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 25-28 September, 2018 | Singapore
ice/compression units.When the post-operative TPLO patient presents to rehabilitation in our practice, the patient is still recovering from anesthesia. We assess the patient thoroughly, and using the objective data, create a problem list. For the typical TPLO patient this list will appear as follows:
Pain, Muscle Atrophy, Skin Incision, Joint Swelling, Osteotomy, Implant, Decreased ROM: stifle and tarsus, Hip Flexor Shortening. From this problem list, we create a narrative or assessment: 9 year old M/I Golden Retriever with 4 week history of LPL lameness presents immediately post-op with pain, atrophy of the muscles of the thigh and crus (mild), skin incision (staples), joint swelling with heat, radiographic evidence of osteotomy repaired with plate and screws, decreased ROM stifle (loss of approximately 25 degrees of flexion compared to R side) and tarsus (loss of 25-30 degrees of flexion compared to R side), loss of flexibility in hip flexors (moderate compared to R side).
This assessment provides the framework from which the therapist creates the treatment plan, based upon the functional goals for this patient. We may wish for ‘normal’ ROM for all joints in our patients, but for many, this is
not a functional or achievable goal. For the 9-year old Golden Retriever in this example, moderate OA in hips, stifles and tarsi might preclude his obtaining ‘normal’ ROM. The therapist’s goal for this patient is to reach ROM’s that are functional and realistic. In our example here, the functional goals would be:
Pain control, symmetrical muscling, healed skin incision, elimination of joint swelling, healed osteotomy, functional ROM in stifle and tarsus, and functional flexibility at
the coxofemoral joint.The treatment plan to achieve these goals will address each goal separately. Pain control will be addressed through use of TENS and cold compression. These will be applied immediately post operatively. Once pain is controlled, muscle atrophy can be addressed using NMES to create co-contractions of the quadriceps group and the hamstrings simultaneously, so no joint motion occurs during this acute phase. The skin incision is treated with laser daily to speed healing, and cold compression is applied to prevent swelling and pain. Joint swelling is addressed via manual therapies, specifically Grade 1-2 joint mobilizations. NMES and laser are used to decrease swelling as well. The osteotomy is treated via extracorporeal shock wave therapy prior to extubation, repeated at the time of suture removal, and again at the 4-week post op visit when initial radiographs are obtained. Weight bearing across the osteotomy is encouraged via early weight shifting exercises.Range of motion issues are treated using manual therapies. The stifle is treated with Grade 1-2 joint mobilizations until
the swelling and discomfort are resolved. Grade 2-3 mobilizations are then applied as needed. Therapeutic exercises to increase ROM include work over cavaletti
poles. Tarsal ROM issues in TPLO dogs can be more challenging to resolve due to their often long-standing nature. Here, Grade 3-4 joint mobilizations are employed to gain joint capsule lengthening. Hip flexor shortening is treated via stretches and soft tissue mobilization techniques to the iliopsoas, tensor fascia latae, and rectus femoris.In conclusion, treating post-operative TPLO patients requires a thorough evaluation of their orthopedic as well as soft tissue impairments, creating
a problem list, generating a list of functional goals for each of the impairments, and carrying out a treatment plan that addresses each of the goals. The temptation is to look for ‘protocols’ to treat these commonly-seen patients, however, each patient recovers at their own rate, and they do not ‘read the book’ on how fast they are ‘supposed’ to reach each level of recovery. Creative problem solving, attention to detail, and focusing upon creating and meeting goals that are functional for each patient will result in superior results.

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