What Should I Ask the Veterinary Orthopedic Surgeon? Seven Questions for a Fifteen-Minute Consult

The specialist consult is short — fifteen or twenty minutes is normal — and left to itself it will be spent almost entirely on the procedure: what gets cut, what gets implanted, when the staples come out. All of that will also be in the discharge paperwork. What is not in any paperwork is the set of things only this conversation can tell you: your dog's specific anesthetic risk and what would lower it, who actually operates and who watches the recovery, this surgeon's own complication rate, what the recovery will demand of your household, and what the road without surgery honestly looks like. Those are the seven questions in this article. None of them is rude. All of them have answers.

Why do you have to ask at all?#

Because the published numbers cannot be specific about your dog, and the person in front of you can.

Here is the honest state of the evidence for TPLO, one of the most widely performed orthopedic procedures in dogs: reported complication rates run from 10% to 34%.^[1] That is a threefold spread. A spread like that is not a fact about the operation being a lottery. It is a fact about how much of the outcome lives outside the textbook — in which dog, which surgeon, which anesthesia service, and which household does the eight weeks afterwards. The same review says it plainly: the best available evidence suggests complications can be reduced with increased surgeon experience, careful surgical planning, and accurate execution.^[1]

Every variable in that sentence is something you are allowed to ask about. Almost nobody does. Owners arrive at a specialist consult as recipients of information, nod through a procedure description they will be given again in writing, and spend none of the fifteen minutes on the questions whose answers exist only in that room. This article is the list we would want in our own pocket.

One framing note before the questions: you are not auditing the surgeon. You are doing what the literature does — asking for base rates instead of impressions. A specialist who tracks outcomes has nothing to fear from any question below, and the rare one who bristles at all of them has answered a different question for you.

Question 1: Who exactly will be doing the surgery?#

Any licensed veterinarian may legally perform surgery — extra training is not required to offer it. A board-certified veterinary surgeon (DACVS — Diplomate of the American College of Veterinary Surgeons) has completed a minimum of a one-year internship followed by a three-year residency, published research, and passed the board examinations.^[2] You can check any name against the ACVS directory before the consult.

At a university or large referral hospital, add the follow-up: will a resident be operating? This is routine and it is not a scandal — at one veterinary teaching hospital, residents performed 71% of TPLOs, always under the direct supervision of a faculty surgeon. Resident-performed surgeries took about 54% longer (a geometric mean of 153 minutes against 99), with most of the improvement arriving after the first year of training.^[3]

Be careful what that number does and does not say. It measured duration, not outcomes — the study did not compare complication rates, and we know of no good evidence that supervised resident surgery produces worse results. Longer anesthetic time has been proposed as one contributor to infection risk after TPLO, but at least one study found no correlation between anesthesia duration and infection.^[1] So the honest use of this question is not to veto a teaching hospital — it is to know what you are consenting to, and to hear how the practice talks about it. "A resident may perform parts of it under my direct supervision, and I scrub in for the osteotomy" is a confident answer. Discomfort with the question is not.

Question 2: What is my dog's ASA grade — and can we improve it before surgery day?#

This is the single highest-value question on the list, because it converts the scariest number in the room from an average into a fact about your dog.

Before anesthesia, patients are assigned an ASA physical status grade — 1 for a healthy animal, up through 5 — and that grade predicts risk better than almost anything else. The largest study of anesthetic death in dogs, the Confidential Enquiry into Perioperative Small Animal Fatalities, followed 98,036 dogs across 117 UK practices. The overall risk of anesthetic and sedation-related death within 48 hours was 0.17% — about 1 in 601. Split by health status, the average dissolves: healthy dogs (ASA 1–2) died at 0.05%, about 1 in 1,849. Sick dogs (ASA 3–5) died at 1.33%, about 1 in 75.^[4]

The mortality number you have heard is an average of two different dogs: one in 1,849 for the healthy one, one in 75 for the sick one. The first question is which dog is yours — and unlike most fears at 2am, this one has an answer with a name.

Three follow-ups earn their place: What grade is my dog, and why? Is there anything — weight loss, stabilizing another condition, repeating bloodwork — that would move the grade before surgery day? And for an elective orthopedic procedure, is there any medical reason to prefer a date further out? Most orthopedic surgery is not emergency surgery. If two months of weight loss moves your dog toward the healthy column, that is a real risk reduction available for free, and it is exactly the kind of thing a fifteen-minute consult never volunteers unless asked. One number to know before that conversation: these UK figures are from 2002–2004 and practice standards have improved since — but the ratio between the healthy and sick columns is the durable lesson, and no newer study has overturned it.

Question 3: Who monitors the anesthesia — and who watches him after he wakes up?#

Owners fear the moment the dog goes under. The data points somewhere else: 47% of anesthetic-related deaths in dogs occur in the postoperative period,^[4] and the AAHA anesthesia guidelines put most of those in the first three hours after the procedure ends — which is why they state that monitoring of the recovering patient by trained personnel "should be maintained with the same vigilance" as during anesthesia itself.^[5]

So the question is not "do you monitor?" — everyone says yes. Ask it in three specific parts:

• During: who is dedicated to anesthesia while the surgeon operates, and what do they track? (The guidelines' core set: heart rate and rhythm, respiration, oxygen saturation, blood pressure, and body temperature.^[5])
• The first three hours after: who is physically with him, and how often are checks recorded?
• Overnight: is anyone in the building? This is the one that surprises people. Some excellent practices have no overnight staff and transfer surgical patients to a 24-hour facility; some keep them with periodic checks; some have continuous staffing. None of these is automatically wrong — but you should know which one you are buying before the morning you hand over the lead.

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Question 4: What is your complication rate for this procedure?#

Nobody publishes per-surgeon complication rates in veterinary medicine. There is no registry, no league table, no site to check. The only place this number exists is in the practice's own records and the surgeon's own honesty — which is precisely why it belongs in the consult.

The published background: 10–34% of TPLOs experience a complication of some severity, most minor; roughly 2–4% require revision surgery; reported infection rates run 0.8–14.3%, against the 1.5–2.6% expected for clean surgical procedures generally.^[1] Your surgeon's answer now has context: a claimed rate near zero over any real volume means complications are being defined narrowly, not prevented entirely.

Which is why the follow-up matters more than the headline number: "how do you count them?" A surgeon who counts every seroma and incision reaction will honestly report a higher rate than one who counts only returns to the operating theatre. What you are listening for is not a low number. It is a specific one, produced without defensiveness, with its definition attached — "about 12% overall the way we count them, mostly minor incision issues; call it 3% that need anything done under anesthesia again." That answer, in that tone, is worth more than any credential on the wall.

And ask it about this procedure and this dog's size band. Complication profiles differ between a 9 lb terrier and a 130 lb Newfoundland, and a surgeon's honest rate for the procedure they do weekly may not transfer to the one they do quarterly. If your dog's case is the quarterly kind, "how many of these do you do a year?" is the gentlest version of the volume question, and it is fair.

Question 5: What will the recovery ask of my household, week by week — in writing?#

Here is where we would spend whatever minutes remain, because this is the part of the outcome you own.

The pattern we have written about before as the second delay goes like this: the surgery succeeds, the dog starts looking better, everyone relaxes, and the rehab quietly stops — the prescribed lead-walks decay, the review appointment drifts, and a technically successful operation delivers half of what it could have. The defence against it is set up in this consult, not discovered in week five.

Restriction itself has a measurable price, which is worth hearing before you sign. In the placebo arm of a randomized trial of 100 dogs recovering from TPLO, eight weeks of standard post-surgical restriction cost the operated leg 1.21 cm of thigh circumference — and the leg that was never operated on lost 2.04 cm.^[6] Both hind legs of a restricted dog are shrinking through recovery. The restriction is still correct and still must be obeyed — but it is a treatment with a cost, and the prescribed short walks and controlled exercises are not optional extras on top of the plan. They are the part of the plan that limits the cost.

“Because your dog can't tell you how much pain he or she is in.”

So ask for the recovery as a document, not a verb: Can I have the week-by-week plan in writing — how many minutes of lead-walking at week two, week four, week six; what is forbidden and until when; and what are the review dates? Then ask the household questions the discharge sheet never covers: Can he do stairs, and if not, who carries a 70 lb dog to the garden at 6am? Which room does he live in for eight weeks? When can he be alone, and for how long? What would make you want to see him before the scheduled recheck?

A surgeon who hands you a dated, numbered plan has just told you something about their complication rate too. The practices that do the first thing tend to be the practices that earn the second.

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Question 6: What happens if we say no?#

This question does not offend surgeons either — and the answer you get is one of the most revealing in the whole consult.

There is, to our knowledge, exactly one randomized trial that has tested surgery against structured nonsurgical care for the commonest condition on this table. Forty overweight dogs with unilateral cruciate rupture were randomized to TPLO plus medical management, or medical management alone — and "medical management" meant something real: a weight-loss program, physical therapy, and NSAIDs, not a shrug and a lead. By the trial's objective definition of success (limb loading above 85% of a healthy dog's on a force plate, plus a ≥10% owner-scored improvement), the surgical group succeeded in 68%, 93%, and 75% of dogs at 12, 24, and 52 weeks. The nonsurgical group: 47%, 33%, and 64% — with only the 24-week difference reaching statistical significance.^[7]

Read both halves honestly. Surgery was clearly better at six months, and if a fast, reliable return to function matters — a working dog, a two-storey house, a second knee already suspect — that is the argument for it. And: nearly two-thirds of the nonsurgical dogs met an objective success bar by one year, in the specific population studied (overweight, large-breed), on a program that was actually delivered. Saying no to surgery is not saying no to treatment. It is choosing a different treatment with its own price tag of effort — the weigh-ins, the structured rehab, the months — and its own honest uncertainty.

Two cautions before you lean on that trial. It is 40 dogs, in one population, for one condition; it does not generalize to a luxating patella, a dysplastic hip, or a fragmented coronoid. And the slowest way to decide is to not decide — declining surgery and not delivering the conservative program buys the worst of both. We wrote about that trap, and about age as a reason not to operate, in is my dog too old for orthopedic surgery; the decision framework between procedures lives in TPLO vs total hip replacement.

So the question to bring: If we chose not to operate, what would properly done conservative management look like for this dog, what would you expect at six months, and what would make you want to revisit the decision? A surgeon who can describe the road they don't profit from, with the same specificity as the one they do, has earned a great deal of trust for question 4's answer too.

Question 7: What will this cost, all in — including the complication we hope not to have?#

Ask for the estimate to include: imaging, the procedure, anesthesia, hospitalization, medications, the standard rechecks with radiographs, and — this is the part that gets skipped — the practice's typical cost range if a minor complication needs treating, and what a revision would run. With a 10–34% chance of some complication and 2–4% of revision,^[1] the possibility is common enough to price before rather than after. If money is a genuine constraint on saying yes to surgery at all, say so in the room: staged approaches, payment plans, and the honest conservative-management conversation above all go better at the start than at the invoice.

The seven questions on one card#

The one purchase worth making before surgery day, and the one mistake in timing it#

Week one after orthopedic surgery is when you least want to be shopping, and the single most useful piece of gear on night one is also the one that takes days to arrive: something to hold your dog's back end up while he re-learns his legs — on the walk to the garden at midnight, over the doorstep, on the three steps you forgot your house had.

The free version first, and genuinely first: a bath towel folded lengthwise under the belly, one end in each hand, does the job for the first days and for many dogs the first fortnight. Its limits are real — it bunches, it presses on a male dog's plumbing on longer holds, and it needs both your hands. If your dog is small, or the restriction period is short, the towel may be the whole answer, and we would rather you find that out before spending anything.

Where the towel stops being enough — a bigger dog, an eight-week restriction, a handler with their own back to protect — a purpose-built sling is the upgrade. The GingerLead is the one we recommend: a padded support pad with handles and an integrated leash, and the manufacturer publishes a towel test that answers the sizing question for free — fold a towel to the candidate pad width and try it under your dog before you order.

The honest caveats we have published before still stand: the chest harness its own instructions expect for older dogs is not included, and the clean-return window is 10 days — short for a sizing-led product. That second one creates a genuine timing trap for the pre-surgical buyer: order it a month before surgery day and the return window closes before the first real use. The fix is to time the order to the pre-op appointment, about a week out, and run the towel test the day the box arrives — not the day the dog comes home. Our full week-one list, from flooring to the cone he will actually tolerate, is in the TPLO recovery gear checklist, and it applies with minor edits to most orthopedic procedures.

What to do this week#

If the consult is already booked: write the seven questions on a card or in your phone, in your own words, with question 2 first — the ASA answer shapes everything else. Bring your dog's current weight and a list of every supplement and medication, including fish oil, which can affect clotting and belongs in the pre-anesthetic conversation.

If the consult is not booked yet, book it. The consult is not the commitment — it is the information, and every week between the first quiet limp and the appointment is a week the joint spends getting worse and the muscle spends wasting. If you are still at the "is this limp even real" stage, start with our protocol for tracking a limp honestly and bring the file with you; the surgeon can do more with three weeks of your notes than with any adjective.

And after the yes, if it is a yes: put the review dates from the written plan into your phone before the surgery happens. The first delay — the one before the diagnosis — is behind you and cannot be shortened now. The second one, where the rehab quietly stops the week he starts looking better, is entirely yours to prevent, and it is prevented in fifteen minutes, in a consult room, by asking.

Sources#

1. Bergh MS, Peirone B. "Complications of tibial plateau levelling osteotomy in dogs." Veterinary and Comparative Orthopaedics and Traumatology. 2012;25(5):349-358. doi:10.3415/VCOT-11-09-0122 — review; 10–34% of TPLO procedures experience a complication and approximately 2–4% require revision surgery; reported infection rates 0.8–14.3% against 1.5–2.6% expected for clean surgeries; "the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure"; notes excessive anaesthetic time among proposed infection risk factors while citing one study finding no correlation between anaesthesia duration and infection rate.
2. American College of Veterinary Surgeons. "What is a Veterinary Surgeon?" acvs.org — board certification requires a minimum of a one-year internship followed by a three-year ACVS-approved residency, published research, and passing the board examinations; Diplomates carry the DACVS designation.
3. Niida A, Chou PY, Filliquist B, Marcellin-Little DJ, Kapatkin AS, Kass PH. "The impact of surgery resident training on the duration of tibial plateau leveling osteotomy surgery." Veterinary Surgery. 2024. doi:10.1111/vsu.14113 — 256 client-owned dogs; 10 residents performed 182 TPLOs (71%) under direct faculty supervision, 4 faculty surgeons performed 74; residents required 54% more surgery time (geometric least squares mean 153 vs 99 minutes); first-year residents 15% longer than second- and third-years; duration decreased significantly after the first year of residency and not thereafter. The study measured duration, not complication rates.
4. Brodbelt DC, Blissitt KJ, Hammond RA, Neath PJ, Young LE, Pfeiffer DU, Wood JLN. "The risk of death: the confidential enquiry into perioperative small animal fatalities." Veterinary Anaesthesia and Analgesia. 2008;35(5):365-373. doi:10.1111/j.1467-2995.2008.00397.x — prospective cohort of 98,036 dogs anaesthetized and sedated at 117 UK practices, 2002–2004; overall anaesthetic and sedation-related death risk in dogs 0.17% (1 in 601, 95% CI 0.14–0.19%) within 48 hours; healthy dogs (ASA 1–2) 0.05% (1 in 1,849); sick dogs (ASA 3–5) 1.33% (1 in 75); postoperative deaths accounted for 47% of dog deaths; the authors conclude greater patient care in the postoperative period could reduce fatalities.
5. Grubb T, Sager J, Gaynor JS, Montgomery E, Parker JA, Shafford H, Tearney C. "2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats." Journal of the American Animal Hospital Association. 2020;56(2):59-82. doi:10.5326/JAAHA-MS-7055 — between 47 and 60% of anesthetic-related dog and cat deaths respectively occur during the postoperative period, most within the first 3 hours; care and monitoring of the recovering patient by trained personnel "is critical and should be maintained with the same vigilance" as during the procedure; core monitored parameters include heart rate/rhythm, respiration, oxygen saturation, blood pressure, and body temperature.
6. White DA, Harkin KR, Roush JK, Renberg WC, Biller D. "Fortetropin inhibits disuse muscle atrophy in dogs after tibial plateau leveling osteotomy." PLoS ONE. 2020;15(4):e0231306. doi:10.1371/journal.pone.0231306 — prospective, randomized, double-blinded, placebo-controlled trial of 100 client-owned dogs after TPLO; in the placebo group (n = 48), thigh circumference fell 1.21 cm in the operated limb and 2.04 cm in the unoperated limb from week 0 to week 8. Funded by the supplement's manufacturer, which reportedly had no role in design, analysis, or publication decisions; cited here only for the placebo arm's restriction data.
7. Wucherer KL, Conzemius MG, Evans R, Wilke VL. "Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically." Journal of the American Veterinary Medical Association. 2013;242(10):1364-1372. doi:10.2460/javma.242.10.1364 — 40 client-owned overweight dogs with unilateral CCL rupture randomized to TPLO plus medical management or medical management alone (weight loss, physical therapy, NSAIDs); success defined as net ground reaction force >85% of healthy-dog values plus ≥10% improvement in owner questionnaire variables; success rates 68%, 93%, 75% (surgical) versus 47%, 33%, 64% (nonsurgical) at 12, 24, and 52 weeks; the between-group difference reached statistical significance only at 24 weeks.

This article is educational and does not replace veterinary advice. It is a list of questions to bring to a veterinary specialist, not a substitute for the specialist. If your dog suddenly cannot bear weight, cannot stand, or loses bladder or bowel control, that is a same-day veterinary problem, not a consult to schedule.