Tibial tuberosity advancement (TTA) versus a Tibial Plateau Leveling Osteotomy (TPLO) in dogs

As a follow on to yesterday's introductory post on a tibial tuberosity advancement (TTA), here is more from Dr. K on the subject.

Studies evaluating long term outcome of this procedure are currently being performed; however, the current short term follow up seems very promising. The procedure is currently being performed by over 200 veterinarians worldwide and seems to be quickly finding its place in the arsenal of treatment options for damage to the cranial cruciate ligament in canine patients.

I asked Dr. K how the TTA compares to the TPLO procedure and here is a summary of what she told me:

  • The TTA is less invasive but does not address dogs with very steep tibial plateau angles or very large/very small dogs)
  • The TTA is the newest surgical procedure for management of cranial cruciate deficiency in the dog. TPLO is more common than TTA but TTA was only released into clinical practice in 2005 while TPLO has been around since the 1990's.
  • Cost is variable by clinic but comparable between TTA and TPLO.
  • The biggest difference between the two procedures is that TTA moves the tibial tuberosity cranially to help use the quadriceps to neutralize cranial tibial thrust. TPLO undercuts the joint surface and rotates it so that thrust is neutralized. Because of the cut and the dissection, the TPLO is more invasive that the TTA, so patients that have a TTA tend to be more comfortable more quickly.
  • It is too early to tell the long term outcome from the TTA but so far it looks promising.

Has your dog experienced either of these procedures? Feel free to share in the comments so that others can share in your experience.

Related Posts:
An introduction to a tibial tuberosity advacement (say that in one breath, can you?)
What happens when my dog's cruciate ligament tears?
How much did you say a ruptured cruciate ligament cost to treat in my dog?
Ski - a dog who recovered from a cruciate ligament injury without surgery
My dog or cat is limping

An introduction to a tibial tuberosity advancement (say that in one breath, can you?)

Confused about the difference between a TTA and a TPLO for your dog's torn cruciate ligament? I know, me too :) So, a vet friend-of-a-friend called Dr. K, agreed to write me up a ghost blog post on TTAs and what they are all about.

[Dr. K is shy and won't let me share her name or location but she-who-shall-not-be-named is a peach for doing this for me - you know who you are :)] 

Tibial tuberosity advancement or TTA for short is the newest procedure in the field of surgical management for rupture of the canine cranial cruciate ligament.

Cranial_thrust This ligament serves several functions in the canine knee (or stifle). It prevents overextension, excessive internal rotation of the stifle but most importantly prevents cranial shear. Cranial shear or tibial thrust is an abnormal motion in which the tibia (shin bone) shifts forward and the femur (thigh bone) will shift back, as in the diagram to the right. This instability of the knee results in chronic pain, inflammation and the development of arthritis.

TTA is similar to TPLO (Tibial Plateau Leveling Osteotomy) in that it surgically addresses this force. It differs in that it takes into account the pull of the quadriceps muscles. TTA is less invasive than the TPLO as the amount of dissection and the amount of bone that is moved is much less. As a result, patients are comfortable much sooner after surgery.

Tta_postNot every dog is a candidate for TTA. Only your veterinarian can decide the best procedure for your pet. The TTA does not address patients that have very steep slopes of the tibial plateau (top of the tibia that touches the femur). The implants also do not come for excessively small or excessively large dogs. To the left, you can see a radiograph of a patient after the TTA procedure.

It is very important to follow your doctor’s instructions after surgery. Failure to keep your dog away from the incision can result in infection of the leg/implants (which may result in a second procedure) as well as delayed healing. Even though your dog will be more comfortable sooner after surgery, he/she still needs time for the bone to heal. Permitting your dog to be too active in the recovery can result in fracture of the implants or the leg, which will prolong recovery and likely necessitate a second surgical procedure.

Fascinating stuff but inquiring minds want to know more so I'll post additional info about this leading edge surgical procedure tomorrow.

Got anything you want me to ask Dr. K about the TTA?

Related Posts:
What happens when my dog's cruciate ligament tears?
How much did you say a ruptured cruciate ligament cost to treat in my dog?
Ski - a dog who recovered from a cruciate ligament injury without surgery
My dog or cat is limping

How much did you say hip dysplasia surgery cost for my dog?

Cowboy_front_profile_running Anywhere from $1,700 to $4,700 depending on the treatment and where you live

Here's an example of hip replacement surgery performed on Cowboy, a one year old Labrador in Santa Clarita, California, December 2007.

Total cost for the surgery is $4,661 - gulp!

Examination 48.00
Operating Room Fee 175.00
Cardiac Monitor 45.00
Blood Pressure 45.00
Cefazolin  31.00
Torbutrol 45.00
Adequan 45.00
Pain Management Patch 64.62
Gas Anesthesia 60-120 375.00
Ortho Implants 1,250.00
Total Hip Replacement 1,750.00
Hospitalization Large Dog 285.00
Medication Bid 135.00
Injection Bid 1 120.00
Hazardous Waste Disposal  5.00
Cephalexin 30.00
Deramaxx 30.00
Synovi G3 Soft Chews #240 93.26
Synovi G3 Soft Chews #180 75.78
Tax 13.94
Acepromazine  30.00

Cowboy_front_profile There were some items not covered by the Cowboy's Embrace Pet Insurance policy. Heather (Cowboy's owner) did not select the Drugs and Dental Extension for example so the Cephalexin and Deramaxx were not covered (a total of $273 of drugs not covered - a good lesson to get the Drugs and Dental Extension) - but the total Embrace payout in this case was $3,534.90.

Heather sent us a note about what happened:

Cowboy is not only my dog but my best friend. When I got him, I wanted to do my best to care of the little guy so I decided to get pet insurance.

One day when I was having a play day with Cowboy at the park, another dog charged at him and collied right into Cowboys side. I knew right away that he was hurting because he let out a loud yipe and from that moment on was limping. The following day, I took him to the vet and figured that he was going to have a sprain or a minor injury. To my surprise, the doctor wanted to take an X-ray and then diagnosed Cowboy with hip dysplasia. How could this happen to me and my dog? I didn't even know what hip dysplasia was.

The treatment that the doctors thought would be best for Cowboy was to undergo surgery. Thanks to Embrace Pet Insurance, my dog is now happy and healthy. Without this company's support and help my dog never would have gotten better!

Cowboy is once again going to the dog park and taking evening walks with me! Its nice to know that when something so devastating can happen that there is an insurance company that truly cares. The staff at Embrace was always friendly, constantly asking how cowboys surgery went and how the healing process was going, and always answered any questions i might have had! Cowboy and I are so grateful and will always consider them Cowboy's guardian angel.

Cowboy_standing_tall_grass_2 Thanks Heather! That's what we are here for.

Note that if your pet insurance does not cover hereditary conditions or breed specific illnesses, this hip dysplasia claim would not have been covered as hip dysplasia is genetic.

As you can tell, Embrace does cover hip dysplasia, luxating patellas, cherry eye, and all those other hereditary conditions as long as your pet doesn't have any signs of them when you sign up for your insurance.

If you have a larger dog such as a Golden Retriever, German Shepherd or Rottweiler, you probably want dog insurance that covers hip dysplasia - you'd expect it to be covered, wouldn't you?

Related Posts:
Hip dysplasia in dogs (and cats)
$3,449 claim: Rottweiler with hip dysplasia has ACL repair
My dog or cat is limping

Finding all the cool pet blogs over at Alltop

Alltop, all the cool kids (and me) In between business and family, I try to keep up with what the cool kids are up to in cyberspace (or the interweb as some of my favorite mommy blogs tell it - that always cracks me up!).

Goodness knows, there's about 5 mins between mouthfuls of lunch where I can fit my roaming in, but about a month ago, I discovered one of the newest and useful websites Alltop. Alltop is a service I'd wished I'd had 5 years ago when I was asking everyone where all the good pet blogs were but no-one knew. Darn it, I just had to find them all by myself. Bah humbug!

Alltop, launched by Guy Kawasaki, is a site that categorizes and lists some of the more interesting blogs in a particular category. So if you wanted to find your own favorite mommy blogs but don't know where to start, you can go to the mom alltop category (and even if you do know where to start, there's bound to be one or two you weren't aware of.)

Or you had a hankering to follow all things to do with Gadgets, search no more - the gadget category is here...

You get the idea...

So, when I went to check out that pet category, I was aghast - there wasn't one! So with a quick email to some of my most respected pet bloggers, I pulled together a list of candidates and winged them off to Guy who kindly humored me and put them all up - woohoo!

So now you have it - the pet alltop category. Enjoy the list; there are some really good pet blogs in there.

Many thanks to Gina, Yvonne, Theresa, and Patty for helping out. I think we put together a pretty good list to kick things off.

What other pet blogs do you think should be added?

Geeking out - who owns certain pet insurance website domains?

I was playing around with Whois - a fun service for geeks who want to know who has registered a particular domain name. I figured I would take a look at who owns some hypothetical pet insurance domains - and what fun it turned out to be.

Let's start with www.purinapetinsurance.com - an obvious (but wrong) candidate for Purina to launch with. Who owns it? Strangely enough Veterinary Pet Insurance (VPI - largest pet insurer in the US) [if you are wondering, the Purina product is going out under www.PurinaCare.com.] Perhaps they have this because they used to have a relationship with Purina many years ago.

Moving right along, how about Walmart Pet Insurance - we all know Wal*mart has been getting its fingers into the financial services arena. No reason they wouldn't consider pet insurance for their stable of products. Turns out that has been snapped up by the Hartville Group (third largest pet insurer in the US.)

Along the same lines, what about Target Pet Insurance? Pet Protect has it (a smaller pet insurer that stopped selling new business in 2006.)

Very interesting! I wonder what the motivation for holding these urls is.

My question to my geekier friends out there - can you get big money out of holding branded domain names like this?

By the way, for those of you looking for some pet insurance web real estate to invest in, www.AmazonPetInsurance.com, www.BlueCrossPetInsurance.com, and www.CostcoPetInsurance.com are all free - for now.

Dig in!

Update: Looks like AmazonPetInsurance.com was snapped up by a Hong Kong firm July 2008.

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