Date *

Client Details

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Animal Details

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Cat
Dog

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Male
Neutered Male
Female
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Your Pet has been admitted for None Specified

Your pet needs a tibial plateau leveling osteotomy in the Left or Right Stifle? *

Left Stifle
Right Stifle

Has your pet eaten after 8pm last night? *

Yes
No

Has your pet had any medication recently? *

Yes
No

Anesthesia is required, I understand that there are risks involved and that in the event of an emergency, the hospital will take all necessary actions to control the problem and will notify me as soon as possible. *

I understand and agree to the use of human medicine in my animal when deemed appropriate by the Veterinarian.

The hospital has given you an estimate for surgery. *

I fully understand that this is an estimate only. Jacqueline J Mair DVM, DACVS, MBA makes every effort to remain within the estimate given.

I hereby authorizes the admitting veterinarian (and his/her designated associates or assistants) to administer such treatment as is necessary to perform the below-mentioned procedure. The nature of the procedure(s) has been explained to me and no guarantee has been made as to results or cure. I understand that there may be risk involved in these procedures. I consent to the administration of such anesthetics or tranquilizers as are necessary. *

I authorize.

Anesthetic Risks: (Although every effort is made to make anesthesia as safe as possible including vital sign monitoring and use of the most up to date anesthetic agents and equipment, understand that anesthesia has inherent risks). The incidence of complications from anesthesia is extremely low and we do not anticipate any in your pet but on rare occasions the following can occur: 1. Allergic reaction to the anesthetic agents 2. Heart rhythm abnormalities 3. Untoward reactions to the gas including drops in blood pressure or respiratory difficulties 4. Just like in humans, on very rare occasions, general anesthesia can result in death. *

I have read and understand the risks.

Surgical Risks Include: 1. Infection (less than 3%) which may require additional testing and medication at an additional cost. 2. Blood clots that can lodge in major organs causing stroke or rarely death. 3. Overactivity can lead to implant failure. 4. Medial Patellar luxations have a risk of recurrence due to other comorbities, hip dysplasia, overweight, severity of femoral varus and tibial valgus. Overactivity can lead to pin migration and movement of the tibial tuberosity. *

I have read and understand the risks.

NOCITA (bupivacaine liposome injectable suspension) is a long-acting, local anesthetic that provides up to 72 hours of post-operative pain relief by releasing bupivacaine (anesthetic pain relief agent) over time from multi-vesicular liposomes. Dr. Mair is happy to provide this additional form of pain medication during surgery for your patient if you would like to do so. Nocita is labeled For single-dose infiltration into the surgical site to provide local postoperative analgesia for cranial cruciate ligament surgery (TPLO, Extracapsular repair, etc) in dogs and as a nerve block in cats for declaw procedures. Like many drugs in the veterinary space that are used commonly but not specifically labeled for veterinary medical usage, we offer Nocita usage for pain control for our surgical patients off label to be used where deemed appropriate and safe. *

YES - I approve to have Nocita used at the time of surgery on my pet for pain control understand that in select instances it may be used off label when deemed safe by Dr. Jacqueline Mair. Please check with your regular veterinary clinic if it is already included in your estimate(this is included in all TPLO estimates automatically). If not included in your original estimate, generally a single dose of Nocita runs $200. If your pet is greater than 50lbs we will need to use 2 full doses at cost of an additional $400.
NO - I do not approve Nocita pain control for my pet’s surgery.

Simini Protect Lavage is an additional step at the end of surgery to help prevent and protect against infection. Simini protect lavage is placed on the wound at the end of surgery. Then rinsed with saline. The solution has been used in human medicine for years. It is know to protect against 99.8% of all bacteria, eliminate methicillin resistant bacteria, remove bacteria and biofilms. *

YES - I approve to have Simini protect used at the time of surgery on my pet to help prevent infection. This will add $150 to my estimate.
NO - I do not approve Simini Protect as an extra step in the prevention of infection for my pet’s surgery.

I authorize Dr. Jacqueline Mair, DVM, DACVS-sa, MBA to perform surgery on my pet. Dr. Mair is a board certified small animal surgeon. *

I have read and authorize.

Tibial Plateau Leveling Osteotomy for Cranial Cruciate Tear

Cranial cruciate ligament rupture is one of the most common orthopedic injuries in the dog. The primary cause of rupture is degeneration of the ligament and rarely just trauma. About 40-60% of dogs that tear one cruciate ligament will tear the other within 1 to 2 years of the first injury.

The cranial cruciate ligament is the primary stabilizer of the knee. Once it ruptures the dog will become acutely lame due to severe inflammation that occurs within the joint. This will generally improve within the first few days if the dog is placed on anti-inflammatory medications. The chronic lameness is associated with the instability within the stifle joint. This chronic lameness is caused by the tibial plateau angle.

In the dog, the tibial plateau (the joint surface or top of the tibial is a hill sloping backward) slopes caudally. When the dog bears weight the femur hits the top of the tibia and slips backward down the tibial plateau (this is tibial thrust). When this occurs chronically, the immobile medial meniscus can be crushed and torn. When the meniscus tears this is a very painful event.

Cranial cruciate ligament injury leads to a cascade of events including progressive osteoarthritis and medial meniscal tears. The instability results in synovitis (inflammation of the joint capsule), articular cartilage degeneration, periarticular osteophyte formation and capsular fibrosis (arthritis).
Progressive osteoarthritis continues even after stabilization of the knee regardless of the procedure used for stabilization. There are studies to support early stabilization with a tibial plateau leveling osteotomy slows the progression or severity of osteoarthritis.

Tibial Plateau Leveling Osteotomy (TPLO)
The tibial plateau leveling osteotomy is chosen by most surgeons for both small and large breed active dogs. This choice is made over concerns for larger heavier dogs damaging an extra- capsular repair resulting in chronic lameness. This can also occur in smaller breed dogs that are young and active. Dogs having a TPLO are immediately stable after surgery and return to function earlier than other procedures. Another reason to choose this procedure is for dogs with bilateral disease to get them walking as soon as possible. There is some evidence that choosing a TPLO over another procedure will result in less osteoarthritis over the life of your pet.

The tibial plateau leveling osteotomy changes the biomechanics to the canine stifle (knee). Normally the knee is stabilized both passively (cruciate ligament, menisci, joint capsule) and actively (muscles & tendons). The cranial cruciate is a passive constraint to cranial tibial translation as well as internal rotation. The cranial tibial translation is tested by cranial tibial thrust test. The severity of cranial tibial thrust is related to the slope of the tibia. The premise of the TPLO is that if you reduce cranial tibial thrust to neutral the pain associated with cranial tibial translation will resolve.

The tibial plateau leveling osteotomy requires well positioned radiographs that allow the surgeon to measure the slope of the tibial plateau. The slope angle is then converted to millimeters depending on the size of the osteotomy. The procedure incorporates the release of meniscus and debridement of remaining cruciate ligament. A curved saw blade is utilized to make the osteotomy. The osteotomy is then rotated a specified number of millimeters. The osteotomy is then stabilized by a bone plate. Once this is completed cranial tibial thrust should be eliminated.

The tibial plateau leveling osteotomy takes approximately 8 weeks to heal. The osteotomy must go through the process of bone healing just like a fracture. During the healing period your dog should have only controlled exercise. This procedure requires radiographs at the 8 week after surgery to determine if healing is sufficient to allow release back to normal activity.

Complications:
With any surgery there is the potential for complications. The TPLO procedure has an 11.4% rate of both major and minor complications. The major complication rate is about 3% and minor is about 8%.

The most common complications are swelling at the incision site, seroma along the incision, premature staple/suture removal by dog. These complications are fairly easily dealt with. If the dog removes his staples or sutures the incision should be flushed and closed and he should be placed on antibiotics. Swelling can be minimized by icing the incision 3 times a day. Seroma is a benign build up of fluid in the space between the skin and the fascia. Seromas tend to be self limiting but if they are very big they should be drained and the dog should be placed in a bandage. The concern with draining them is that you can introduce bacteria into the surgical site. Most of the time hot packing and time resolves the problem.

Infection is a potential problem with any surgery. It can occur for no reason just because of having surgery this happens in less than 1% of the cases. Infection most often occurs secondary to licking or chewing at the incision. This can be minimized by the use of an e-collar. If the infection is severe surgery may be necessary to flush the joint and obtain cultures.

The most concerning problem is implant failure and migration. Reported complications are tibial tuberosity fracture, fibular fracture, screw loosing or screw fracture. The most common reason for these types of complications is an event that traumatizes the surgical repair, overactivity, falling, running, jumping etc. They have however been reported not in association with a traumatic event. These complications require revision surgeries to stabilize and repair damage.

Meniscal tears are fairly frequent in association with cranial cruciate tears. If the meniscus is not torn we release it from its caudal attachment. Subsequent meniscal tears occur in 6.3% of the cases.

I understand the risks and complications of these procedures, which have been explained to me by the primary care doctor and/or Dr. Jacqueline Mair. This estimate does not include any complications should they arise. *

Owner's Signature

Date *

TPLO Consent Form