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Orthopedic Surgery Post-Operative Instructions

Your dog has had a procedure called a TTA-2 to address a torn cranial cruciate ligament (CCL).  You may have heard this ligament referred to as the anterior cruciate ligament (ACL). The following numerical list is a brief description of the restrictions, care, and what to expect post-operatively. If any of this is unclear or you have any questions, please call.

  1. Pain management. This surgery is a painful procedure and pain management is a necessity.  We have prescribed non-steroidal anti-inflammatory drugs/NSAID (carprofen or meloxicam) as well as an opioid (Tramadol). We also prescribe additional pain medications such as gabapentin. It is important that these medications are given on a regular schedule, as directed. If pain medications are still needed after a few weeks, it is best to follow up with your referring veterinarian.
  2. Antibiotics. Antibiotics are given as a prevention of post-operative infection. These are usually given for 10 days. If, however, your dog’s skin was inflamed or infected, a longer course of antibiotics will be prescribed.
  3. Ice. Icing/cryotherapy is one of the most important things you can do to help your dog in the immediate post-operative period. It controls and decreases inflammation and will help to reduce post-operative pain. Cryotherapy (application of cold to the surgical area) should be performed several times daily after walking. Allow the cold to contact limb for 10 minutes 2-3 times a day. A cloth must be placed between the skin and cold pack to prevent damage to the skin.
  4. Exercise.  Keep your dog on a leash at all times when not in the house for 8 weeks.  And, yes, that means AT ALL TIMES.  No doggie door.  No being out in the backyard.  No matter what time of day, no matter what the weather, always on a leash when outside for 8 weeks. The patient may need to be separated from other pets to prevent playing. More active patients may need to be crated for most of the recovery period (I know, this sounds harsh, but being crated is better than having a broken leg as a result of too much activity). Walking is encouraged.  This is on a short leash (no extension leashes).  Here are some guidelines, but they are only that; if your dog is doing well and can tolerate more without discomfort it is OK to accelerate these distances as tolerated. That means that the patient is not worse at the end of the walk than the beginning and that at the beginning of the next walk, is no worse that at the end of the previous walk. Begin with 2-3 houses and back for a few days and slowly build to ¼ mile twice a day.  From there, continue to build up to ½ mile twice daily over the next 2 weeks.  This is probably a good level to stay at for the next 4 weeks.  At 2 months post-operatively, off-leash exercise is permitted.  No ball, stick, or Frisbee tossing for another 2 months. At 4 months, if all is well, he/she can resume full exercise if it is well tolerated.
  5. Physical Rehab. Physical rehab can be used to expedite and smooth your dog’s recovery. Newer procedures can decrease the need for intense rehab. (More details below).
  6. Stairs.  Stairs are permitted but should be limited.  Try to avoid stairs when possible, but when necessary, they should be done slowly and on leash.  Ramps are not better than stairs and should also be avoided, when possible. A towel or sling may be placed under the hips to help control the patient if they stumble.
  7. Slick flooring.  Slippery floors should always be avoided for 8 weeks.
  8. Wound care.  There is no bandage placed on the incision.  There may be some bloody or blood-tinged discharge for the first 24 hours after surgery.  Discharge should be gently cleaned away from the skin with a water-moist cloth (no peroxide or alcohol).  If discharge is excessive, or lasts longer please contact us – we will want to recheck the patient right away. Creams and salves are not needed and should be avoided.
  9. Bruising.  There will be bruising around the incision and down the leg.  It may be red or darker.  This is normal and may increase for up to 2 days after surgery, then slowly resolve.
  10. Swelling.  It is not unusual to have some incisional swelling.  It should not be excessive or be fluid-filled.  On HIND LIMB surgeries, sometimes swelling will develop at the tarsus (ankle) region 48-72 hours after surgery.
  11. Massage. Begin with gentle massage of the surgical area, (including all the upper and inner thigh muscles) concentrating on edema (swelling) resolution, muscle relaxation, mobilization of soft tissues near the incision and gentle mobilization of the patella in all directions. Massaging should be done from the toes, working upward. 
  12. Licking.  Licking is NEVER OK.  Licking is bad for the incision and will prevent healing, or worse, cause the incision to open up and expose the surgery site to infection.  If you dog is licking, or you think might lick, you need to purchase an E-collar.  This is a large plastic cone that goes over their head and prevents access to the incision. 
  13. Rechecks. Return in 14 days or text a picture of the incision to us.  We usually like to see our patients for an x-ray at 4 weeks and 8 weeks after the surgery. 
  14. Doorbells.  Doorbells cause a sudden reaction from the dog that can lead to injury or breaking of the leg. Deactivation of doorbells is recommended during the recovery process. I also recommend putting up a sign that reads, “Day Sleeper-Do Not Disturb.”
  15. Diet. The patient can resume its normal diet the morning after surgery. Due to the anesthesia and epidural, it may be up to 72 hours before the patient defecates.

Post-Surgical Orthopedic Rehabilitation

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Signs of potential complications which warrant contacting the clinic include but are not limited to: persistent edema, acute pain, change in use of the affected limb, licking of the incision site, drainage, excessive swelling, or pain at the incision. 

It is very important that the patient not be allowed to run, jump or play until instructed by me to do so.  He/She should not be allowed outside, except under the control of a leash. 

– Dr. Bradberry, Advanced Veterinary Care