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The Veterinary Medical Center of CNY is among a small percentage of veterinary facilities in the United States offering Total Hip Replacement (THR) surgery. Total Hip Replacement is offered as a potential treatment for canine hip dysplasia.
For pets suffering from this crippling disease, Total Hip Replacement offers:
- Relief from pain
- improved hip function
- allows the pet to return to an active life style.
Please refer to the Frequently Asked Questions below for details about Total Hip Replacement. Veterinarians are encouraged to contact the VMC surgical service directly for additional information.
The VMC will offer Total Knee Replacement (TKR) beginning in summer 2007. The VMC will be among a select group of facilities in the United States to offer this procedure in a clinical setting.
Total Hip Replacement FAQs
What is Hip Dysplasia?
What are the Clinical Signs of Hip Dysplasia?
What are the Current Treatment Options for Hip Dysplasia?
What is Canine Total Hip Replacement?
Why choose a Total Hip Replacement?
Can both hips be treated with Total Hip Replacement?
Is My Dog a Candidate for Total Hip Replacement Surgery?
What Can You Tell from X-Rays?
How Long Will my Dog be Hospitalized?
My pet currently takes medication. Should I stop giving medication prior to the surgery?
What will your pet experience prior to the surgery?
What Happens in the Operating Room during THR Surgery?
What will your pet experience after the surgery?
What is the cost of the surgery?
What is the Recommended Post-Operative Care following THR?
What About Post-Operative Check-Ups?
What Can I Expect from Canine THR Surgery?
What is the Success Rate for Canine Total Hip Replacement?
What are the Potential Complications of THR?
Do Total Hip Replacements "Wear out" in Dogs?
How do I make an appointment for THR?
What is Hip Dysplasia?
Hip Dysplasia (HD) is a genetic condition that results in abnormal development and growth of the hip joint. In most dogs, both hips are affected, although one hip may be more severely affected than the other. There is usually some degree of looseness (laxity) in the hip joint. With time, this laxity leads to damage of the joint surfaces and the development of arthritis.
What are the Clinical Signs of Hip Dysplasia?
The most typical presenting features of a dog with Hip Dysplasia are lameness and hip pain. The severity of the symptoms can be highly variable, ranging from subtle abnormalities in the dog’s stride pattern to more obvious signs such as stiffness and reluctance to exercise. Although the disease is present at birth, it may take several years for dogs to develop the clinical symptoms that prompt a visit to the veterinarian. However, young dogs with severe disease may become symptomatic within the first 6 months of their life.
What are the Current Treatment Options for Hip Dysplasia?
Most dogs with hip disease will initially be managed with conservative (non-surgical) therapies such as pain relieving medications and perhaps physical therapy. Dogs that do not respond to these approaches, or that require long-term mediation, may need to be referred for surgical management.
There are several surgical options for managing Hip Dysplasia. The choice as to which is most appropriate is influenced by:
- the age of the dog
- the severity of hip disease
- the nature of the dog’s daily activities (working dog versus pet)
- financial considerations
Young dogs (6-12 months of age) with dysplastic hips but minimal signs of arthritis are candidates for a reconstructive procedure known as triple pelvic osteotomy (TPO), in which the bones of the pelvis are realigned to provide a more stable articulation of the hip.
Older dogs, or those with significant arthritic changes, are not candidates for TPO but are potential candidates for total hip replacement (THR). THR is a reconstructive procedure that is intended to provide your dog with a stable, pain-free hip and normal hip function.
Currently, the only surgical alternative to total hip replacement involves removal of the diseased part of the femur (femoral head ostectomy, or FHO) and replacement of the joint with scar tissue that will stabilize the hip. However, femoral head ostectomy (FHO) is considered a salvage procedure and the clinical results are not as good as those with Total Hip Replacement (THR). We do not recommend FHO surgery for most dogs with Hip Dysplasia.
What is Canine Total Hip Replacement?
Total hip replacement (THR) is a surgical procedure in which the natural ball and socket joint of the hip is replaced with artificial implants that serve the same function (i.e. to create smooth and pain-free movement of the joint). In the case of the dog, the ball (actually the head of the femur, or thigh bone) is replaced with a metallic implant while the socket (the acetabulum) is replaced with a plastic cup that is made from medical-grade ultra-high molecular weight polyethylene (UHMWPE). The implants are available in multiple sizes so that the surgeon can ensure an adequate fit and correct tensioning of the joint at the time of surgery. As in human THR surgery, the implants are typically attached to the surrounding bone with bone cement.
Why choose a Total Hip Replacement?
THR is performed to relieve pain, improve hip function, and allow your dog to return to an active life style. The diseased joint is replaced with the implant to eliminate the pain resulting from bone rubbing on bone in the arthritic joint. The reduced motion of the arthritic joint is also corrected, allowing your pet to regain a full range of motion in the operated limb.
Can both hips be treated with Total Hip Replacement?
For some dogs with disease in both hips, THR in the more severely affected limb can provide sufficient improvement in hip function to eliminate the need for surgery on the second leg. For dogs with intractable pain in both hips, the more severely affected hip would be replaced first and surgery on the second hip would then be performed 2-3 months later.
Is My Dog a Candidate for Total Hip Replacement Surgery?
If your dog has Hip Dysplasia, is over 9 months of age (with growth plates fully developed) and weighs more than 30 pounds, he/she is likely to be a candidate for THR surgery. As with any medical or surgical decision, the first step will involve a thorough diagnostic work-up. Our surgical team will evaluate your pet’s medical and surgical history, perform a complete physical examination (including both orthopedic and neurological examinations) and obtain X-rays and blood samples for laboratory analysis. Your pet’s health will be comprehensively evaluated to determine whether your pet is a good candidate for this surgery. Post-surgical physical rehabilitation is a key aspect of recovery for dogs receiving a total hip replacement. A formal plan for physical rehabilitation will be thoroughly explained to you during the initial consultation. It is essential that you understand and are prepared to commit to post-surgical physical rehabilitation. Inability to fulfill physical rehabilitation requirements may remove a dog from consideration for this surgery.
What Can You Tell from X-Rays?
X-rays are very helpful in determining the extent of disease in the affected hip joint(s) and in ruling out the presence of disease in other parts of the skeleton (e.g. spine problems) that may impact your dog’s suitability for THR surgery. We also use X-rays to measure the dimensions of the skeleton so that we can select implants of an appropriate size for your dog.
How Long Will my Dog be Hospitalized?
Your pet will be admitted to the hospital the day before the surgery. The delay is necessary to observe your pet for other signs of infection and to begin a course of pain medications. After surgery, your pet will stay in the hospital for a further 2-3 days to allow us to monitor the surgical site and ensure that he/she is tolerating the pain medications. The average hospital stay is approximately four to five days.
My pet currently takes medication. Should I stop giving medication prior to the surgery?
It is important to provide our veterinarians with complete information regarding your pet’s medication, including nutritional supplements, vitamins and other nutraceuticals. Some medications should be administered continuously throughout your pet’s stay with us, while other types of medications should be discontinued prior to surgery. Our surgeon will provide you with specific instructions based upon your pet’s individual needs.
What will your pet experience prior to the surgery?
- Your pet will spend the night prior to the surgery at the VMC. The VMC provides comfortable bedding and strives to make your pet as comfortable as possible.
- On the day of surgery, an intravenous catheter will be placed in your pet’s foreleg by a skilled licensed veterinary technician. This catheter allows for administration of fluids and medications, with only the mild discomfort of a needle prick when the catheter is initially placed.
- After the catheter is placed, your pet will receive a combination of medications designed to relax and sedate.
- Additional medications will be administered throughout the preparatory and operative process to prevent pain during the procedure and throughout the recovery period. The VMC of CNY has a comprehensive pain protocol that addresses each aspect of a patient’s pain – our goal is to prevent pain altogether, not to manage it after it has been exhibited.
- When the surgeons are ready for your pet, stronger medications will be administered through the catheter which will cause your pet to lose consciousness. Inhalant anesthesia will be introduced, and the surgical preparations (clipping and cleansing of the surgical area) will begin. Your pet will be kept in a fully anesthetized, unconscious state until the surgery is complete.
What Happens in the Operating Room during THR Surgery?
Two veterinary surgeons will work together to perform this complex surgery on your pet. Your pet will also have the benefit of a highly trained surgical support team, consisting three licensed veterinary technicians (LVTs) and two trained surgical assistants, performing the following duties:
- One LVT to prepare your pet for anesthesia, then prepare the surgical site
- One sterile and scrubbed LVT to directly assist the veterinarians with the procedure itself
- One masked and gowned LVT to monitor your pet’s vital signs, such as heart rate, heart rhythm, respiratory rate, tissue perfusion, blood gases, blood pressure, and temperature while under anesthesia
- One surgical assistant to ensure appropriate availability of instrumentation and other supplies.
What will your pet experience after the surgery?
Your pet will regain consciousness in a controlled, comfortable environment. Your pet will be assigned one highly trained LVT or surgical assistant to stay with and monitor your pet until your pet has fully recovered from anesthesia. Your pet will be monitored for any signs of pain, discomfort, or anxiety and will receive appropriate medications to increase the overall comfort level. Many pets begin using the affected limb within twenty-four hours after surgery.
What is the cost of the surgery?
The total cost of the surgery is approximately $TBA. This includes the laboratory tests, X-rays, anesthesia, surgical fees, cost of the implants, medications and hospitalization.
What is the Recommended Post-Operative Care following THR?
Following the VMC’s plan for your dog’s postoperative care is critical to the long term success of the surgery. The surgical incision should be monitored for any evidence of redness, swelling or discharge. Licking or chewing at the incision is absolutely prohibited and placement of a special collar may be necessary to discourage this. Suture removal will be performed 10 to 14 days after surgery.
The activity level of your pet must be very strictly controlled. Although the cement that secures the implants will cure within 24 hours of surgery, the soft tissues around the new hip joint take several weeks to heal. This means your pet must be prevented from running or jumping around. Stairs should be avoided if at all possible. We will provide you with specific methods of negotiating stairs based upon your individual situation. Solid, non-slip flooring is also important, especially during the first month after surgery. Slick floors should be avoided or covered with rugs. Jumping on and off furniture must also be strictly avoided.
During the first month, you can take your dog out on a leash for short periods (5 – 10 minutes only) to urinate and defecate. When not under your direct supervision, your dog should be confined to a small area where no jumping or running can occur – a large airline crate is best. From weeks 6 to 12, the periods of leash walking can be increased (up to 30 minutes total daily). By 12 weeks after surgery your dog should be able to return to full function.
What About Post-Operative Check-Ups?
Sutures (or staples) will be removed 10-14 days after surgery. At that time, we will check that the wound is healing satisfactorily and confirm that the new joint is stable. At 6 weeks post-surgery, we will ask you to bring your dog in for X-rays to confirm that everything is healing as expected. Assuming that all is well, we will discharge your dog to the care of your referring veterinarian. If we identify any concerns, we may recommend a course of physical therapy to accelerate healing and functional recovery.
We recommend annual X-rays for the lifetime of your dog. These X-rays will be made under sedation and will not require general anesthesia. X-rays can be scheduled either with us or with your referring veterinarian. In the event that you elect to have follow-up X-rays performed by your local veterinarian, we would ask to be sent copies of the X-rays so that we can continue to monitor your dog’s recovery.
What Can I Expect from Canine THR Surgery?
Dogs usually start to walk on their new hip the morning after surgery. Most pet owners report that their dog's personality improves because their hip pain is eliminated. Full recovery of hip function will typically take between 8 and 12 weeks. Long-term clinical studies have confirmed the value of THR in treating degenerative hip disease, with most dogs displaying marked improvement in walking, sitting, climbing stairs, running, jumping into cars, playing and exercising following surgery. THR surgery is also very effective in working dogs, with many animals returning to normal work duties after surgery.
What is the Success Rate for Canine Total Hip Replacement?
Total hip replacements have been successfully performed in canine patients since 1974 and have enjoyed excellent results. Over 95% of patients return to normal function after the surgery. Most dogs will run, jump, play normally, and have an improved quality of life.
What are the Potential Complications of THR?
As with any surgery, there is always a possibility of complications either during or after surgery. The risk of infection, implant loosening, technical problems, and anesthetic complications can never be totally eliminated but we do everything we can to minimize these risks in our patients.
Do Total Hip Replacements "Wear out" in Dogs?
Modern implant materials are expected to survive 10-20 years in adult humans. If the implants wear, they can be replaced in a second surgery (known as revision surgery). In dogs, there have been very few cases of revision surgery for implant wear. The current design of canine THR implants should be expected to survive the lifetime of the average canine patient.
How do I make an appointment for THR?
Typically, your veterinarian makes the initial recommendation for THR. Our surgical service welcomes and encourages your veterinarian to consult with us regarding any potential THR candidates. After your veterinarian has referred your pet to the VMC of CNY for a consultation, an appointment is scheduled with our surgical service. During the initial consultation, our surgeon will determine if your dog is a possible candidate for THR, and will create a plan for additional diagnostic tests. Radiographs (x-rays) and other laboratory tests may be completed on the same day as the initial consult. An appointment date for the surgical procedure will be made when the results of the diagnostic testing have been thoroughly analyzed.
Links
www.ACVS.org
www.biomedtrix.com
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