Complications of Cruciate Ligament Surgeries
All surgeries have the potential to generate complications. These can lead to additional pain for our patients, and stress for their owners. At Peninsula Vet Care our surgical team is set up to try and minimise all complications, but try as we might they still happen from time to time.
Dr Chris Franklin has been practising in the field of veterinary orthopaedics and especially cruciate ligament surgery for long enough that he has seen and handled the common complications which can occur in the various cruciate ligament surgeries. Your can have peace of mind, knowing that someone with experience is handling your pet's case.
Cruciate ligament surgeries all suffer from similar types of complications - the major complications are listed below.
1. Infection: Most commonly caused by a patient licking their wound, but also caused in surgery. One of these is our responsibility, one of these is yours! We try and prevent surgically induced infections by a number of methods
- Using waterproof, sterile, disposable draping systems, disposable gowns, and orthopaedic surgical gloves.
- Our Mornington ERH hospital has dedicated orthopaedic theatres - not like in general practice, where one minute a dirty anal gland surgery might be followed by a cruciate repair, or in the same airspace a dental procedure.
- The experience of the surgeon can cut surgical times dramatically, each hour of open surgical time, doubles the infection rates.
- The experience of the surgeon will drop the tissue damage that is caused in surgery, damage creates swelling which promotes infection
Journal reported infection rates in region of 3-5%
2. Implant failure: More commonly associated with 'extracapsular' techniques and not the bone cutting techniques. Implant failure is less common with the more modern tightrope and suture anchor techniques, but still occurs.
Journal reported implant failure rates in region of 2%
3. Meniscal injury: All cruciate ligament cases have their joint inspected during surgery normally by arthrotomy (a cut into the joint) or at ERH with arthroscopy (keyhole), looking for evidence of meniscal cartilage damage. In about 50% of dogs with fully ruptured cruciates there is cartilage damage, which needs to be removed. It will lead to arthritis. Sometimes a dog will have no evidence of meniscal damage during the surgery, but once back on their feet, a moment will occur when a previously intact meniscus will tear. This 'late meniscal injury' will necessitate another look in the joint and removal of the offending piece.
Journal reported late meniscal injury rates 5-15% depending on procedure.
4. Contralateral cruciate ligament rupture: Unfortunately it is true to say that often if one ligament goes, the same ligament on the other knee might well go too.
Journal reported 'other knee' rates approx. 60%, in one study 38% of rottweilers did their other knee within 6months.
For comparison I've lists my complication rates below, worked out from the histories of the first 125 TPLO procedures I performed.
Minor complications first:
Seroma (a fluid filled swelling under the wound which discharges sometimes and resolves without treatment) 1
Suture loosening/chewed out (Elizabethan collars not optional - all 3 cases resolved following placement of 1 or 2 staples) 3
Licked Wound (requiring an extra week of antibiotics) 1
(4% in total - all but one preventable by Elizabethan collar use)
Late Meniscal Injury 4 (3%)
Plate Removal due to Infection (The plate is not normally removed, but if there is infection involving the plate - it needs removal once healed) 3 (2%)
Medially luxating patella developing post op (a slipping patella due to bowed legs can occur due to cruciate ligament tearing, but sometimes the anatomical tendency shows up after surgery and requires surgery) 2 (1.5%)
As you can see these are all comparable or better than reported statistics, except for the luxating patella problem, which is deemed rare. Maybe when I've done the stats for the next 125, it will become less frequent!