title: Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs.
abstract: OBJECTIVE
  To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling osteotomy (TPLO) and transverse corrective osteotomy.
  
  
  METHODS
  Cases series.
  
  
  METHODS
  Dogs (n=12; 19 stifle joints).
  
  
  METHODS
  Medical records of dogs that had combination TPLO and transverse corrective osteotomy, were reviewed. Pre- and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective osteotomy technique, method of fixation, and complications were recorded. In hospital re-evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long-term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview.
  
  
  RESULTS
  Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre- and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88-96°) and 96.1° (range, 94-101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In-hospital re-evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long-term follow-up was obtained.
  
  
  CONCLUSIONS
  Long-term clinical outcome of combination TPLO and transverse corrective osteotomy was excellent, and had a high owner satisfaction. Healing times were comparable to standard TPLO with a similar complication rate.
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Weh
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kowaleski
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Boudrieau
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D004283:Dog Diseases / Q000601:surgery*; D004285:Dogs; D005260:Female; D008297:Male; D010027:Osteotomy / Q000379:methods / Q000662:veterinary*; D011183:Postoperative Complications / Q000662:veterinary; D012189:Retrospective Studies; D013264:Stifle / Q000293:injuries; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome