Q1. Why do we need another cruciate technique?
A. Both TPLO and TTA have their drawbacks. TPLO by radial cut uses an inefficient radial saw leading to thermal necrosis and the technique does not necessarily neutralise the shear forces within the stifle under load. TPLO by wedge osteotomy shortens the tibia slightly and the pull of the straight patella ligament tries to open up the osteotomy. TTA effectively neutralises the shear forces in the stifle but by creating a large defect in the cranial tibia requiring expensive implants to stabilise. TTO addresses all of these issues. By using a little TPLO and a little TTA it achieves the angular correction without a radical change in the anatomy of the stifle. The small wedge is protected from the pull of the straight patella ligament and does not cause tibial shortening. Healing is rapid and the post op complication rate is low. Implant failure is not seen.
Q2. Will I get better results with TTO?
A. The outcomes with TTO are similar to other tibial plateau altering techniques. The rapid healing resulting from clean osteotomies which leave small gaps to fill minimises post operative complications.
Q3. Do I need to be an orthopaedic specialist?
A. You do need to be a competant orthopeadic surgeon. If you are comfortable with your fracture work, TTO is within your competancy.
Q4. I have heard that infections can be a problem with TPLO waht about TTO?
A. The relatively high number of post TPLO (radial cut) infections has been attributed to the degree of soft tissue clearing and damage necessary to expose to osteotomy site. The radial cut blade and in particular the user sharpened biradial blade is very inefficient which creates more heat than sharp (semi disposable) flat blade Dead bone caused by thermal necrosis is much more susceptible to infection than healthy bone.
Q5. What if the the osteotomies fracture? Will I end up with three floating fragments?
A. The single most common complication of TTO is fracture at the end of one of the osteotomies. The fracture occurs during the manipulation of the osteotomies. Repair is straight forward by pin and tension band wire (tibial crest osteotomy) or by plating (wedge osteotomy) and does not affect the outcome.
Q6. I would like to revise a lateral suture using TTO, will the hole for the lateral suture in the proximal tibia be a problem.
A. If the hole is large or infected you should remove the lateral suture and let the hole fill with both and treat any infection prior to TTO. 6 weeks should be enough.