extensively consulted with European surgeons (including the University of Zurich) and none of them would ever do surgery on both knees at the same time. I know it’s done in North America, but the Europeans all do one knee first and the other one 8-12 weeks later once the first one has healed.

I am not sure I understood correctly how your dog was diagnosed, but after my experience I would never rely on x-rays and an opinion anymore. I would want a proper diagnosis (at least ultrasound by a specialized radiologist, preferably MRI or arthroscopy) before agreeing to any kind of surgery.
Typically, cruciate tears present as sudden high-grade lameness and not as “on and off” for a long period of time. It can happen that a cruciate is partially torn and at some point ruptures completely, but the case of your dog strikes me as a bit untypical for ACL tears. I would want to have this diagnosis confirmed.

So in a nutshell I would have the following advice:

• get the ACL ruptures properly diagnosed
• get the surgeon to take proper x-rays (with the condyles projected straight over each other) and SHOW you on the x-ray how he measures the angle of the knee.
• get a second opinion on TTA vs TPLO/TTO for your particular dog (the surgeons at the University of Zurich have been very helpful to me)
• do one knee at a time
• make sure you have a vet with TTA experience for the follow up care.
• make sure you get a copy of the surgery report (despite asking many times, we never did. At this point I am quite sure that this report never existed)

Feel free to PM me if you are interested to hear our whole story in detail and/or want a recommendation which surgeon NOT to go to in the PNW.

[FalseImpression]

My dog had TTA surgery 3 years ago and recovered very well. He was a 8 1/2 yo big lab (90+ lbs of muscle not fat). We followed the surgeon’s instructions to a T. No stairs (we are in a bungalow) and built ramps for the one or two steps. Lots of slow walks in the backyard on a leash. PT as directed. He is doing fine at 11 yo now. No limp.
He did fall last winter on ice and did hurt himself. He scared us when he refused to get up/could not get up. But a few days on Metacam and he was back. But we have stopped the long hikes/runs. He himself decided he did not want to jump on beds on into the car, so we use a ramp in the station wagon.
My BO’s shepherd had the same surgery by the same surgeon a year later and they also followed instructions to a T. He is totally fine, no limp at all.

[Where_sMyWhite]

FWIW, my vet did take a number of courses from vets that were part of the development effort in Switzerland