TPLO Surgery: Post-Operative Care Guidelines for Dogs

At Pittwater Animal Hospital (PAH), we want your dog to have the best possible recovery following TPLO surgery. This procedure is one of the most successful treatments for dogs with cranial cruciate ligament (ACL) injuries, providing long-term knee stability and helping dogs return to an active, comfortable life.

Successful recovery depends on careful home management, appropriate pain relief, controlled exercise and regular veterinary follow-up. These guidelines will help you understand what to expect during each stage of your dog’s recovery.

Day of Surgery – Going Home

Most dogs can return home on the evening of their TPLO surgery, provided they have recovered well from their anaesthetic and are comfortable.

We encourage dogs to recover at home with their families, where they can settle in a familiar, quiet environment. Our veterinary team will provide detailed discharge instructions, medications and advice on managing the first night.

Pain management: A nerve block is placed in the operated leg during surgery. This provides excellent pain relief but may leave the leg temporarily numb or difficult to use.
Rest: Keep your dog somewhere quiet, comfortable and secure, with non-slip flooring and no access to stairs or furniture.
Supervision: Your dog may still be a little unsteady following anaesthesia, so assist them when getting up and going outside to toilet.

Overnight Veterinary Care at NEVS

If your dog requires additional monitoring, or you are concerned about managing them at home, we can arrange overnight care at NEVS (Northside Emergency Veterinary Service).

We organise transport from PAH to NEVS, where your dog receives overnight veterinary monitoring, pain relief and nursing care. Your dog will then return to PAH the following morning for discharge. Any additional costs will be explained beforehand.

Going Home – Medications

Your dog will be discharged with an individual medication plan, which our veterinary team will explain.

Depending on your dog’s needs, medications may include:

Antibiotics – if prescribed following surgery
Anti-inflammatory medication – to reduce inflammation and provide pain relief
Additional pain relief – such as opioid medication or paracetamol where appropriate
Anti-anxiety or calming medication – to help active or anxious dogs settle during the restricted recovery period

Not every dog requires every medication listed above. Please follow the instructions on your dog’s individual medication labels and contact PAH if you have any questions.

Do not give additional pain relief or human medications unless specifically directed by your veterinarian.

First 48 Hours After Surgery

Your dog may be sleepy or a little unsettled following surgery, with the effects of anaesthesia and pain relief sometimes lingering into the following day.

Keep your dog calm, comfortable and indoors, with clean, soft bedding.
Offer small meals initially to reduce the chance of nausea.
Provide fresh drinking water.
Allow only brief, controlled toilet walks on a lead, using a belly sling for support if required.
Prevent jumping, running, stairs and access to furniture.
If tolerated and recommended, apply a wrapped cold pack to the surgical area for 5–10 minutes twice daily during the first few days.
Monitor the operated leg for swelling, bruising or discharge. Mild swelling and bruising can occur, sometimes extending towards the ankle.

Please contact PAH if your dog becomes increasingly painful, refuses food, develops worsening swelling, has discharge from the wound or seems unwell.

For urgent concerns outside our opening hours, contact NEVS on 9452 2933

Wound Care and Protective Collars

Preventing your dog from licking or chewing the surgical wound is extremely important.

Do not allow licking: This can cause infection, bleeding or breakdown of the surgical wound.
E-collars (cones): These are usually essential until the wound has healed. Doughnut collars may be suitable for some dogs, but only if they completely prevent access to the surgical site.
Bandages: Routine bandaging is not generally required. In some cases, we may apply a special PAH knee bandage.
Adhesive dressing: A sticky dressing is usually applied at surgery. Follow your discharge instructions regarding removal. If the dressing is firmly attached, do not force it off.
Keep the wound dry: Avoid bathing or swimming until the surgical wound has healed and your veterinarian has approved these activities.

Your dog’s wound will be examined at the post-operative check, usually around 10 days after surgery.

Feeding and Weight Management

It is common for dogs to have a reduced appetite for the first day or two following surgery.

Offer smaller meals initially, returning gradually to their normal feeding routine.
Some dogs may not have a bowel movement for a couple of days following surgery.
Contact us if your dog is repeatedly vomiting, refuses food beyond the expected recovery period or has difficulty urinating.

Weight management is particularly important during TPLO recovery.

Because your dog’s activity will be significantly reduced, their daily calorie requirements may also decrease. We may recommend reducing food portions to avoid weight gain, depending on your dog’s weight, body condition and normal activity level.

Excess weight places additional strain on both knees, so maintaining a healthy body weight is important for long-term recovery.

Follow-Up Appointments at PAH

Your dog’s routine postoperative appointments, Cartrophen course and six-week sedated X-rays are included in our all-inclusive TPLO surgical package.

We particularly value these follow-up visits, as they give our veterinary and nursing team regular opportunities to assess your dog’s comfort, mobility and progress during recovery.

Approximately 10 Days After Surgery – Veterinary Check

Your dog returns for a veterinary examination of the surgical wound, assessment of mobility and suture removal if required.

The first Cartrophen injection is also given at this appointment.

Four Weekly Cartrophen Injections

Our usual course consists of four weekly injections:

Week 1: First injection at the approximately 10-day veterinary check
Week 2: Second injection with a veterinary nurse
Week 3: Third injection with a veterinary nurse
Week 4: Fourth injection with a veterinary nurse

Cartrophen is used to support joint health and help manage osteoarthritis.

These regular nurse visits are also an excellent opportunity to discuss your dog’s exercise, comfort, medications and any concerns about recovery.

Six-Week Follow-Up X-rays – An Appointment with Your Dog

At approximately six weeks after surgery, your dog returns to PAH for an important examination and X-rays.

This is usually booked for 8 am and takes approximately 60–90 minutes. You stay at the hospital throughout the appointment.

Your dog is sedated so we can obtain accurately positioned X-rays of the operated knee.

Once the X-rays are completed, the sedation is reversed and your dog is returned to the consultation room. You can then watch your dog recover before taking them home.

Our reception team will organise the appointment beforehand and explain the necessary preparations, including fasting instructions.

The X-rays are sent to specialist surgeon Dr Eugene Buffa, who assesses the healing bone and surgical implants.

Once his review is available, we will advise you on the next stage of rehabilitation and when exercise can safely increase.

Activity Restriction – The First Six Weeks

TPLO surgery involves cutting and repositioning the tibia (shin bone) and securing it with a metal plate and screws.

The implants stabilise the bone while healing takes place. Excessive movement during this period can cause serious complications.

We recommend crate confinement during the first six weeks when your dog is not directly supervised.

Your dog can still go outside for short, controlled lead walks as part of their rehabilitation.

Provide a comfortable crate or secure confinement area.
Keep your dog calm and indoors between walks.
Use a belly sling if additional support is needed.
Prevent jumping, running, rough play, access to furniture and uncontrolled stair use.
Use non-slip mats on slippery floors.
Allow only carefully controlled lead walking and approved rehabilitation exercises.

Some dogs may need calming medication to help them settle during this period. Please contact us if you are struggling to manage an active or anxious dog.

Rehabilitation Timeline

Every dog recovers at a slightly different rate. Your dog’s comfort, muscle strength, healing and specialist’s recommendations will determine when exercise can safely increase.

First 72 Hours to Three Weeks

Your dog may initially be reluctant to place weight on the operated leg. Some dogs start using the leg soon after surgery, while others take longer.

Begin with slow, controlled lead walks of approximately five minutes, two to three times daily, if comfortable.
Use a belly sling to assist if your dog is not yet weight-bearing well.
Gradually increase walking duration by approximately one minute every few days as comfort improves.
Walks can increase towards 15 minutes if your dog is progressing well.
Gentle hindlimb massage may be helpful if tolerated.

Your dog must remain confined between walks, with no running, jumping or rough play.

If your dog becomes suddenly more lame or develops increasing pain, please contact PAH.

Four to Six Weeks After Surgery

By this stage, some dogs are walking comfortably for 15–20 minutes on a slow, controlled lead.

Depending on progress, we may introduce:

Gentle uphill walking for up to five minutes
Sit-to-stand exercises, initially five repetitions and gradually increasing towards ten
Slow figure-eight walking, beginning with wide turns
Continued controlled lead walking

These exercises should be introduced only if your dog is comfortable and they have been recommended by your veterinarian or physiotherapist.

Your dog must remain on lead, with no running, jumping or uncontrolled activity.

Six-Week X-rays – An Important Checkpoint

At six weeks, your dog returns for sedated X-rays to assess bone healing and the surgical implants.

Dr Eugene Buffa reviews these images before we advise you on increasing exercise.

Reaching six weeks does not automatically mean your dog is ready for more demanding activity.

Six to Eight Weeks After Surgery

Once the specialist has reviewed the X-rays and cleared your dog for increased activity, the following may be introduced gradually:

Lead walks increasing towards 30 minutes
Short periods of controlled trotting in a straight line
Carefully supervised stairs, beginning with a small number
Gentle zigzag walking on an incline
Slow obstacle walking
Sit-to-stand exercises, increasing repetitions as tolerated

Some dogs may also be cleared for short, controlled off-lead walking.

If specifically approved, this may begin with approximately five minutes in a safe, enclosed environment, following a normal lead walk. Duration can then increase gradually according to comfort and specialist recommendations.

Off-lead walking does not mean unrestricted running or playing. Ball chasing, jumping and vigorous play with other dogs must still be avoided.

Eight Weeks to Six Months

Your dog can gradually build strength, endurance and confidence as rehabilitation progresses.

Exercise increases should remain controlled and appropriate to your dog’s healing.

Running after toys, jumping and rough play with other dogs should be avoided until your dog has completed sufficient rehabilitation and has been cleared to return to these activities.

Full Recovery – Approximately Six Months

By approximately six months, most dogs have a strong, stable knee and can return to normal activities, including running, swimming and play.

Although TPLO surgery provides excellent long-term stability, it cannot reverse arthritis already present in the knee. Maintaining a healthy weight and good muscle strength remains important throughout your dog’s life.

Dogs with cruciate disease in one knee are also at increased risk of developing disease in the opposite knee.

Professional Rehabilitation and Physiotherapy

We strongly recommend considering professional animal physiotherapy following TPLO surgery.

A qualified rehabilitation practitioner can develop an individual exercise program that considers your dog’s age, size, fitness, muscle strength and rate of healing.

This is particularly helpful for dogs experiencing muscle loss, delayed recovery or additional joint problems.

We recommend the following local practitioners:

Madi at Paddling Paws

Fran at Three Monkeys Rehab

Please follow PAH’s recommendations regarding when particular rehabilitation activities, including hydrotherapy, can safely begin.

TPLO Surgery Post-Operative Care FAQ

Can my dog come home the same day as their TPLO surgery?

Yes. Most dogs return home on the evening of surgery, provided they have recovered well from their anaesthetic and are comfortable.

We encourage dogs to recover at home in familiar surroundings and provide detailed medication and home care instructions.

If your dog requires additional monitoring, particularly if they have other health conditions, need more intensive pain management or have had a slower anaesthetic recovery, we can arrange overnight care at NEVS.

We can also arrange overnight care if you are worried about caring for your dog at home. Our team will discuss the most appropriate option and any additional costs with you.

What medications will my dog go home with?

Your dog will receive an individual medication plan depending on their needs.

This may include:

Anti-inflammatory medication for pain and inflammation
Additional pain relief, including opioid medication or paracetamol when appropriate
Antibiotics as prescribed
Calming medication to help your dog settle during recovery

Our veterinary team will explain all medications, their dosing instructions and when to start them before discharge.

If you run out of pain relief or calming medication and feel your dog would benefit from continuing treatment, please contact PAH. Additional medication can be supplied following veterinary approval.

What happens if my dog licks the wound?

Licking can cause infection, bleeding or breakdown of the surgical wound, delaying healing.

An E-collar (cone) is usually essential until the wound has healed. A doughnut collar may be suitable for some dogs, but only if it completely prevents access to the surgical site.

Will my dog's leg be bandaged?

Not usually. Routine bandaging is generally unnecessary and can sometimes cause complications.

In selected cases, we may apply a special PAH knee bandage.

An adhesive dressing is usually placed over the surgical wound. Follow your discharge instructions regarding dressing care and removal.

Why is movement so restricted after TPLO surgery?

TPLO involves cutting and repositioning the tibia and securing it with a metal plate and screws.

The bone needs several weeks to heal around the implants. Excessive activity during this period can damage the repair or delay healing.

We recommend crate confinement during the first six weeks, together with short, controlled lead walks and approved rehabilitation exercises.

Even after six weeks, exercise must increase gradually according to bone healing and specialist advice.

How should I restrict my dog's movement at home?

Small dogs: A suitably sized crate is ideal during the initial six weeks.
Larger dogs: A large crate or appropriately secured confinement area may be suitable, depending on your dog’s size and temperament.
Belly sling: Useful for supporting your dog when getting up or walking outside.
Non-slip flooring: Use mats or carpet runners to help prevent slipping.
All dogs: Avoid running, jumping, rough play, uncontrolled stairs and off-lead exercise during the initial healing period.

We recommend confinement when your dog is not directly supervised and can advise you on the best arrangement for your home.

When can my dog go for a walk?

Your dog can begin with very short, controlled lead walks for toileting soon after surgery.

As they become more comfortable, short walks of approximately five minutes, two or three times daily, may be appropriate.

Walking duration can gradually increase by approximately one minute every few days, towards 15 minutes during the first three weeks if your dog is progressing comfortably.

Gentle strengthening exercises may be introduced during weeks four to six according to veterinary or physiotherapy advice.

All exercise must remain controlled and on lead during the first six weeks.

What follow-up care does PAH provide after TPLO surgery?

Our all-inclusive surgical package includes routine follow-up care and four weekly Cartrophen injections.

Approximately 10 days after surgery: A veterinary examination of the wound and recovery, suture removal if required, and the first Cartrophen injection.

Three further weekly nurse appointments: Your dog receives the remaining Cartrophen injections. These visits also provide a great opportunity for our nursing team to monitor recovery, check comfort and answer your questions.

Six-week X-rays: Your dog returns to PAH for sedation, X-rays and sedation reversal. The images are sent to specialist surgeon Dr Eugene Buffa for review.

All these routine appointments are included in your TPLO surgical package.

What happens at the six-week X-ray appointment?

Your dog’s six-week X-rays are usually arranged as an 8 am appointment lasting approximately 60–90 minutes.

You stay at the hospital during the appointment.

Your dog is sedated so we can obtain accurately positioned X-rays of the operated knee. Once the X-rays are completed, the sedation is reversed.

Your dog is then returned to the consultation room, where you can watch them recover before taking them home.

Our reception team will organise all the details beforehand, including fasting instructions.

The X-rays are sent to specialist surgeon Dr Eugene Buffa for review. Once he has assessed the healing bone and implants, we will advise you when and how to increase your dog’s exercise.

When can my dog be off lead again?

Your dog must remain on lead during the first six weeks following surgery.

At approximately six weeks, we take X-rays to assess bone healing. Once the specialist has reviewed these images, we can advise on safely increasing exercise.

Some dogs may be cleared for short, supervised off-lead walking during the following weeks, starting with approximately five minutes in a safe, enclosed environment.

This does not mean unrestricted activity. Running, jumping, chasing balls and playing with other dogs must still be avoided until your dog has recovered sufficiently and has been cleared for these activities.

Most dogs are approaching full recovery by approximately six months.

When is my dog fully recovered?

Most dogs recover extremely well following TPLO surgery.

Bone healing occurs over the first several weeks, followed by gradual strengthening and rehabilitation.

By approximately six months, most dogs have a strong, stable knee and can return to normal activities, including running, swimming and play.

Can the implant break or cause problems?

Implant complications are uncommon but can occur, particularly if a dog slips, falls or undertakes excessive activity before the bone has healed.

Other possible complications include infection, delayed bone healing or irritation associated with the implants.

If your dog develops sudden or worsening lameness, pain or swelling, please contact PAH for advice.

Is physiotherapy helpful after TPLO surgery?

Yes. We strongly recommend professional animal physiotherapy following TPLO surgery.

Professional rehabilitation can help rebuild muscle strength, improve joint movement and support a safe return to normal activity.

Some gentle exercises can begin early in recovery, while more demanding activities must wait until adequate healing has occurred.

A physiotherapist can develop an individual program suited to your dog’s age, size, activity level and progress.

What if my dog has had surgery on both knees?

Many dogs that undergo TPLO surgery on both knees regain excellent mobility and return to a comfortable, active life.

Recovery depends on each dog’s general health, arthritis, muscle strength and rehabilitation.

Can my dog injure the other knee later?

Yes. Unfortunately, dogs that develop cruciate ligament disease in one knee are at increased risk of developing the same problem in the opposite knee.

This may happen months or even years after the first injury.

Maintaining a healthy weight, good muscle strength and appropriate exercise can help protect both knees.

Who can I contact for rehabilitation support?

We recommend three experienced local rehabilitation practitioners:

Tim at Both Ends for the Lead