HIP SURGERIES

WHAT ARE THE SURGICAL TREATMENT OPTIONS FOR HIP DYSPLASIA?

There are three primary surgical procedures used to address hip dysplasia. These include Triple Pelvic Osteotomy (TPO), Femoral Head and Neck Ostectomy (FHO), and Total Hip Replacement. The type of treatment appropriate for your pet will depend on several factors including age, severity of hip dysplasia, degree of arthritis and lifestyle.

1. Triple Pelvic Osteotomy (TPO): Triple Pelvic Osteotomy is an option for young dogs, ideally less than 12 months of age, with mild lameness and no evidence of arthritis on radiographs (x-ray). The pelvic bone is cut in three places and rotated to create tighter fit between the femoral head (ball) and acetabulum (socket).

2. Total Hip Replacement (THR): Total Hip Replacement is a surgical option for dogs 1 year and older. Like in humans, the ball and socket are replaced with metal and plastic implants and fixed in place either via “press fit” or bone cement. The implants replicate the mechanics of a normal hip joint and allow for pain free motion and a normalized gait. Exercise and activity must be limited for at least 6 months following this procedure to allow for optimal recovery. After the recovery period, many of these dogs are able to return to athletic activities like running with their owners, hunting and high-level obedience.

3. Femoral Head and Neck Ostectomy (FHO): This surgery can be performed in dogs of all ages but is most effective in dogs weighing less than 60 ponds. The femoral head and neck (ball) are removed to eliminate the painful contact between the damaged cartilage of the hip joint. After the surgery, the body forms a “false joint” with scar tissue and the muscles surrounding the hip area. Ultimately, dogs will walk well on the limbs after recovering from this surgery, but joint range of motion is always limited. Exercise is encouraged beginning as early as 2 weeks after the surgery, but high-level athletic activities are never possible as these dogs do better with limited, low-impact exercise.

IS ONE PROCEDURE RISKIER THAN THE OTHERS?

Chances that your pet will be able to return to normal activities after DPO and THR are very good. Because both procedures use implants, there is a risk for post-operative complications. Infection, implant “loosening”, hip dislocation, nerve injury and changes in hip range of motion may occur. Your pet’s activity will need to be restricted leash walks when outside and confined to a small area inside for at least 8 weeks after surgery. Stairs, slippery surfaces and interactions with other dogs should also be avoided. Most pets will feel better soon after surgery because their pain has been alleviated, so it is important they are not allowed to over-use or injure the limb until it has fully healed. After the initial period of restriction, you will be guided on how to slowly increase activity.

While there are no implants that may cause a problem after the FHO procedure, infection, nerve damage and slow return to function are potential complications. Recovery rate is variable depending on size, age and chronicity of pain and lameness prior to surgery. Pets are encouraged to use the limb in a controlled manner as soon as possible. Optimal outcomes are typically achieved with rehabilitation. It takes time for the “false joint” to form, so your pet may not place weight on the limb for as long as 6 weeks or longer following surgery.

No matter which surgery is selected, it is important for all pets who have undergone one of these procedures to maintain a lean body weight throughout their lives.

WHAT IS A HIP LUXATION? DOES THAT MEAN MY PET HAS HIP DYSPLASIA?

Hip luxation occurs when the head of the femur (ball) is dislodged from the acetabulum (socket). Dislocation damages the joint capsule, ligaments and sometimes bone. Hip luxation most commonly occurs with trauma; however, pets with underlying hip dysplasia have an increased risk of developing spontaneous hip luxations.

WHAT CAN I EXPECT AFTER HIP LUXATION SURGERY?

Several weeks are needed to allow the body to heal the damaged structures surrounding the hip joint and to protect the repair. It will be important to restrict your pet’s activity for at least 6-8 weeks following the injury. Once the area has healed, controlled re-introduction of activity will be necessary for muscle re-strengthening and improving weight bearing on the limb. Post-operative complications that may occur include re-luxation of the hip joint, implant loosening/failure, temporary nerve damage, and infection.

HOW IS HIP LUXATION TREATED?

There are three main methods of treating hip luxation: closed reduction, surgical reduction, Femoral Head Ostectomy (FHO) or Total Hip Replacement (THR).

1. Closed reduction: The hip is replaced manually under anesthesia and kept in position using a sling or hobbles. Closed reduction is rarely successfully for the most common form of hip dislocation.

2. Surgical reduction: There are different methods of surgically repairing hip luxation and restoring the joint. VOMC uses a toggle method to surgically stabilize the hip following luxation. The chance for long-term success is high and many pets can begin placing weight on the limb soon after surgery. For this procedure, a bone tunnel is drilled through the femoral head (ball) and neck and a second hole is drilled though the acetabulum (socket) on the pelvis. Synthetic suture is then used to reconstruct the damaged ligament that normal connects the femoral head to the socket.

3. Femoral Head Ostectomy (FHO) or Total Hip Replacement (THR): One of these options is selected if hip joint repair is not possible or underlying Hip Dysplasia is present. See the section above for specific information about each procedures.

MOST OF THESE PROCEDURES REQUIRE ME TO RESTRICT MY PET'S ACTIVITY. IS THAT REALISTIC?

We understand that even the best patients are not always fully cooperative with exercise restriction, and it can seem like an impossible undertaking. The time at VOMC will help guide you during this period of time. It is important to remember that a few weeks/months truly is a short time compared to your dog’s total lifetime. Perseverance and patience during the post-operative period eventually leads to a great outcome in most patients.