Hip Dysplasia, Total Hip Replacement & Femoral Head Osteotomy at Saint Francis

February 18, 2019

Osteoarthritis From Canine Hip Dysplasia

dog-hip_dysplasiaCanine hip dysplasia is a developmental disorder in which the hip joint is abnormally shaped. Because of the altered biomechanics of the hip joint, osteoarthritis develops early, causing significant pain and disability.

Hip dysplasia is a deformity of the hip that occurs during growth. The hip joint is a “ball and socket” joint. During growth, both the “ball” (the head of the femur or thighbone) and the “socket” in the pelvis (acetabulum) must grow at equal rates.

In hip dysplasia, this uniform growth during puppyhood does not occur. The result is laxity of the joint, followed by degenerative joint disease (DJD) or osteoarthritis (OA), which is the body’s attempt to stabilize the loose hip joint.

The degree of lameness that occurs is dependent on the extent of these arthritic changes, and may not be correlated with the appearance of the hip joint on X-rays. Some pets with significant signs of hip dysplasia or osteoarthritis on X-rays may not exhibit any clinical signs, while others with minimal changes may experience severe pain and lameness.

What causes it?

There are two primary causes of hip dysplasia, genetics and diet. The genes involved in hip dysplasia have not been conclusively identified, but it is believed to involve more than one gene. Advances in nutritional research have shown that diet also plays an important role in the development of hip dysplasia. Large breed (generally greater than 50 lbs) puppies should be kept at a normal, lean weight during growth, rather than overfed and encouraged to grow “big.”

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One study of puppies at-risk for hip dysplasia found that when fed as much as they wanted to eat, two-thirds of the puppies went on to develop hip dysplasia, while only one-third of puppies fed measured meals suffered from hip dysplasia. A study of German shepherds found that overweight puppies were almost twice as likely to develop hip dysplasia as their normal-weight counterparts. These studies have allowed food manufacturers to develop specially formulated diets for large breed puppies.

If it is hereditary, are certain breeds affected more than others?

Yes, although any dog can be affected, it is predominantly seen in larger dogs such as German Shepherds, Saint Bernards, Labrador Retrievers, Golden Retrievers, Old English Sheepdogs, Bulldogs, etc. Large mixed-breed dogs are also at risk for developing hip dysplasia and should be fed a special large breed growth diet the first year.

What symptoms should I look for?

Weakness and pain in the hind legs are the usual clinical signs. The dog appears wobbly and is reluctant to rise from a sitting or lying position. Some dogs will limp or be reluctant to climb stairs. These signs can be seen in puppies as early as a few months old but are most common in dogs one to two years of age. Dogs with mild hip dysplasia on X-rays may develop minimal arthritis without clinical signs until they are older. In fact, although hip dysplasia begins in puppyhood, most dogs don’t develop clinical signs until they are older. It often takes years of gradual bone degeneration until a dog becomes symptomatic.

How is it diagnosed?

A hip radiograph under general anesthetic is the preferred method for diagnosing hip dysplasia. Clinical signs and palpable joint laxity may also indicate hip dysplasia. Any pet suspected of having hip dysplasia should be radiographed as soon as possible.

What is the treatment?

degenerative_myelopathy_in_the_dog-1_-_2009This depends upon the pet’s clinical signs and amount of discomfort. There are very effective non-steroidal anti-inflammatory drugs (NSAIDs) that have minimal side effects. The choice of medication is made on an individual basis, and various drugs may be tried before finding the most effective one.

Most dogs with hip dysplasia should receive veterinary-approved glucosamine, chondroitin sulfate, and omega-3 fatty acid nutritional supplements. Many dogs with painful hip dysplasia will benefit from polysulfated glycosaminoglycan injections on a regular basis. Moderate daily exercise, avoiding high impact activities such as jumping, may help keep the patient mobile and strengthen surrounding support structures. Physical therapy has been demonstrated to be highly effective at improving an affected dog’s quality of life and should be part of any treatment regimen. Since excess weight puts undue stress on the hip joints, weight loss is strongly recommended in overweight dogs.

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What if NSAIDs don’t help?

The alternative to NSAID and medical therapy is surgery. There are several surgical procedures available to treat hip dysplasia. The two most common surgical techniques for hip dysplasia are total hip replacement and femoral head ostectomy (FHO). Other less common surgical procedures used to treat hip dysplasia include triple pelvic osteotomy (TPO), juvenile pubic symphysiodesis, and DARthroplasty. The choice of surgery will be determined by your pet’s age, condition, and lifestyle.

What about alternative medicine treatments?

Acupuncture, class 4 laser, stem cell treatments, and traditional Chinese medicine have all been used to treat hip dysplasia with varying results. To date, rigorous scientific studies on these alternative therapies have been sparse, although some are very encouraging in small studies. Talk with your veterinarian about their experiences and recommendations for complementary medical procedures to help your dog.

Total Hip Replacement

The hip joint is a ball and socket joint. The ball is at the top of the thigh bone (femur), and the socket (acetabulum) is in the pelvis. Total hip replacement surgery removes and replaces both the ball and socket with prostheses. Most canine hip replacement prostheses have a metal ball at the top of the femur that fits into a dense plastic socket. The prostheses are generally held in place using special bone cement. Some surgeons place hip prostheses that use no bone cement. These are referred to as “cementless” implants. At the moment, there appears to be no distinct advantage between cemented versus cementless implants for the total hip replacement.

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How do I know if my dog is a good candidate for total hip replacement?

She needs to be in good overall health with no other bone disease, nerve disease, or other serious medical conditions. Her skeleton must be mature so she must be finished growing. This typically occurs between 9 and 12 months of age, sometimes later in giant breed dogs. A board-certified veterinary surgeon will be able to evaluate your dog clinically, evaluate her x-rays, and her hip function in order to guide your decision making.

How will my dog be prepared for her total hip replacement, and how long will she be in the hospital?

Most commonly, dogs having a total hip replacement will have thorough examination and a blood screening profile to prepare for general anaesthesia. If she is cleared for surgery, she will spend 3 to 5 days in the hospital to get her healing off to a good start. Approximately 90 – 95% of dogs who have a total hip replacement do very well and end up with excellent function. All surgery carries an element of risk, but your dog’s surgeon will do everything possible to prevent any problems. Hip dislocation, loosening implants, infection, and nerve damage are uncommon complications that can usually be successfully treated.

What about post-operative care for my dog?

Once your dog is released from the hospital it will be critical to ensure that she leaves her incision alone to prevent infection and speed healing. Stitches or staples will be removed in 10 to 14 days. Comprehensive pain management is also critical to get healing off to a good start. Your veterinarian can answer your questions about what’s best for your dog.

Physical rehabilitation with a credentialed canine rehabilitation practitioner should begin shortly after surgery. Strict activity restriction at home, along with crate confinement when she is unsupervised are very important. The rehabilitation practitioner will guide you about gradually increasing your dog’s activities as healing progresses. Most dogs are ready for full activity within 3 months.

Because both of her hips are affected, will she need surgery on both hips?  How long must I wait between surgeries?

Approximately 80% of dogs with osteoarthritis in both hips only require one total hip replacement in order to enjoy good comfort and function. Your veterinarian, the veterinary surgeon, and you will work together to determine which hip should be operated on first, and then to decide if the second hip needs to be replaced as well.

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Femoral Head Ostectomy (FHO) in Dogs

What is FHO surgery?

An FHO, or femoral head ostectomy, is a surgical procedure that aims to restore pain-free mobility to a diseased or damaged hip, by removing the head and neck of the femur (the long leg bone or thighbone).

How does an FHO change the hip?

The normal hip is a ball-and-socket joint. The acetabulum, which is a part of the pelvis, composes the socket of the joint. The head of the femur, a projection from the long bone located between the hip and the knee, composes the ball that fits within the socket. The head of the femur fits within the acetabulum, allowing the hip to move freely in all directions.fho_surgery_dog_hip_joint-01

When the hip becomes damaged or diseased, however, this mobility can be affected. If the acetabulum and the head of the femur do not fit together properly, this poor fit can influence the degree of movement that the joint can achieve. In addition, this poor joint fit can lead to chronic pain and inflammation.

An FHO restores mobility to the hip by removing the head of the femur. This removes the ball of the ball-and-socket joint, leaving just an empty socket. The muscles of the leg will initially hold the femur in place and, over time, scar tissue will form between the acetabulum and the femur to provide cushioning that is referred to as a ‘false joint’. Although this joint is anatomically very different from a normal hip joint, it provides pain-free mobility in most patients.

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Is my dog a good candidate for FHO?

This procedure is primarily recommended for small dogs (under approximately 50 pounds) and cats, especially those who are at a healthy weight. The false joint that is created in a FHO works very well to support the weight of small animals, but may be less effective in large-breed dogs. There are exceptions, however, and veterinarians may sometimes recommend an FHO even for a dog over 50 pounds if the specifics of the case dictate that doing so would be appropriate.fho_dog

Active dogs often experience better results with FHO than less-active dogs. The muscle mass that has been built up through activity helps to stabilize the joint, allowing the dog to regain pain-free mobility more quickly than inactive pets. Inactive dogs have less muscle mass around the joint, making the joint less stable post-operatively and leading to longer recovery times.

Why is an FHO performed?

The primary goal of an FHO is to remove bone-on-bone contact, restoring pain-free mobility. The most common reasons for FHO include:

  • Fractures involving the hip. When a fracture involves the hip joint and cannot be repaired surgically (either due to patient considerations or financial considerations for the owner), an FHO may provide the best option for pain-free mobility.
  • Hip luxation/dislocation (associated with trauma or severe hip dysplasia). In some cases, a hip that is out of socket cannot be replaced with manipulation or other medical means. Surgical repair of hip luxations can be costly and is not always successful, so many dog owners elect FHO for small dogs with hip luxation.
  • Severe arthritis of the hip. In chronic, end-stage arthritis, the cartilage that protects both the head of the femur and the acetabulum can become eroded away, leading to painful bone-on-bone grating whenever the hip is moved. Performing an FHO can remove this point of contact and alleviate pain.
  • Legg-Perthes disease (also known as avascular necrosis of the femoral head). This uncommon condition, most frequently seen in miniature and toy breed dogs, causes the bone within the femoral head to begin to die at early age. The bone collapses due to these degenerative changes, leading to severe pain. Removing the femoral head via FHO removes the source of pain for the dog.

What can I expect on the day of surgery?

This surgery is performed under general anesthesia. In most situations, you will take your dog to the veterinary clinic early in the morning on the day of surgery. Your veterinarian will likely instruct you to withhold food the morning of surgery, to prevent vomiting that may occur under anesthesia.

After surgery, your dog will remain in the hospital for anywhere from several hours to several days depending on the specific circumstances of his health and his surgery. When you pick him up from the hospital, your dog probably will not be bearing any weight on the leg that had surgery. An incision will be visible in the area of the hip, and this incision may or may not have visible external sutures. Some veterinarians use dissolving sutures that are placed under the skin. Your dog will likely be wearing an Elizabethan collar (cone) to prevent licking at the surgical site.

What care will my dog need after FHO surgery?

Care varies based upon the needs of the specific patient, but in general the post-operative recovery can be divided into two phases.

In the first several days post-operatively, your dog will be healing from the surgical procedure. Because bones and muscle are cut during this procedure, the focus during this period will be on pain control. Please give all medications as prescribed by your veterinarian. Moist heat may also be recommended during this period, to provide comfort and decrease stiffness.

Your veterinarian may recommend activity restriction during the first several days postoperatively. If this is the case, confine your dog to a crate or a small room within the house, with only very brief leash-walks outside to eliminate.  If your dog will tolerate it, you can attempt passive range-of-motion exercises during this period, gently moving the hip forward and backward through its range of motion, but this should not be performed if it causes pain for your dog.

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Your veterinarian will likely recommend introducing more physical activity approximately one week after surgery. During this phase of recovery, the focus shifts to rebuilding muscle mass and strength. Keeping your dog mobile will help keep the scar tissue within the false joint from forming too tightly, allowing your dog to remain flexible. Good exercises during this time period include walking (especially up flights of stairs), holding the front portion of your dog’s body in the air while allowing them to ‘walk’ on his hind legs, and walking through water. Walking should be slow, in order to encourage your dog to bear weight on the affected leg; when running, your dog will be more tempted to carry the affected leg.

In the first 30 days after surgery, it is important to avoid rough play or any activity that encourages sudden twists and turns. These high-impact motions will slow the healing that is occurring within the joint and muscles.

Most dogs will be show signs of complete recovery approximately six weeks post-operatively. At this point, your dog can resume his regular activities. Healing may be more rapid in dogs that had normal function up until shortly before the FHO (for example, in the case of a dog that had a sudden, traumatic injury to the hip) and may be slower in dogs with longstanding, chronic issues (because these chronic issues often lead to muscle atrophy, which takes time to resolve).

If your dog is not showing significant improvement by six weeks post-operatively, you may want to consider a formal rehabilitation or physical therapy program. Ask your veterinarian for recommendations if your dog is still having difficulties at or after six weeks.

What is the prognosis after FHO surgery?

Most dogs recover fully after FHO surgery and regain essentially-normal function of the affected leg. Although the leg may have a slightly decreased range of motion or decreased limb length after surgery, these impacts are typically minimal and do not impact the pet’s quality of life.

Ernest Ward, DVM
© Copyright 2015 Lifelearn Inc. Used and/or modified with permission under license.
Robin Downing, DVM, CVPP, CCRP, DAAPM
© Copyright 2014 LifeLearn Inc. Used and/or modified with permission under license.