Eight-week postoperative tibial plateau leveling osteotomy radiographs do not change the prescribed management plan...

To determine how frequently routine 8-week tibial plateau leveling osteotomy (TPLO) radiographs resulted in a change to the prescribed postoperative management plan when evaluated by surgery residents versus senior clinicians, and how often the resident and senior clinician plans differed.

In this prospective interobserver agreement study, dogs that presented for a routine 8-week TPLO evaluation at a single veterinary referral hospital between October 2024 and July 2025 were eligible for enrollment. Three evaluators (2 senior clinicians, 1 surgical resident) independently performed physical examinations (PEs) and later reviewed each dog's radiographic evaluation (RE). After each PE and RE, each evaluator documented their findings and management decision on standard forms. A Cohen κ score was used to evaluate interrater reliability for PE and RE management choice.

97 dogs (291 evaluations) were enrolled. Corresponding PE and RE recommendations were consistent in most cases (173 [59.5%]). The elected case management plans after each evaluation differed more often for senior clinicians (45.4%) than residents (30.5%). Interrater reliability for overall, PE, and RE prescribed management plans were fair (κ = 0.2233), fair (κ = 0.2252), and slight (κ = 0.1965), respectively. Patellar desmitis (99 [34.2%]) was the most common radiographic finding, but rarely resulted in a different management plan (18 [18.2%]).

Management plans based on PE and RE evaluations were inconsistent, with REs resulting in prolonged exercise restriction in up to 40.5% of dogs.

Clinicians should weigh the costs and risks associated with routine radiographs against their anticipated protocol changes until practical guidance about the clinical impact of common radiographic findings is available.