Tibial Plateau Leveling Osteotomy following Tibial Tuberosity Advancement Cage Removal: A Case Report

SIMPLE SUMMARY: Persistent knee joint instability has been recognized as a potential postoperative consequence after Tibial Tuberosity Advancement (TTA) causing chronic lameness. A six-year-old male Labrador retriever (38 kg) with persistent lameness lasting six months after TTA Rapid surgery has been examined. During orthopedic examination, the lameness was subjectively graded 3/5 and the positive drawer and tibial compression tests were performed. Radiographical measurements were performed; the preoperative tibial plateau angle was 27° and the patella ligament angle relative to the tibial plateau was 102°. The decision was made to completely remove the TTA Rapid cage and all screws to have enough room to perform a TPLO and apply a 3.5 LCP plate. Long-term follow-up showed radiologically excellent healing with fusion of the gap and disappearance of the osteotomy line. Six months postoperatively, no lameness was detected at a walk and trot. The owner was completely satisfied and reported the dog being free of lameness even after long walks. ABSTRACT: The purpose of this case report is to describe the functional and clinical outcome of a tibial plateau leveling osteotomy (TPLO) in a dog with joint instability and persistent lameness following a Tibial Tuberosity Advancement surgery (TTA) Rapid. A six-year-old male Labrador retriever (38 kg) with a tibial plateau angle of 27° and a patella ligament to tibial plateau angle of 102° and persistent lameness lasting six months after TTA Rapid surgery has been examined. During orthopedic examination, the lameness was subjectively graded 3/5 and the positive drawer and tibial compression tests were performed. The TTA Rapid cage and all screws were completely removed from the tibia to have enough room to perform a TPLO radial cut. A lameness score evaluation, client satisfaction and radiographic follow-up were performed at 4 weeks, 8 weeks and 6 months postoperatively. Long-term follow-up showed radiologically excellent healing with fusion of the gap and disappearance of the osteotomy line. Six months postoperatively, no lameness was detected at a walk and trot. The owner was completely satisfied and reported the dog being free from lameness even after long walks. No complications related to the TPLO surgery occurred.