15 Common Complications After TPLO Surgery in Dogs
Worried about TPLO surgery complications? Discover 15 common risks, from infection to implant failure, learn how to prevent and manage them effectively

TPLO (Tibial Plateau Leveling Osteotomy) is a common surgery used to treat cranial cruciate ligament (CCL) injuries in dogs. It involves cutting and repositioning the tibia to stabilize the knee joint, reducing the need for the damaged ligament. Although TPLO has a high success rate, complications can still occur even with proper surgical technique.
Complications can arise due to factors like a dog's age, weight, overall health, and how well post-operative care guidelines are followed. Older or overweight dogs are at higher risk for delayed healing and implant failure because of increased strain on the joint. Inadequate rest, early activity, or infections can also cause setbacks.
Even with precise bone healing, some dogs may experience swelling, lameness, or implant-related issues. Being aware of these risks helps ensure timely intervention and optimal recovery. Proper monitoring, limited activity, and follow-up evaluations are crucial in reducing post-surgical complications.
TL;DR: Possible Complications After TPLO Surgery
- Immediate complications: Infection, hemorrhage, implant loosening, excessive swelling, or premature suture removal.
- Mid-term complications: Delayed bone healing, seroma formation, nerve damage, tibial tuberosity fractures.
- Long-term complications: Patellar luxation, arthritis, meniscal injuries, persistent lameness, patellar ligament thickening.
- Severe complications: Osteomyelitis (bone infection), implant failure, chronic pain, or non-union of the bone.
Immediate Post-Surgical Complications (First Few Days to Weeks After Surgery)
In the initial days after TPLO surgery, dogs are at risk for complications that can slow healing and cause discomfort. Careful monitoring and early intervention are crucial to ensuring a smooth recovery.
1. Infection at the Surgical Site
Infection is one of the most common early complications after TPLO surgery. It can happen if bacteria enter the surgical site, delaying healing and potentially affecting the implant.
Signs of infection include redness, swelling, warmth around the incision, pus-like discharge, an unpleasant odor, and increased pain or tenderness. Some dogs may also develop a fever or show signs of discomfort, such as excessive licking or reluctance to put weight on the affected leg.
Causes of infection include poor hygiene, contamination during or after surgery, excessive licking of the incision, and improper wound care. Dogs that lick or chew at their stitches introduce bacteria, increasing the risk of infection. Environmental factors, like a dirty bedding area, can also lead to bacterial growth.
Treatment options depend on how severe the infection is. Mild cases may be managed with oral antibiotics and regular wound cleaning using an antiseptic solution. More severe infections, especially those affecting deep tissues or the implant, require veterinary care.
This may include culture testing to identify the bacteria and, in rare cases, surgical removal of infected tissue. Preventive measures, such as using an Elizabethan collar (E-collar) and ensuring proper wound care, are essential to reducing the risk of infection.
2. Bone Infection (Osteomyelitis)
Osteomyelitis is a serious bone infection that affects deeper bone tissue and can compromise the TPLO implant. Unlike surface infections, osteomyelitis can cause long-lasting inflammation, bone damage, and implant failure.
Symptoms include ongoing swelling, increased pain, fever, pus draining from the incision, and slow healing. Affected dogs may become tired and unwilling to use the operated leg. In chronic cases, the infection can spread, causing a more widespread illness.
Risk factors include contamination during surgery, bacteria from an infected wound, or infections related to the implant. Dogs with weak immune systems or those in unclean environments after surgery are at higher risk.
Treatment involves strong antibiotic therapy, often based on bacterial culture results. In severe cases, surgery may be needed to remove infected bone tissue. If the implant is affected, it might need to be removed and replaced once the infection is under control. Early detection and strict hygiene are key to preventing osteomyelitis.
3. Implant Issues (Loosening, Breaking, or Failure)
Implant complications happen when the TPLO plate or screws don't work properly, causing instability in the knee joint. These issues can occur due to too much movement, poor implant placement, or infections that weaken the bone connection.
Signs of implant failure include ongoing limping, pain, swelling around the implant site, and unusual clicking or grinding sounds from the joint. In severe cases, the implant might shift, leading to bone misalignment. Dogs that suddenly become lame after surgery should be checked right away.
Causes include too much activity after surgery, improper bone healing, and mechanical stress on the implant. Infections can also weaken the bone and screws, increasing the chance of failure. Overweight dogs are at higher risk due to more pressure on the joint.
Possible corrective actions depend on how severe the issue is. Minor loosening might be managed with limited activity, while severe cases could need revision surgery to replace or reposition the implant. If there's an infection, the implant may need to be removed, followed by antibiotic treatment before placing a new implant.
4. Premature Suture Removal by the Dog
Dogs often lick or chew their sutures due to discomfort, irritation, or boredom. However, removing stitches too soon can reopen the surgical site, exposing tissues to infection and delaying healing.
Consequences of removing sutures include the wound reopening, a higher risk of infection, and excessive scarring. In severe cases, exposed tissues may dry out or become contaminated, requiring more surgery. If deeper sutures are disturbed, healing can be significantly delayed.
Preventive measures include using an Elizabethan collar (E-collar) to stop licking and chewing. Bandaging might help, but it must be done carefully to avoid moisture buildup, which can lead to bacterial growth. Supervision is crucial, especially in the first two weeks after surgery.
Providing distractions, like puzzle toys or chew treats, can help keep dogs from focusing on their incision. If stitches are removed too soon, a veterinarian should assess the wound immediately to decide if re-suturing or additional wound care is needed.
5. Hemorrhage During or After Surgery
Hemorrhage, or excessive bleeding, can happen during or after TPLO surgery due to blood vessel injury, clotting disorders, or improper post-operative care. While some mild bruising is normal, significant bleeding is a serious issue that needs immediate attention.
Symptoms of post-surgical hemorrhage include excessive blood oozing from the incision, swelling or bruising that gets worse over time, pale gums, rapid heart rate, and lethargy. In severe cases, internal bleeding may cause a swollen abdomen or breathing difficulties.
Causes include surgical trauma to blood vessels, clotting disorders like Von Willebrand’s disease, or post-operative strain on the incision site. Certain medications, such as NSAIDs and steroids, can also affect the ability to clot.
When to seek emergency vet care: If bleeding continues for more than a few hours, if the wound reopens, or if the dog shows signs of weakness and pale gums, immediate veterinary care is crucial. Treatment may involve pressure bandaging, fluid therapy, or surgical intervention to control internal bleeding. Quick action can prevent life-threatening complications and improve recovery outcomes.
Mid-Term Healing Complications (Weeks to Months Post-Surgery)
As the initial healing phase progresses, some dogs may experience complications that affect recovery in the weeks following surgery. Monitoring for persistent swelling, delayed healing, or mobility issues is essential to prevent long-term problems.
6. Swelling and Bruising at the Incision Site
Some swelling and bruising are expected after TPLO surgery as part of the body's normal healing process. Mild swelling around the incision site, along with light bruising, usually goes away within two weeks.
Concerning signs include swelling that doesn't go away or gets worse beyond the expected recovery time, extreme discoloration (deep purple or black bruising), excessive warmth, and increasing pain. These could indicate an infection, hematoma (blood accumulation), or poor circulation.
Managing swelling effectively requires early action. Cold therapy, like applying an ice pack wrapped in a towel for 10–15 minutes several times a day during the first 72 hours after surgery, helps reduce inflammation. After this initial period, warm compresses can be used to promote circulation. Anti-inflammatory medications, if prescribed by a veterinarian, can also help reduce swelling.
Strict rest and avoiding unnecessary movement help prevent further irritation. If swelling worsens or doesn't improve, a veterinarian should check the incision site to rule out complications such as infection or fluid buildup.
7. Seroma Formation (Fluid Accumulation)
A seroma is a fluid buildup under the skin near the surgical site. It can occur due to too much movement, surgical trauma, or minor irritation, which causes leakage from blood vessels and lymphatic tissues. Unlike an infection, a seroma is usually not painful and doesn't show redness or discharge.
It's important to tell the difference between normal swelling and a problematic seroma. A small, soft, and flexible swelling that doesn't cause discomfort is often a harmless seroma and may go away on its own. However, if seromas are large or don't go away, especially if they grow or become painful, a veterinarian should check them. Signs of infection, like warmth, redness, or pus, need immediate attention.
Treatment options depend on how severe the seroma is. Small seromas are usually managed by monitoring and using compression therapy. Reducing excessive movement can help decrease fluid buildup. Large seromas might need to be drained with a sterile needle.
If fluid continues to build up, a drain may be placed to stop further accumulation. Preventing too much movement and ensuring proper rest after surgery can help reduce the risk of seroma formation.
8. Nerve Damage Leading to Limb Numbness
Nerve damage after TPLO surgery is rare but can happen due to surgical manipulation near major nerve pathways. The peroneal nerve, which controls foot and lower limb function, is most at risk during tibial surgery. In some cases, swelling after surgery can also temporarily affect nerve function.
Symptoms of nerve damage include dragging the paw (knuckling), reduced sensation in the affected leg, lack of response to touch, or an unusual way of walking. Dogs may seem unable to place their foot properly on the ground. In severe cases, they may develop muscle wasting due to not using the limb for a long time.
Prognosis and recovery depend on how severe the nerve injury is. Mild nerve compression from swelling often gets better within weeks as the swelling goes down. Physical therapy, gentle massage, and controlled movement exercises can help with nerve recovery.
Severe nerve damage, such as a completely severed nerve, has a poorer outlook and may require assistive devices or surgery. Close monitoring and early rehabilitation improve the chances of functional recovery.
9. Delayed Bone Healing or Non-Union
Bone healing after TPLO surgery usually takes 8–12 weeks, but sometimes healing is delayed or does not happen properly (non-union). Several factors can affect bone healing, including poor nutrition, too much activity, infection, or improper implant placement.
Signs of delayed healing include prolonged limping, ongoing swelling around the surgical site, and discomfort that lasts beyond the expected recovery time. X-rays may show incomplete bone fusion at the osteotomy site, indicating slowed healing. If not addressed, delayed healing can lead to implant failure or instability in the knee joint.
Treatment approaches focus on encouraging bone regrowth. A veterinarian may suggest calcium and vitamin D supplements to support bone health. Strict activity restriction is essential to prevent too much movement at the healing site. If an infection is suspected, antibiotics are prescribed.
In severe cases, additional surgery may be needed to replace hardware, perform a bone graft, or stimulate healing with advanced techniques like bone-stimulating proteins. Early intervention increases the chances of full recovery and proper joint stabilization.
10. Tibial Tuberosity Fractures
A tibial tuberosity fracture is a rare but serious issue that can happen after TPLO surgery. The tibial tuberosity is the bony bump where the patellar tendon attaches, and too much strain can cause it to fracture, especially in large, active dogs or those not properly cared for after surgery.
Symptoms of a tibial tuberosity fracture include sudden pain, reluctance to put weight on the leg, localized swelling, and knee joint instability. Some dogs may walk abnormally or have trouble extending their leg. This fracture is usually diagnosed with X-rays, which show a break near the TPLO osteotomy site.
Treatment depends on the fracture's severity. Minor fractures may heal with strict rest, pain management, and controlled rehabilitation. More severe cases require surgery, which may involve adding screws or wire to stabilize the fracture.
Proper post-operative care, including limited movement and weight management, is crucial to prevent tibial tuberosity fractures. Early detection and appropriate treatment improve recovery and help restore normal joint function.
Long-Term Complications (Months to Years Post-Surgery)
While most dogs recover well after TPLO surgery, some may develop complications months or even years later. These long-term issues can impact mobility and joint health, requiring ongoing management and veterinary care.
11. Patellar Luxation (Kneecap Dislocation)
TPLO surgery changes how the knee works, which can sometimes affect the position of the patella (kneecap). While TPLO stabilizes the knee joint by adjusting the tibial plateau, it may lead to patellar instability, especially in small-breed dogs or those with existing knee issues.
Symptoms of patellar luxation include a skipping gait, where the dog briefly lifts the leg before walking normally again. There may also be sudden pain, occasional limping, or trouble putting weight on the leg. Some dogs might be hesitant to jump or do high-impact activities.
Treatment options depend on how severe the condition is. Mild cases can be managed with physical therapy, exercises to strengthen muscles, and weight management to lessen stress on the knee.
In severe cases, where the patella often dislocates and causes discomfort, surgery may be needed to realign the patellar groove or tighten the soft tissues around the knee. Long-term monitoring and controlled exercise can help reduce the risk of further joint instability.
12. Patellar Ligament Thickening or Desmopathy
After TPLO surgery, the patellar ligament (which connects the kneecap to the tibia) may thicken due to increased stress and changes in the tissue as it heals. This condition, known as desmopathy, is a response to the altered mechanics of the knee and may cause discomfort or limit mobility.
How it impacts mobility: Thickened patellar ligaments can lead to stiffness, a reduced range of motion, and occasional lameness. Dogs might have trouble fully extending the knee or feel discomfort when walking on uneven surfaces. In some cases, ligament thickening can contribute to patellar luxation or chronic pain.
Treatment and management focus on reducing inflammation and keeping the joint flexible. Cold laser therapy, controlled exercise, and joint supplements (like glucosamine and chondroitin) may help maintain ligament health.
In severe cases where thickening causes functional problems, physical therapy, anti-inflammatory medications, or, in rare instances, surgery may be necessary. Gradually returning to activity and avoiding high-impact exercises can help minimize stress on the ligament.
13. Meniscal Injury or Tear
The meniscus is a cartilage structure that cushions the knee joint. While TPLO surgery stabilizes the knee, it does not remove the risk of meniscal injuries. Sometimes, leftover instability or stress from implants can cause the meniscus to wear down or tear.
Symptoms of meniscal damage include a clicking or popping sound when the dog moves, occasional or constant lameness, reluctance to use the affected leg, and discomfort when bending the knee. Some dogs may suddenly experience more pain after initially showing signs of recovery.
Treatment options depend on how severe the tear is. Mild cases might be managed with pain relief, joint supplements, and controlled exercise. However, if a meniscal tear causes ongoing pain and instability, surgery is often needed.
This may involve a partial meniscectomy, where the damaged part is removed, or meniscal repair if the cartilage can be saved. Long-term management includes weight control, low-impact exercise, and joint-protective therapies to reduce stress on the knee.
14. Persistent or Recurrent Lameness
While temporary lameness is expected during TPLO recovery, persistent or recurrent lameness months or years after surgery indicates an underlying issue. Some dogs may initially regain function but later experience setbacks.
When lameness is normal vs. a complication: Mild stiffness after long periods of rest or in cold weather is common in post-TPLO dogs, especially as they age. However, continuous limping, favoring one leg, or worsening mobility suggests a complication such as implant issues, nerve damage, or progressive joint disease.
Common causes include implant loosening, nerve irritation, arthritis, or secondary joint problems like patellar luxation or meniscal injury. Improper post-op rehabilitation can also lead to muscle weakness, causing uneven weight distribution.
Rehabilitation options focus on hydrotherapy, physiotherapy, and pain relief through NSAIDs or joint supplements. Weight control is crucial in reducing stress on the knee. For severe cases, advanced pain management options like platelet-rich plasma (PRP) therapy, acupuncture, or even surgical revision may be necessary.
15. Development of Arthritis After Surgery
Even after successful TPLO surgery, some dogs develop arthritis over time due to joint wear and tear. While TPLO improves knee stability, it doesn't prevent degenerative joint disease (DJD), especially in older or previously injured dogs.
Why arthritis develops: Chronic inflammation, ongoing joint stress, or minor imperfections in bone healing can lead to cartilage breakdown. Dogs with previous CCL damage, obesity, or an uneven gait are at higher risk.
Symptoms include joint stiffness, difficulty getting up, reluctance to move, limping, and swelling around the knee. Dogs may struggle with stairs, hesitate before jumping, or feel discomfort after exercise. Symptoms often worsen in cold weather or after long periods of inactivity.
Long-term management focuses on weight control, joint supplements (glucosamine, chondroitin, omega-3s), anti-inflammatory treatments (NSAIDs, corticosteroid injections), and physical therapy. Low-impact activities like swimming or controlled walks can maintain muscle strength while reducing joint stress.
In advanced cases, regenerative therapies such as stem cell treatment or PRP injections may provide relief. Managing arthritis proactively helps maintain mobility and quality of life for years after surgery.
How to Reduce the Risk of TPLO Complications
Minimizing complications after TPLO surgery requires strict post-operative care, proper wound management, and ongoing rehabilitation.
Following veterinary instructions and ensuring a controlled recovery environment significantly improve surgical outcomes.
Strict post-op care
Strict post-op care is essential in preventing implant failure, infections, and delayed healing. Dogs must have limited movement for the first few weeks, avoiding running, jumping, or sudden movements that can strain the surgical site. A crate or confined space ensures controlled rest, while leash-walks allow gradual reintroduction to activity.
Proper wound care and hygiene
Proper wound care and hygiene reduce infection risks. The surgical incision should be checked daily for redness, swelling, or discharge. Using veterinary-recommended antiseptics and preventing licking (via an Elizabethan collar) are key to avoiding contamination.
Many surgeons now use Simini Protect Lavage, a non-antibiotic surgical lavage, to reduce bacterial contamination and biofilm formation, lowering the risk of post-surgical infections.
Rehabilitation and physical therapy
A well-structured rehabilitation plan is essential for restoring mobility, muscle strength, and joint flexibility after TPLO surgery. Early intervention helps prevent stiffness, muscle atrophy, and long-term mobility issues.
Hydrotherapy (underwater treadmill or swimming) provides low-impact exercise, reducing strain on healing joints while strengthening muscles. Passive range-of-motion exercises improve flexibility, while controlled weight-bearing activities help rebuild strength without overloading the surgical site.
Rehabilitation also includes balance exercises, cold laser therapy, and massage therapy, which aid circulation and reduce post-surgical discomfort. A veterinarian or canine rehabilitation specialist can create a customized recovery plan to ensure optimal healing and long-term joint health.
Lastly, early detection improves recovery. Watching for limping, excessive swelling, or behavioral changes helps identify issues before they get worse.
When to Call Your Vet
Recognizing when to seek veterinary care is crucial for preventing serious TPLO complications. Emergency signs that need immediate attention include excessive bleeding, severe swelling, ongoing pain, fever, an open incision, or a sudden inability to bear weight on the operated leg.
Mild symptoms like slight swelling, occasional limping, or minor wound discharge should still be checked if they persist or get worse. Delayed healing or changes in behavior may indicate an underlying issue.
Regular post-op checkups are important for monitoring bone healing, implant stability, and joint function. Early intervention helps prevent complications, ensuring a smooth and successful recovery for your dog.
Read more about -
- TPLO failure symptoms
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- TPLO surgery for older dogs: Is it a worthwhile option?
Conclusion
TPLO surgery is very effective for stabilizing a dog’s knee, but complications can occur without proper post-operative care. Understanding potential risks and taking preventive steps can ensure a smoother recovery.
- Strict post-op care – Limiting movement, using an E-collar, and following vet instructions help prevent implant failure and infections.
- Proper wound hygiene – Keeping the incision clean and watching for redness, swelling, or discharge reduces infection risks.
- Early detection of complications – Signs like persistent limping, fever, or swelling should lead to immediate veterinary evaluation.
- Rehabilitation and physical therapy – Hydrotherapy and controlled exercises help with muscle recovery and joint flexibility.
- Regular vet checkups – Routine follow-ups ensure proper bone healing, implant stability, and early complication management.
- Using advanced surgical solutions – Many surgeons use Simini Protect Lavage to reduce infection risks and improve post-surgical outcomes.
- Long-term joint health management – Weight control, joint supplements, and arthritis prevention strategies enhance mobility and quality of life.
By staying proactive and working closely with your veterinarian, you can minimize complications and support your dog’s full recovery after TPLO surgery.
FAQs
What are the long-term complications of TPLO surgery?
Long-term complications can include patellar luxation, arthritis, implant failure, meniscal injuries, and persistent lameness. Some dogs may develop patellar ligament thickening or nerve-related mobility issues. While many dogs recover well, maintaining joint health, weight control, and regular vet checkups helps minimize long-term risks.
What to watch for after TPLO surgery?
Monitor for swelling, redness, discharge, excessive pain, fever, or sudden lameness. Signs of complications include persistent limping, wound infection, delayed healing, or implant issues. If the dog refuses to bear weight or shows increased discomfort over time, a veterinary evaluation is necessary to rule out serious post-surgical issues.
What are the mistakes for TPLO?
Common mistakes include allowing too much activity too soon, neglecting wound care, not using an E-collar, missing follow-up visits, and improper rehabilitation. Failing to restrict movement can lead to implant failure, delayed bone healing, or reinjury. Strict adherence to post-op care reduces these risks.
What is the complication rate of TPLO?
The overall complication rate for TPLO surgery ranges from 10-34%, with most being minor issues like swelling or mild infections. Serious complications, such as implant failure, fractures, or osteomyelitis (bone infection), occur in a smaller percentage of cases. Proper post-operative care significantly reduces complication risks.
Do dogs fully recover from TPLO surgery?
Most dogs fully recover within 12-16 weeks and regain normal mobility. With proper rehabilitation, they can return to an active lifestyle, including running and playing. However, some may develop mild stiffness or arthritis later in life. Regular exercise, weight control, and joint supplements help maintain long-term joint health.
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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!
