Bulldogs World

I'm doing some research on the TPLO surgery and after speaking with a new vet I decided to dig into it more and I have certainly found some interesting reading.  Thought I would post a portion from one article I found.

My vet has attended several seminars and conferences recently and she said the lecturers (orthopedic specialists) have stated that there are no studies that have shown that the TPLO surgery is any more successful then the Extracapsular Repair.  She felt that the TPLO was best used for field hunting type dogs who are running lots, very active dogs.  This was also the concensus of the first orthopedic surgeon who did Norbert's surgery some 11 years ago.  At that time the TPLO was relatively new and they did not have plates back then that would fit well on a bulldog.

So if you have to have a repair done it is important you weigh all the pros and cons and do your own research before you jump into the TPLO surgery.

 

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?
Slocum Enterprises quietly went out of business in the Summer of 2010.  No explanation was offered.  While the company is now defunct, there are still many vets pushing the highly profitable TPLO procedure.   

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. Costs involved in doing the procedure are very small relative to the price charged. A few hundred dollars worth of implants and one assistant in the operating room. 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. With between $2000 and $4000 US dollars in profit for each TPLO, the surgeon makes between two million and four million dollars in profit on 1000 TPLOs. This one type of procedure has tripled the income of a bunch of ortho-specialists.

With the Slocum Enterprises patent on TPLO 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 $3500? 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 price they charge for TPLOs. 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 very expensive. TPLO 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 encouraged 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:

--- 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 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?