Wang et al: Accuracy of fluoroscopy-guided osteotomy placement in TPLO: Postoperative tibial plateau angle and preoperative planning evaluation
Veterinary Surgery 7, 2025

🔍 Key Findings

Fluoroscopy-guided osteotomy placement achieved a median postoperative TPA of 3° (range: 0–4.5°), showing excellent accuracy.
The D1 measurement (from patellar ligament insertion to osteotomy exit) was more reproducible and accurate intraoperatively than D2.
Median R1 value (D1-based) matched the intended 21 mm radius with only 0.5 mm deviation, while R2 deviated by 2.5 mm.
Real-time fluoroscopy allowed dynamic limb positioning and reduced osteotomy placement variability.
Intraoperative fluoroscopy reduced reliance on preoperative planning, especially in cases with difficult anatomy or positioning.
Radiation exposure was minimal (avg. 3 images per case) and within safe limits using standard protection protocols.
Study standardized to 21 mm blades and excluded dogs with developmental orthopedic conditions to reduce confounders.
Targeting a lower postoperative TPA (3°) may reduce meniscal load and cranio-caudal instability, though long-term outcomes require further study.

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Wang et al: Accuracy of fluoroscopy-guided osteotomy placement in TPLO: Postoperative tibial plateau angle and preoperative planning evaluation
Veterinary Surgery 7, 2025

🔍 Key Findings

Fluoroscopy-guided osteotomy placement achieved a median postoperative TPA of 3° (range: 0–4.5°), showing excellent accuracy.
The D1 measurement (from patellar ligament insertion to osteotomy exit) was more reproducible and accurate intraoperatively than D2.
Median R1 value (D1-based) matched the intended 21 mm radius with only 0.5 mm deviation, while R2 deviated by 2.5 mm.
Real-time fluoroscopy allowed dynamic limb positioning and reduced osteotomy placement variability.
Intraoperative fluoroscopy reduced reliance on preoperative planning, especially in cases with difficult anatomy or positioning.
Radiation exposure was minimal (avg. 3 images per case) and within safe limits using standard protection protocols.
Study standardized to 21 mm blades and excluded dogs with developmental orthopedic conditions to reduce confounders.
Targeting a lower postoperative TPA (3°) may reduce meniscal load and cranio-caudal instability, though long-term outcomes require further study.

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Multiple Choice Questions on this study

In Wang 2025 et al., on TPLO osteotomy alignment, what was a potential **advantage of using intraoperative fluoroscopy** in challenging cases?

A. Allows for pre-surgical templating

B. Provides real-time adjustment for precise osteotomy alignment

C. Eliminates need for surgical planning

D. Improves bone healing rate

E. Removes need for surgical instrumentation

Answer: Provides real-time adjustment for precise osteotomy alignment

Explanation: Intraoperative fluoroscopy allowed dynamic limb repositioning and real-time targeting of the intercondylar eminence to improve alignment.

In Wang 2025 et al., on TPLO osteotomy alignment, what was the primary benefit of using intraoperative fluoroscopy?

A. Reduced surgical time

B. Improved limb muscle mass postoperatively

C. Decreased radiation dose to the patient

D. More accurate postoperative tibial plateau angle (TPA)

E. Prevention of implant migration

Answer: More accurate postoperative tibial plateau angle (TPA)

Explanation: Fluoroscopy-guided osteotomy placement led to a median postoperative TPA of 3°, with a narrow range of 0–4.5°, indicating high precision.

In Wang 2025 et al., on TPLO osteotomy alignment, what conclusion was drawn about fluoroscopy's impact on surgical variability?

A. It increases variability due to complexity

B. It eliminates the need for radiographs

C. Fluoroscopy reduces variability in TPA outcomes

D. Fluoroscopy leads to inconsistent bone cuts

E. It was not evaluated in the study

Answer: Fluoroscopy reduces variability in TPA outcomes

Explanation: Fluoroscopy led to a more consistent and narrow range of postoperative TPAs, reducing variability in surgical outcomes.

In Wang 2025 et al., on TPLO osteotomy alignment, which measurement was found to be more accurate intraoperatively?

A. D2 (perpendicular to tibial crest)

B. D1 (from patellar ligament insertion)

C. Both D1 and D2 were equally accurate

D. R3 (center to implant plate)

E. Tibial tuberosity width

Answer: D1 (from patellar ligament insertion)

Explanation: D1 showed a median R1 radius deviation of only 0.5 mm from the intended 21 mm, while D2 (R2) showed a 2.5 mm deviation.

In Wang 2025 et al., on TPLO osteotomy alignment, what was the **intended postoperative TPA** targeted in this study?

A. 5°–6.5°

B. 0°–2°

C. 3°

D. 7°–9°

E. ≥10°

Answer: 3°

Explanation: Surgeons aimed for a TPA of 3°, which is lower than traditional values, to potentially reduce meniscal contact force and cranio-caudal instability.

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