Bilateral TPLO Surgery Explained
Comprehensive guide to bilateral TPLO surgery for dogs, covering procedure, recovery, benefits, risks, and cost considerations for better mobility

What Is Bilateral TPLO Surgery?
Tibial Plateau Leveling Osteotomy (TPLO) is a surgical procedure used to treat cranial cruciate ligament (CCL) rupture in dogs. Instead of replacing the torn ligament, TPLO alters the tibial plateau angle, stabilizing the knee joint and reducing abnormal movement.
Bilateral TPLO surgery is performed when both knees require correction. Some dogs suffer CCL injuries in both hind limbs, either simultaneously or within a short period. In such cases, a surgeon may recommend performing TPLO on both knees in a single procedure or as staged surgeries.
Large, active breeds like Labrador Retrievers, Rottweilers, Golden Retrievers, and German Shepherds are more prone to CCL injuries due to their size and activity level. Obesity, genetics, and structural predisposition also contribute to ligament degeneration, making bilateral TPLO necessary for some dogs. Early intervention helps restore mobility and prevent long-term joint damage.
When Is Double or Bilateral TPLO Surgery Necessary?
Some dogs develop cranial cruciate ligament (CCL) injuries in both knees, either at the same time or within a few months. This often occurs due to genetic factors, excessive strain on the healthy limb after an initial injury, or progressive ligament wear in both knees. When both knees are unstable, bilateral TPLO surgery is necessary to restore mobility and prevent further joint damage.
Dogs needing bilateral TPLO often show signs like severe limping, difficulty standing up, reluctance to walk or play, and an unusual sitting posture. They may shift their weight excessively, struggling to support themselves on either leg.
Veterinarians determine the need for bilateral TPLO through a detailed orthopedic exam, gait analysis, and imaging tests like X-rays. If both knees are significantly unstable, vets may recommend simultaneous TPLO to correct both knees in one procedure.
However, for older dogs or those with other health issues, a staged approach—operating on one leg first and the other after recovery—may be safer to reduce surgical risks.
Simultaneous vs. Staged TPLO Surgery: What’s the Best Choice?
When a dog needs TPLO on both knees, veterinarians consider two approaches: simultaneous TPLO (operating on both legs at once) or staged TPLO (operating on one leg first and the other after recovery).
Simultaneous TPLO
Simultaneous TPLO offers the advantage of a single anesthesia event and a shorter overall recovery period. Dogs regain balanced mobility faster since both knees heal together.
However, post-surgical care is more challenging because the dog cannot rely on a strong leg for support, requiring owners to provide intensive assistance. Risks include increased surgical stress and a higher chance of post-operative complications like swelling or infection.
Staged TPLO
Staged TPLO involves operating on one knee first, allowing recovery before addressing the second leg. This approach reduces surgical risk, making it ideal for older dogs, those with other health issues, or those struggling with post-surgical pain. However, the overall treatment period is longer, and the dog may continue to experience discomfort in the untreated leg during the recovery phase.
Veterinarians decide the best approach based on factors like the dog’s overall health, weight, pain tolerance, and the owner’s ability to manage post-surgical care.
Large dogs with strong front limbs may handle simultaneous TPLO better, while smaller or weaker dogs may benefit from a staged approach.
Benefits of Doing Bilateral TPLO Surgery at Once
For dogs needing TPLO on both knees, opting for simultaneous bilateral TPLO surgery has several advantages compared to staging the procedures months apart.
- One major benefit is a faster overall recovery period. When both knees are corrected in a single surgery, the dog undergoes just one healing phase rather than two separate ones. This means they can return to normal activity sooner compared to waiting for two rounds of surgery and rehabilitation.
- Another advantage is lower long-term costs. While simultaneous TPLO may have a higher upfront expense, it often reduces overall costs by avoiding duplicate anesthesia, hospitalization, and post-operative care fees associated with two separate surgeries. Pet owners also save on pain medications and follow-up appointments.
- Bilateral TPLO also helps prevent excessive strain on the unoperated leg. When only one knee is repaired first, the dog must rely heavily on the untreated leg, which can worsen ligament damage or lead to muscle imbalances. Simultaneous TPLO eliminates this risk by addressing both knees at once, ensuring balanced weight distribution during recovery.
- Lastly, dogs who undergo bilateral TPLO often experience better mobility post-recovery. When both knees heal together, they regain strength and stability more evenly, allowing for a smoother transition back to normal activities. This approach minimizes long-term joint issues and improves overall quality of life.
For young, healthy, and active dogs, bilateral TPLO surgery can be the best option for a quicker and more effective recovery.
Read more about - Long-Term Outcomes of TPLO Surgery
How Double TPLO Surgery Is Performed
Step 1: Pre-Surgery Preparation
Before bilateral TPLO surgery, veterinarians perform a thorough evaluation, including X-rays to assess the tibial plateau angle and confirm the need for surgery.
Bloodwork ensures the dog is healthy enough for anesthesia. The dog is then sedated, intubated, and placed under general anesthesia. The surgical area on both knees is shaved and disinfected to minimize infection risk.
Step 2: Surgical Process
During the procedure, the surgeon makes an incision over each knee to access the tibia. A specialized oscillating saw is used to cut and rotate the tibial plateau, adjusting its angle to stabilize the joint and eliminate abnormal motion caused by cranial cruciate ligament (CCL) rupture. Once repositioned, a metal plate and screws are secured to hold the bone in place, ensuring proper healing and function.
To reduce the risk of biofilm formation and post-surgical infections, many surgeons use advanced solutions like Simini Protect Lavage. This non-antibiotic lavage solution helps flush out bacteria and prevent biofilm development, significantly lowering the chances of infection and promoting a safer recovery.
Combined with sterile surgical techniques and post-operative antibiotics, these measures enhance healing outcomes and minimize complications.
Step 3: Post-Surgical Stabilization and Suturing
Once both knees are stabilized, the surgeon checks for proper alignment. Soft tissues and muscles are carefully repositioned before closing the incision with sutures or staples. A sterile bandage may be applied to protect the area.
Step 4: Immediate Post-Op Monitoring at the Vet Clinic
After surgery, the dog is moved to recovery and closely monitored for pain, bleeding, or complications. Pain medications and antibiotics are administered, and vets ensure the dog is stable before planning the transition home. Owners receive detailed post-op care instructions for managing pain, mobility, and incision care.
Risks and Potential Complications of Double TPLO Surgery
While bilateral TPLO surgery is highly effective, it comes with risks and potential complications that pet owners should be aware of.
- One significant concern is the risk of infection, which can occur at the surgical site or internally around the implants. Infection risk is minimized by using sterile surgical techniques, prescribing antibiotics, and ensuring proper at-home wound care. Keeping the incision site clean and preventing the dog from licking or biting the sutures is essential for avoiding post-operative infections.
- Another risk is delayed healing, as both legs are recovering at the same time. Unlike a staged TPLO, where the healthy leg supports weight during recovery, dogs undergoing bilateral TPLO may struggle with mobility. Strict activity restrictions, proper pain management, and joint-supporting supplements can help promote faster healing.
- Implant failure or loosening is another complication that may arise, especially in highly active dogs or those with improper post-op care. Excessive movement or jumping can put stress on the surgical plates and screws, potentially leading to implant shifting or breakage. This can require additional surgery to correct.
- Lastly, anesthesia-related risks and post-operative pain are concerns with any major surgery. Though modern anesthetics are generally safe, dogs with underlying health conditions may face complications. Post-op pain is managed with medications, but owners must monitor for signs of discomfort, swelling, or limping.
Following the vet’s post-op care instructions, including strict rest and controlled rehabilitation, significantly reduces these risks and ensures a smoother recovery.
What to Expect After Double TPLO Surgery
First 24–48 Hours: Managing Pain, Limited Movement
Immediately after surgery, your dog will experience grogginess from anesthesia and discomfort from the procedure. Pain management is crucial, with vets prescribing anti-inflammatory medications and opioids for relief.
Movement should be extremely limited, and your dog may need assistance standing or going outside for bathroom breaks. Using a harness or sling can help support their weight. Swelling around the incisions is normal, but excessive redness, oozing, or heat could indicate infection.
First 2 Weeks: Strict Rest, Keeping the Dog Confined
During this period, strict crate rest or confinement in a small, quiet space is essential. Jumping, running, or sudden movements should be avoided to prevent stress on the healing bones.
Short, controlled leash walks for bathroom breaks are allowed, but no excessive movement. The surgical site should be monitored daily for any signs of infection or swelling.
Weeks 3–6: Gradual Improvement, Light Movement
By the third week, mild weight-bearing on both legs should improve, but full activity is still restricted. Short, controlled leash walks (5-10 minutes) may be introduced if the vet approves. Most dogs begin regaining stability, but muscle weakness is common.
Weeks 6–12: Rehab Starts, Monitoring for Complications
With vet approval, rehabilitation exercises such as slow leash walks, underwater treadmill therapy, or passive range-of-motion exercises can begin. Any signs of excessive limping, pain, or swelling should be reported to the vet immediately.
Full Recovery Timeline: When the Dog Can Walk, Run, and Return to Normal
By 12–16 weeks, most dogs can walk comfortably, and by 4–6 months, they regain full mobility, including running and playing. However, high-impact activities should be reintroduced cautiously under veterinary guidance to prevent re-injury.
Read more about - Post-Surgery Recovery After TPLO in Dogs
Pain Management and Medications After Surgery
Managing pain effectively after bilateral TPLO surgery is crucial for a smooth recovery. Veterinarians typically prescribe a combination of NSAIDs (non-steroidal anti-inflammatory drugs), opioids, and supplements to control pain and inflammation.
- NSAIDs (e.g., Carprofen, Meloxicam) help reduce inflammation and swelling. These should always be given with food to prevent stomach irritation.
- Opioids (e.g., Tramadol, Buprenorphine) provide stronger pain relief in the first few days post-surgery, especially when discomfort is severe.
- Joint supplements (e.g., glucosamine, chondroitin, omega-3 fatty acids) support long-term joint health and aid in recovery.
To manage swelling and discomfort, cold therapy (icing the surgical area for 10–15 minutes, 2–3 times a day) can help reduce inflammation. Anti-inflammatory treatments, including prescribed medications and natural supplements, may further support healing.
It’s important to monitor for signs of excessive pain, such as persistent whining, heavy panting, restlessness, refusal to move, or loss of appetite. If your dog shows these symptoms despite medication, or if swelling and redness worsen, contact your vet immediately. Proper pain management not only ensures comfort but also promotes faster recovery and prevents complications.
Importance of Physical Therapy and Rehabilitation
Physical therapy plays a critical role in speeding up healing and restoring mobility after bilateral TPLO surgery. Without proper rehabilitation, dogs may experience muscle atrophy, stiffness, or prolonged discomfort.
Controlled movement helps strengthen the muscles around the knee joints, improves flexibility, and ensures a smoother recovery.
Recommended Rehab Exercises:
- Passive stretching – Gentle range-of-motion exercises help prevent stiffness and improve flexibility. These should be done 2–3 times daily with slow, controlled movements.
- Water therapy (underwater treadmill or swimming) – This is an excellent low-impact exercise that builds strength while reducing stress on the joints. Typically introduced 4–6 weeks post-surgery, if approved by the vet.
- Controlled leash walks – Short, slow walks (starting at 5 minutes per session) encourage weight-bearing and muscle engagement. Walk duration is gradually increased over time.
When to Start Rehab and Frequency:
Most rehab exercises begin around 2–3 weeks post-surgery, depending on the dog’s progress. Sessions should be daily but short to avoid fatigue. A structured rehabilitation plan, guided by a veterinarian or certified canine rehab therapist, ensures the safest and most effective recovery. Proper rehab improves strength, reduces re-injury risks, and helps dogs regain full mobility faster.
Home Care and Activity Restrictions for Recovery
Creating a safe and controlled recovery space is essential after bilateral TPLO surgery. A quiet, confined area with non-slip flooring, soft bedding, and limited space to move helps prevent accidental injuries. Using a crate or a small enclosed area with baby gates ensures your dog stays in a controlled environment while healing.
Restricting movement is crucial in the first 8–12 weeks. Jumping, running, or climbing stairs must be avoided, as sudden movements can put stress on healing bones and implants. Furniture should be blocked off, and leash walks should be strictly supervised.
For mobility assistance, supportive slings or harnesses (such as a rear-lift harness) help dogs stand up, walk for bathroom breaks, and shift weight safely. This is particularly important in the first few weeks when both legs are weak.
Since physical activity is limited, mental stimulation is key to preventing boredom and restlessness. Provide interactive toys, puzzle feeders, and scent-based games to keep your dog engaged without physical strain.
Spending extra time with your dog through gentle petting and calm interaction helps keep them relaxed and comfortable throughout recovery. Careful management ensures a smoother healing process and reduces complications.
Cost of Double or Bilateral TPLO Surgery and Financial Considerations
The cost of bilateral TPLO surgery varies depending on location, veterinary expertise, and hospital fees. In the U.S., the average cost for a single TPLO ranges from $3,500 to $6,000 per knee, meaning bilateral TPLO can cost $7,000 to $12,000. In other regions, such as Canada, the U.K., or Australia, prices may be slightly lower or higher based on veterinary costs and currency differences.
Factors affecting cost include:
- Geographic location – Urban areas with higher living costs tend to have more expensive veterinary services.
- Veterinarian experience – Board-certified surgeons may charge higher fees due to their expertise.
- Hospital fees – Costs for anesthesia, post-op care, medications, and follow-up visits add to the total.
Does pet insurance cover TPLO surgery? Coverage depends on the policy. Many comprehensive pet insurance plans cover TPLO if it’s not a pre-existing condition. Some require a waiting period before covering ligament injuries.
Financing options include payment plans through veterinary clinics, CareCredit, Scratchpay, or pet-specific credit programs to help spread out the cost. Some non-profits and crowdfunding platforms also assist pet owners facing high medical expenses.
Read more about - How Much Does TPLO Surgery Cost?
Final Thoughts on Double or Bilateral TPLO Surgery
Bilateral TPLO surgery is a highly effective solution for dogs with cranial cruciate ligament injuries in both knees. While the procedure requires a significant commitment in terms of cost, recovery time, and post-op care, the long-term benefits—restored mobility, reduced pain, and improved quality of life—make it worth considering for most dogs.
If your dog is struggling with severe knee instability but surgery isn’t an immediate option, consult your vet about alternative treatments like physical therapy, joint supplements, weight management, or custom braces. However, these may only provide temporary relief rather than a permanent solution.
For pet owners navigating this process, patience and commitment are key. Recovery may feel overwhelming, but with proper care and rehabilitation, most dogs return to an active, happy life. Stay in close contact with your vet, follow post-op guidelines, and trust the healing process.
Read more about -
FAQs
Can a dog have TPLO surgery on both legs?
Yes, a dog can undergo bilateral TPLO surgery if both cranial cruciate ligaments (CCLs) are torn or unstable. This can be done simultaneously or in a staged approach. Simultaneous TPLO addresses both knees in one procedure, while staged TPLO repairs one knee first, followed by the second after recovery. The choice depends on the dog’s health and the surgeon’s recommendation.
How much does bilateral TPLO surgery cost?
The cost of bilateral TPLO surgery varies by location and veterinary clinic. In the U.S., it typically ranges from $7,000 to $12,000 for both knees. Factors such as surgeon expertise, hospital fees, medications, and follow-up care affect the final price. Some pet insurance policies may cover TPLO if it is not a pre-existing condition, and financing options are available at many clinics.
What is the recovery time for bilateral TPLO surgery in dogs?
Full recovery from bilateral TPLO surgery typically takes 12 to 16 weeks. In the first 2 weeks, strict rest and pain management are essential. By weeks 3 to 6, controlled movement starts. Around weeks 6 to 12, rehab exercises begin, gradually improving strength. Most dogs return to normal activity by 4 to 6 months, but high-impact activities should be reintroduced cautiously.
What is bilateral TPLO?
Bilateral TPLO refers to Tibial Plateau Leveling Osteotomy surgery performed on both knees to treat cranial cruciate ligament (CCL) tears. It stabilizes the knee joint by altering the tibial plateau angle, preventing excessive movement. This procedure is common in large, active dogs or those genetically prone to CCL injuries. It can be done simultaneously or in two separate surgeries.
What happens if a dog tears both CCLs?
If a dog tears both cranial cruciate ligaments (CCLs), it may experience severe pain, difficulty standing, and an unstable gait. Without surgery, arthritis and joint degeneration can develop quickly. Treatment options include bilateral TPLO surgery, custom knee braces, weight management, and physical therapy. Surgery is typically the best option for restoring long-term mobility and preventing further joint damage.
Get a Free Poster
Enhance your workspace with a high-quality radiographs reference poster, designed for veterinary professionals. This free physical poster will be shipped directly to you—just fill out the form to request your copy.
Step #1
Getting Ready
Ensuring a clean surgical field starts with proper skin preparation. This video demonstrates the best practices for:
- Shaving the patient – Achieving a close, even shave while minimizing skin irritation
- The Dirty Scrub – The initial skin prep step to remove surface debris and reduce bacterial load before the sterile scrub.
Following these techniques helps reduce infection risk and improve surgical outcomes. Watch the video to see how it’s done effectively!
Step #2
Reduce Your Risks
Many surgeons are shocked to find out that their patients are not protected from biofilms and resistant bacteria when they use saline and post-op antibiotics.
That’s Where Simini Comes In.
Why leave these risks and unmanaged? Just apply Simini Protect Lavage for one minute. Biofilms and resistant bacteria can be removed, and you can reduce two significant sources of infection.
Step #3
Take the Course
Preventing surgical infections is critical for patient safety and successful outcomes. This course covers:
- Aseptic techniques – Best practices to maintain a sterile field.
- Skin prep & draping – Proper methods to minimize contamination.
- Antibiotic stewardship – When and how to use perioperative antibiotics effectively.
Stay up to date with the latest evidence-based protocols. Click the link to start learning and earn CE credits!
