When people take their dog
to an ortho-specialist vet, they expect a consultation with an expert who will provide them with the objective facts they
need to make a well-informed decision. But if the consultation is with the wrong surgeon, what they get instead may be a TPLO
sales presentation. The treatment of ligament injury in general, and their own dog's condition in particular, may be described
in a slanted manner intended to influence them to agree to have a TPLO or TTA done on their dog.
In searching for information
on TPLO or TTA, when you see articles that speak highly of TPLO or TTA, look to see who the author is and what his relationship
to these procedures is. Does he sell these highly profitable procedures? Chances are that he does. There
are many Class III and Class IV "studies" by TPLO & TTA surgeons which claim great outcomes for the surgeries which are
their bread & butter. This kind of article is not true research, but self-serving subjective opinion, as is explained
on this website's page titled "But The Vet Said...".
The problems that
can develop during and after a TPLO can be extremely serious.
---- All surgeries have risk,
but there are some especially nasty potential complications that are specific to TPLO surgery:
-- Cracking and splintering
of the bones where the metal plates are attached to bone with screws;
-- Persistent infections in
the bones;
-- Failure of the patellar
ligament due to increased stress on that ligament caused by the altered geometry of the joint.
-- Failure of the bone to
knit back together.
-- Further damage to the joint
menisci following the 'meniscal-release' often done in association with TPLOs.
(Please see the section
on 'Meniscal Release' on the 'Meniscus Info' page here at this website.)
-- Loosening of the metal
plates caused by backing-out of the screws after surgery or failure of the screws' attachment from crumbling bone or other
causes .
--Tibial tuberosity fracturing;
-- Spinal problems resulting
from the altered bone structure;
-- Increased cancer rates
associated with the metal implants.
-- And more.
With TPLO you have these risks,
plus the risks that unavoidably exist in all surgeries, and all without a potential outcome superior to other treatment options.
There is seldom a good reason to choose to subject your dog to these risks.
The
most reasonable first choice when dealing with most dogs' ligament injuries is non-surgical treatment.
---- This
is called 'Conservative Management' or 'Conservative Treatment'. Many dogs recover well from ligament injury without surgery.
Carefully restricting a dog's activity to prevent excessive stresses to the injured leg is the best possible diagnostic tool
to find out if the dog really requires surgery. A dog who improves over the course of 8 weeks of restriction and continues
to slowly improve is almost certainly not in need of surgery. There is more information on other pages here at
this website about the non-surgical treatment option.
---- For
some dogs with ligament injuries, non-surgical efforts will be ineffective, and then surgery will be appropriate. Conventional
stabilization surgery, done by an experienced and skilled vet, is the best choice for most dogs when surgery is needed.
Conventional surgery aims to stabilize the injured joint without altering the dog's bone structure. Conventional surgical
procedures are much less invasive and less expensive than TPLO. While not risk-free, they do not have the horrific potential
complications that are specific to TPLO. There is more information on conventional surgery and non-surgical treatment elsewhere
on this website.
When
you want to find the truth about the qualities and reliability of a car you're thinking of buying, you look
for objective evidence like that found in a 'Consumer Reports' review of the car. You don't just accept the statements
of the car salesman about the car. He will profit from your decision to buy. He wants to convince you to buy,
whether or not that is best for you. You need to recognize that the TPLO surgeon will make thousands of dollars profit
on the sale if he convinces you to get the TPLO. Be skeptical of a TPLO sales-pitch. When large profits for the provider
of a service are involved you need to be cautious about accepting his description of the situation as accurate.
--- There
are several websites that describe good experiences people had with their dogs' TPLOs. On these websites you often see secondhand
claims about TPLO, such as "My surgeon told me two-thirds of dogs he does TPLOs on have amazingly superior results and
the other third does well too!..." I think these are written by honest good-hearted people who are happy their
dogs recovered well. They haven't looked into the subject in any depth. They are simply repeating what they have been told
by TPLO surgeons. Don't fall into the trap of accepting this kind of claim as true because you read it on a nice person's
website. You need to look at the objective evidence, not the sales pitch. The sales-pitch may come directly from the surgeon
or be innocently repeated secondhand by a dog-loving person you feel friendly toward.
Demosthenes
said:
"Self-deceit comes easily.
For what each man wishes to be true,
he will readily accept as fact."
--- We would all like it to be true. When a surgeon recommends TPLO or TTA, we want very much to believe that there
is available to us a remarkably superior, very successful surgery for our dogs. We want to believe that if we just pay
a high price for this surgery then our dogs will recover wonderfully well. But the sales-pitch is not the truth.
TPLO & TTA success rates are not superior. These are extremely invasive procedures which have mediocre
success rates along with the potential for horrific complications.
Here's how Slocum Enterprizes, developer of the TPLO procedure, responded to an inquiry asking
for information regarding problems associated with TPLO:
--- Question "...I am interested in follow-up studies regarding the type and frequency of
problems encountered by surgeons while performing TPLOs, and also interested in information on post-op complications following
TPLOs..."
--- Answer from Slocum Enterprises:
"...To answer your question
regarding post-operative studies, there is no legal requirement between Slocum Enterprises and any veterinarian who performs
the TPLO procedure to report their surgeries and/or complications to us. ..."
--- Why would Slocum Enterprises take this position when asked about complications associated
with their TPLO procedure, providing no information about potential problems? Wouldn't you expect Slocum Enterprises
to be making all possible efforts to gather information on problems encountered during TPLO surgery? Wouldn't feed-back
about such problems and post-op complications make it possible to improve treatment? Why would they decide against gathering
such information?
--- Or is it possible that in fact Slocum Enterprises does compile such information, but then
keeps that information private under cover of a claim that the information was not legally required to have been gathered?
---- If a tire manufacturer reacted like Slocum Enterprises when asked about problems with
their tires, what would you think was the likely reason?
Consider what orthopedic experts who are not selling TPLOs say:
Here is a quote taken from an email written by Gail Smith, Professor of Orthopedics and Department Chairman
at the University of Pennsylvania Vet School:
"... [In regard to TPLO there is a] virtual absence of research
to show that this highly invasive and expensive method has any benefits whatsoever in post operative clinical function over
other less invasive and expensive methods. I have taken a stand early in my career to avoid endorsing procedures that are
not evidence-based ...and TPLO is a classic case of surgeons ... jumping on the bandwagon without adequate investigation to
demonstrate the purported benefits of the procedure.
Sincerely, Gail"
[Gail Smith - Professor of Orthopedic Surgery; Chairman, Dept of Clinical Research, University
of Pennsylvania Vet School]
--- I think there is one main reason those vet-surgeons Professor Smith refers to "jumped on the TPLO
bandwagon". That reason is money. TPLO is a very high-profit procedure. It would not be realistic to believe that this
very large profit potential could not influence surgeons' treatment recommendations.
---- Training to do TPLO is a few
hours and a few hundred dollars at Slocum Enterprises' training facility. Or a vet can simply buy a teaching DVD from Slocum,
watch it, spend several thousand dollars buying from Slocum Enterprises the special saw and other equipment required and he's
ready to do the surgery. Costs involved in doing the procedure are very small relative to the price charged. There is a huge
profit.
---- The TPLO procedure usually takes less than one hour. (Some vets have been known to do 6 or more a day.) Surgeons
commonly charge well over $2500 and sometimes over $4500. It is not at all unusual for an ortho-surgeon vet to do over 1000
TPLOs in a few years as part of his practice. If we use an estimate of $2000 in profit for each TPLO (and that's a very low
estimate of the average profit), the surgeon makes two million dollars in profit on 1000 TPLOs. This one type of procedure
has tripled the income of a bunch of orthopedic specialist vets.
With
the Slocum Enterprises patent on TPLO now expired, TPLOs are being sold at a lower price by some surgeons in some locations.
This does not make TPLO a better choice.
---- When I first looked into ligament injury treatment, I assumed that a TPLO must be a very time-consuming
operation which required expensive specialized equipment. Why else would it cost over $3000? But I learned that a TPLO didn't
take long to do, and the equipment & training costs to the surgeon were modest. Why the high cost to dog owners then?
The TPLO surgeons I talked with could offer no good explanation for the cost. In my opinion the explanation for the high price
is that Slocum Enterprises originally set up the marketing of the patented TPLO with high profits for surgeons built-in in
order to attract ortho-specialists to adopt the procedure, and that pricing has usually been maintained (unofficially with
a wink and a nod) among TPLO surgeons since the patent expired. It is easy for surgeons to market this procedure at this high
price because dog owners love their dogs and are easily convinced that the high cost means it is a superior procedure. People
are inclined to trust medical professionals. If an ortho-specialist vet tells them TPLO is the best, they seldom question
his motives. The high price can even be a selling point. "You love your dog and want the best? The
surgeon recommends TPLO and it is quite expensive. Must be good if it costs so much, eh?"
---- TPLO's profitability has fueled its popularity among vet-surgeons.
The very high profit in TPLO surgery has led to a great increase in a special kind of risk for dogs. The risk of being subjected
unnecessarily to a very invasive surgery which involves the possibility of horrific complications. Some dogs are maimed and
crippled by TPLO surgeries when they would have recovered well without any surgery or with a less invasive surgical procedure.
This happens because there are thousands of dollars of profit in every TPLO.
---- Some TPLO surgeons are truly despicable in their willingness to put dogs at
risk with inappropriate TPLOs. In my email I often hear from people who have been given a sales-pitch for a clearly
inappropriate TPLO procedure. For example, sometimes dogs have a limp but recover well while waiting a few weeks for
an appointment with an ortho-specialist. Quick recoveries like that indicate the dogs had minor injuries for which no
honest vet would recommend surgery. But when seen by the TPLO surgeon they may be diagnosed as needing TPLOs.
It seems that there are a number of TPLO surgeons who try to sell TPLOs to everyone who comes through their office door.
In fact, you don't need to come through the door to get the sales pitch from some of them. I hear of dogs diagnosed
over the phone as needing TPLOs ("Limping? Needs a TPLO then. Lets set up a surgery appointment right now on the phone.")
And people write me that they have had surgeons try to frighten them into agreeing to the surgery by telling them that they
must choose between TPLO and amputation. Or in other cases that they must choose between TPLO and euthanasia.
---- All this malpractice is brought about by the extremely high profit
in each TPLO / TTA.
Dogs' best interests are not served by their people blindly trusting
that all vets have as their primary concern the welfare of dogs. There are vets who are building fortunes on the combination
of people's love for their dogs and misplaced trust.
Just look at the facts and think it through:
--- Can anyone point to real evidence that TPLO should be
preferred for some reason except in the rare circumstances described lower on this page? Can anyone show any reason to believe
TPLO is a generally superior treatment option for ligament injury? That is, show real evidence from objective studies, rather
than opinion-piece pseudo-research articles from ortho-surgeons who have made millions doing TPLOs?
--- Can anyone believe some TPLO surgeons are not profiteering?
Does anyone think several thousand dollars is a reasonable profit for vets who do this procedure in an hour?
--- Can anyone believe that the excessively high profits
made doing TPLOs aren't a factor in ortho-surgeon vets' recommendations?
--- Could referral fees paid by TPLO surgeons to general
practice vets influence them to send ligament-injured dogs to the TPLO surgeons?
You may be thinking:
----"My
vet isn't like that. He wouldn't send Fido to a TPLO surgeon unless he believed it was best."
---- You may be right that your vet is not someone who would
do this kind of thing to dogs for money. Many honest vets mistakenly favor TPLO. It is true that improvement in leg
use in the first few weeks after TPLO or TTA will be better than with non-surgical treatment or conventional surgery.
Longer-term results are not superior with these very invasive procedures, and the risks of serious complications are
much greater, but this rapid improvement in the short-term may have influenced your vet's opinion of the procedures.
---- Also, general-practice vets depend on specialists to
be the experts in their fields. If the ortho-specialist vets they know are saying "This TPLO is a great procedure!"
then many general-practice vets will just accept that as true. To see the problem with TPLO, they would need to first recognize
that greed could be effecting some ortho-specialists' views of treatment. Then they would need to dig into the professional
literature with an eye to weeding out the subjective, self-interest-based articles while looking for evidence-based objective
research in order to find the truth. GP vets are very busy with their patients and can't keep up with what's new in dozens
of different specialized areas. They depend on ortho-specialists to be knowledgeable and objective in recommending treatment
for this kind of injury. So it's easy for claims to be made by specialists and accepted by your regular vet. Your vet could
honestly believe that TPLO is preferable for dogs based on what TPLO surgeons have told him.
---- The surgeons who convinced him may have tripled their
incomes and become millionaires doing TPLOs. It is not hard to understand why some ortho-specialists see TPLO so favorably.
If a plumber working for one hour makes
ten times the profit installing sink 'B' as he does installing sink 'A', which sink will he tend to think of most favorably?
Which sink is he most likely to recommend? Plumbers and surgeons are equally human and equally likely to see what
is best for themselves as being best overall. When the plumber tells you "Sink 'B' is a great sink!", he may
really believe it. His opinion of sink 'B's attributes has been effected by self-interest. Even honest surgeons'
opinions may be effected by self-interest in the same way. A TPLO takes about an hour to do and results in several thousand
dollars profit for the surgeon.
"TPLO is a great procedure!"
Great for who?
What you must do to make the
best decisions for your dog is to be skeptical about the expressed opinions of anyone who will profit from your acceptance
of their recommendations. When the profit will be large, your skepticism should also be large. We automatically do this
in most situations where someone wants to sell us something. But we tend to trust medical professionals more than
we should.
---- The trust we place in vets
and our expectation that medical professionals will not be influenced by profit help create this situation. The surgeons who
recommend and do inappropriate high-profit surgeries bear the most responsibility. But we, as our dogs' decision
makers, are also at fault. Blindly trusting that a surgeon's treatment recommendation is not effected by the profit
he makes on the procedure is not wise. We should know better.
"...Medical history is littered with once-popular
procedures that subsequently proved ineffective or dangerous. ..."
---A quote from Consumer Reports
'On Health'
