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Tibial Tuberosity Advancement

POST-OPERATIVE INSTRUCTIONS

Your dog has had a tibial tuberosity advancement (TTA) to correct its ruptured cranial cruciate ligament.

Tibial Tuberosity Advancement (TTA) involves changing the mechanics of the stifle joint during weight bearing by adjusting the angle between the top of the tibia and the patellar (knee cap) tendon. This changes the forces that act through the stifle during weight bearing and allows the stifle to be stable without a cranial cruciate ligament. A longitudinal cut is made in the tibial tuberosity at the front of the tibia. This piece of bone is moved forward, using a titanium cage as a spacer. The tibial tuberosity is then fixed in its new position using a titanium plate and screws.

Your dog will have dissolvable stitches under the skin.

Your dog will have been sent home with anti-inflammatory painkillers, please give these according to label instruction.

Please do not allow your dog to interfere with the wound or he/she will need a buster collar.

Appointments:

Please book an appointment to see your surgeon (Dr Arthurs or Mrs Pope) in 2 weeks for a post-operative check- up.

You can also come and see our nurse Hollie who is in charge of physiotherapy. She will guide you through your dog’s rehabilitation program. We recommend you see Hollie at weeks 4 and 6 post-operatively.

In 8 weeks your dog will need to be re-radiographed to assess bone healing and examine the implants. This wil be done under sedation and he/she will stay in for the morning. There will be an additional charge for this (around £100). If the bone has healed then your dog can return to normal levels of exercise and commence hydrotherapy.

Exercise

Exercise following surgery must be restricted until the soft tissues and bone have fully healed. If the surgical implants are placed under excessive loads then they may fail by bending or breaking. All walks must be on lead or harness and at no time should he/she be running or jumping.

Physiotherapy

Daily physiotherapy will be beneficial to your dog’s recovery; our physiotherapy nurse has formulated a recovery programme that will help to maintain a good range of movement in the knee joint and to encourage early use.

1-14 dayspost-op
  • Passive range of motion: 20 reps 2-3 times daily (bicycling movements, flexion and extension – as shown on discharge)
  • Lead/harness walks: up to 5 minutes, 3-4 times daily
  • Cold packs: 15 minutes (to affected joint) 1-2 times daily
  • Massage the ankle joint as shown on discharge

 

3-4 weeks post-op
  • Passive range of motion: 20 reps 2-3 times daily
  • Lead/harness walks: up to 10 minutes, 3-4 times daily
  • Cold packs: 15 minutes (to affected joint) 1-2 times daily
  • Heat packs: 10 minutes (to affected joint) 1-2 times daily

 

5-8 weekspost-op
  • Passive range of motion: 20 reps , 2-3times daily
  • Lead/harness walks: up to 15 minutes, 3-4 times daily
  • Cold packs: 15 minutes (to affected joint) 1-2 times daily
  • Heat packs: 10 minutes (to affected joint) 1-2 times daily
  • Sit-to-stand 5-10 times, 2-3times daily (Nurse will demonstrate)
  • Controlled stair climbing on lead, 2-3times daily.
  • Dancing, 2-3times daily (Nurse will demonstrate)
  • Begin trotting exercises

We strongly recommend hydrotherapy as part of the rehabilitation program as it allows the muscles around the knee to strengthen with minimal forces acting on the joint itself. This can be started once the bone has healed (after the 8 weeks post-operative radiographs).