Research indicates that dogs are
born with normal appearing hips, and dysplasia develops over time. Surgery
for hip dysplasia is indicated when medical management no longer maintains
quality of life and function. Early detection of hip dysplasis is
key, most young dogs don't show signs of clinical hip dysplasia, or the owners
don't notice until the dog is a year of age, and then it's too late to do
any preventative procedures. The hope is that veterinarians and breeders
will screen their dogs.
Osteoarthritis is one of the most common diseases of dogs, affecting up
to 25% of all dogs during their lifetime, most often in the hip and knee.
The majority of osteoarthritis of the hip is due to hip dysplasia. This disease
is a result of genetics which lead to poor hip conformation and laxity and
subluxation (loose joints) while the dog is young. Medical management of
hip dysplasia and osteoarthritis include basic treatment principles:
Management of body weight
Nutritional supplementation
Moderation of exercise
Physical therapy
Medications
There are two types of early-intervention surgery that attempt to prevent
the progression of hip dysplasia in young dogs. These are Triple Pelvic Osteotomy
and Juvenile Pubic Symphysiodesis. These are designed to improve the integrity
of the hip joints when there are shallow hip sockets or significant joint-laxity.
They both act to rotate the acetabulum upward and outward, so it has greater
coverage and support for the head of the femur.
Both the TPO and JPS require the early identification of candidates for
surgery, before the bony changes of hip dysplasia occur. This creates a
problem, as there is no accepted diagnostic test designed to predict with
high certainty which dogs will develop debilitating hip dysplasia that will
require surgery. Several surgeons recommend early intervention surgery based
on a PennHIP measurement of laxity in young dogs. Dr. Gail Smith, professor
of orthopedic surgery at the University of Pennsylvania School of Veterinary
Medicine, believes that this is a misuse of the technique. “PennHIP was designed
as a selection tool to quantify a probability or risk factor for developing
later hip dysplasia,” says Smith, who developed the PennHIP method. “The technique
wasn’t designed as an indicator for surgery.” He feels that a dog being considered
for any type of hip dysplasia surgery should be demonstrating some clinical
symptom of the condition.
Surgical options include the following:
Triple Pelvic Osteotomy (TPO)
Triple pelvic osteotomy is a common and safe procedure that is usually
very well tolerated by dogs. In most cases they are walking on the operated
leg immediately after surgery. The goal of TPO is that your dog will be
out of pain, not need medications for pain management, and never need a
total hip replacement. TPO is a procedure that has been around for a couple
of decades. TPO is a more complicated and more expensive orthopedic surgery.
Recovery is longer, but the procedure is effective. With a triple pelvic
osteotomy (TPO), three cuts are made in the pelvis with a bone saw to isolate
the hip socket. It is then rotated and reattached with metal plates. This
surgery must be performed before any arthritic changes have begun. The window
of time to perform TPO is open slightly longer. Pups should be evaluated
at 5 to 6 months of age, and the procedure performed before there is any
joint degeneration.
Juvenile Pubic Symphysiodesis
JPS is a relatively minor surgery on the inexpensive end of the orthopedic
surgical spectrum. JPS involves cauterizing part of the pubic growth plate
to fuse it which forces rotation of the acetabulum to achieve better coverage
of the femoral head. The window of time for a successful result is small,
so pups should be evaluated at 3 to 4 months of age.
There are two accepted surgical procedures for removing the pain and lameness
caused by hip dysplasia, femoral head and neck excision, and total hip replacement.
Both of these surgeries are considered salvage procedures, as they remove
the arthritic bone-on-bone contact of the hip joint, thus relieving the pain
associated with it.
Femeral Head Osteotomy
FHO is an excellent option in small dogs (and cats). In this surgery the
ball of the ball and socket joint is removed. The hip then works by having
the leg supported by the muscles of the pelvis (gluteal muscles). Because
of their small body weight small dogs and cats tolerate this procedure very
well. It requires good muscle strength in the leg and buttocks since
these, rather than bone, provide the support. This procedure works
well in most dogs up to 50 pounds, though heavier dogs could also be helped.
Total Hip Replacement (THR)
Total hip replacements have been performed in thousands of dogs around
the world and the outcome is generally excellent in 85% to 90% of dogs. A
permanent and costly alternative for older animals that have already developed
arthritis secondary to hip dysplasia. Total hip replacement, while the more
aggressive surgery, works very well on affected dogs. The head of the femur
is replaced with a metal implant, and the acetabulum is replaced with a
synthetic plastic implant. With updated materials and techniques, dogs receiving
total hip replacement have few complications, and return to normal function
without pain.
The above information is simply informational. It's intent is not
to replace the advice of a veterinarian nor to assist you in making a diagnosis
of your pet. Please consult with your own veterinarian for confirmation
of any diagnosis. Your pets life may depend on it.
