The Nuts and Bolts on Total Hip Replacement in Dogs

Feb 4, 2016 / Practitioner Updates

hip replacement

Canine hip dysplasia (CHD) is a common condition, especially in larger breeds, and is characterized by the femoral head having a poor fit in the acetabulum. This poor fit is a result of looseness or laxity in the hip, which leads to pain, osteoarthritis, and decreased limb function. Many things can contribute to the development of CHD, but genetics is by far the most significant factor.

Treatment options for CHD range from medical management to surgical procedures. Orthopedic surgeon Dr. Tisha Harper at the Veterinary Teaching Hospital says advances in technology, such as new surgical tools and materials, have made total hip replacement (THR) procedures an increasingly relevant option, even for very small dogs.

“A good candidate for THR will be at least skeletally mature and experiencing pain and mobility issues clearly attributable to CHD that medical management has failed to treat,” says Dr. Harper. Other conditions can present with similar pain and mobility signs, so it is crucial to confirm the CHD diagnosis before pursuing surgical treatment.

At four months of age a dog can be evaluated for the likelihood of developing clinical signs of CHD by estimating the degree of laxity in the hips using the PennHIP method. Dr. Harper feels preemptive screening of young dogs is a good idea in breeds that commonly develop CHD, “even if there is no immediate family history of the condition.” Certification of pets that are free of CHD can be done once the dog reaches two years of age by submitting hip radiographs to the Orthopedic Foundation for Animals.

THR offers a high chance of improvement in limb function and elimination of pain due to osteoarthritis. In comparison with a femoral head and neck ostectomy, THR provides a stronger and more resilient joint with a better range of motion, but carries a higher risk of infection.

hip xrayDr. Harper says THR is “the Rolls Royce of hip surgery.” Like a Rolls Royce, THR can be much more expensive than other options. The cost varies based on a variety of factors so it is important to get a quote when considering this procedure.

Dr. Harper stresses, “In situations where a total hip replacement isn’t possible because of cost or other factors, a femoral head and neck ostectomy is a viable option for any size dog. With intensive physical therapy, the procedure can be successful for even very large dogs.”

A THR procedure usually takes two to three hours, and the patient may need hospitalization for one to three days post-surgery. The recovery period is sometimes set as six to eight weeks, but Dr. Harper says, “A 12-week recovery period is much more effective to ensure proper healing.”

At six weeks the dog’s progress should be evaluated and the care instructions adjusted accordingly.

Dr. Harper cautions, “Dogs will often feel very good early on in the healing process and want to be very active. It’s easy for owners to see this and think all the prescribed recovery measures are not necessary. However, if the activity isn’t limited according to veterinary instructions, the dog will overuse the recovering limb. If the new hip luxates, the dog will have to go right back to surgery.”

CHD usually presents in both hips, but surgery can only be performed on one hip at a time, with a three- to six-month gap between procedures. Because surgery on a single hip may be sufficient to resolve the patient’s symptoms, the animal’s condition should be evaluated after the first procedure to determine whether a second surgery is required.

“Total hip replacement is a great option to be considered, but medical management should always be tried first,” advises Dr. Harper. “Canine hip dysplasia is generally part of a vicious cycle where a dog starts to feel discomfort so it is less active, which causes weight gain and weakening of the hind leg muscles. These issues increase discomfort, so the dog is even less active and the degenerative cycle continues.

“The trick is to break the cycle, if you can, with weight management, non-steroidal anti-inflammatory medication, joint protectors like glucosamine, and low-impact exercise to strengthen hind leg muscles.”

If medical management of CHD isn’t initially promising, surgery should then be considered “sooner rather than later,” according to Dr. Harper. If medical management does prove sufficient, the surgery can be cancelled. If surgery is required this helps ensure that the patient is “the best surgical candidate possible.” Delaying surgery increases the likelihood of severe muscle atrophy or total luxation of the hips at the time of surgery, which in turn make complications during recovery more likely.

—Irenka Carney