Tibial plateau levelling osteotomy surgery
A case study and nursing care analysis
DOI: https:// doi. org / 10.56496 / HMMS2359
Sophie Jelley, RVN
ENVELOPE Sophie. Jelley @ vetspecialists. co. uk
Sophie has been working within the veterinary industry since 2019, when she started a Level 3 diploma in veterinary nursing. She qualified in August 2022 and joined Davies Veterinary Specialists in May 2023, where she currently works as a veterinary nurse. Sophie enjoys working within a large team of experts and is keen to further her knowledge.
ABSTRACT Cranial cruciate ligament( CCL) rupture is a prevalent orthopaedic condition in dogs. It often results from progressive degeneration influenced by breed, age, sex and stifle joint conformation, although trauma occurring during exercise can also be a cause.
This case study details the management of a 6-year-old neutered male springer spaniel presenting with right pelvic limb lameness, which was later diagnosed as a CCL rupture. Initial conservative management with non-steroidal anti-inflammatory drugs and rest yielded minimal improvement. Orthopaedic examination revealed stifle instability, which was confirmed by a positive cranial drawer test.
Tibial plateau levelling osteotomy( TPLO) was selected as the surgical intervention, following a comprehensive preoperative assessment. Using the American Society of Anesthesiologists( ASA) physical status classification, the patient was graded ASA I( a normal, healthy patient with no underlying disease).
The article describes the anaesthetic management of the case, including premedication, induction with propofol, intubation and maintenance on isoflurane with low-flow anaesthesia, alongside multimodal analgesia incorporating nerve blocks, methadone and ketamine.
It also discusses intraoperative monitoring – including ECG, pulse oximetry, capnography, blood pressure and temperature – as well as surgical site preparation, intravenous fluid management and antibiotic considerations.
Postoperative management emphasised pain control using the Glasgow Composite Measure Pain Scale, wound protection, nutritional support and early physiotherapy. The case highlights the importance of individualised, multidisciplinary perioperative care and vigilant anaesthetic monitoring to optimise patient outcomes.
Keywords Cranial cruciate ligament, tibial plateau levelling osteotomy, TPLO, low-flow anaesthesia, end-tidal carbon dioxide, blood pressure
48 Veterinary Nursing Journal