Eight-week postoperative tibial plateau leveling osteotomy radiographs do not change the prescribed management plan for most dogs
Abstract
Objective
To determine how frequently routine 8-week tibial plateau leveling osteotomy (TPLO) radiographs resulted in a change to the prescribed postoperative management plan when evaluated by surgery residents versus senior clinicians, and how often the resident and senior clinician plans differed.
Methods
In this prospective interobserver agreement study, dogs that presented for a routine 8-week TPLO evaluation at a single veterinary referral hospital between October 2024 and July 2025 were eligible for enrollment. Three evaluators (2 senior clinicians, 1 surgical resident) independently performed physical examinations (PEs) and later reviewed each dog’s radiographic evaluation (RE). After each PE and RE, each evaluator documented their findings and management decision on standard forms. A Cohen κ score was used to evaluate interrater reliability for PE and RE management choice.
Results
97 dogs (291 evaluations) were enrolled. Corresponding PE and RE recommendations were consistent in most cases (173 [59.5%]). The elected case management plans after each evaluation differed more often for senior clinicians (45.4%) than residents (30.5%). Interrater reliability for overall, PE, and RE prescribed management plans were fair (κ = 0.2233), fair (κ = 0.2252), and slight (κ = 0.1965), respectively. Patellar desmitis (99 [34.2%]) was the most common radiographic finding, but rarely resulted in a different management plan (18 [18.2%]).
Conclusions
Management plans based on PE and RE evaluations were inconsistent, with REs resulting in prolonged exercise restriction in up to 40.5% of dogs.
Clinical Relevance
Clinicians should weigh the costs and risks associated with routine radiographs against their anticipated protocol changes until practical guidance about the clinical impact of common radiographic findings is available.
Keywords: TPLO; routine radiographs; training level; ALARA; experience
Introduction
Cranial cruciate ligament disease is a common cause of pelvic limb lameness in dogs, and it is commonly treated with the tibial plateau leveling osteotomy (TPLO) procedure.1 Short-term postoperative care following TPLO minimally includes a combination of exercise restriction and periodic in-person evaluations with the operating surgeon to monitor recovery progress, with radiographic evaluation of the stifle and osteotomy site performed after 6 to 12 postoperative weeks.2–4 Yet, owing to the financial costs and potential unnecessary exposure to ionizing radiation associated with routine radiographic evaluations in cases that are presented for routine (not “for-cause”) evaluations, the inclusion of periodic TPLO radiographs solely for monitoring have been questioned in recent years.5,6
Olivencia et al5 and Alexander et al6 retrospectively found that postoperative TPLO radiographs performed solely as a matter of policy (not “for cause”) rarely resulted in the surgeon recommending a change to the dog’s prescribed postoperative management plan. However, the cases evaluated for those studies were all operated and managed by senior surgeons with vast experience with the TPLO procedure. It is unclear to what extent the evaluator’s experience with the TPLO procedure impacts evaluator confidence in assessing the dog’s recovery solely with an orthopedic examination and whether less experienced evaluators rely more heavily on the more robust information provided by radiographic evaluation of the surgical site.
The objective of this prospective study was to determine how frequently the findings on routine (not “for cause”) postoperative stifle radiographs performed 8 weeks after TPLO resulted in a change to the prescribed postoperative management plan when evaluated by a surgery resident versus a senior clinician. Our second objective was to determine how often the prescribed postoperative management recommendations made by evaluators from the surgical resident group and the senior clinician group differed. We hypothesized that the prescribed postoperative management plans based solely on the results of the orthopedic examination or radiographic evaluation would differ in < 5% of cases, consistent with the findings reported by Alexander et al.6 Our second hypothesis was that the prescribed postoperative management plan would not differ between senior clinicians and surgery residents.
Methods
This study was reviewed by the BluePearl Science Veterinary Clinical Studies Committee prior to case enrollment, and the study was approved to begin enrollment on October 9, 2024. Written client consent was obtained for all dogs that were enrolled.
Client-owned, skeletally mature dogs that were presented to a single veterinary referral hospital for routine (not “for-cause”) 8-week (56 ± 7 days) TPLO evaluation between October 9, 2024, and July 31, 2025, were eligible for enrollment. All TPLOs were performed by a senior clinician with at least 5 years of postresidency experience with TPLO, and all osteotomies were stabilized with locking TPLO implants from Arthrex Inc or Synthes (DePuy Synthes traditional TPLO plate; Johnson & Johnson MedTech). Dogs were ineligible for enrollment if they were presented “for cause” at any time between the TPLO procedure and the 8-week evaluation or if the dog had a grade 3/5 to 5/5 lameness or overt findings consistent with major complications during the 8-week orthopedic examination (Table 1).7
