Clean Run - March 2012 - 33

If medical management does not work, is surgery available for this condition?
Thankfully, yes! There have been several procedures developed for the treatment of canine hip dysplasia. In young dogs, there are two procedures that aim to improve the clinical signs associated with laxity by increasing the amount of acetabular rim coverage over the femoral head. One procedure, called juvenile pubic symphysiodesis (JPS), fuses the growth plate at the base of the pelvis. As the remainder of the growth plates continues to grow, it creates more coverage over the femoral head. While this procedure can be effective, it offers little benefit in dogs older than 20 weeks of age. It therefore has a very narrow window of application and is not commonly performed. Another procedure, called triple or double pelvic osteotomy (TPO or DPO), increases the coverage of the femoral head. This is achieved by making several cuts or breaks in the bone surrounding the acetabulum, manually rotating the acetabulum over the femoral head, and stabilizing it with a plate. This procedure is also effective at reducing the discomfort associated with hip laxity. Unfortunately, the progression of osteoarthritis is still possible with both of these procedures, particularly in patients that already have damage to the ligament or cartilage of the joint. Pre-operative arthroscopy of the hip joint is recommended in our practice prior to performing a TPO or DPO to document severe wear of the cartilage, which may preclude the patient as a good candidate for the procedure. Another surgical option is a total hip replacement (THR). A THR is when the dog’s abnormal socket (acetabulum), and ball (femoral head) are surgically removed and then replaced with a polyethylene cup and metallic stem and head. This procedure can be performed in dogs as young as 6-12 months of age if their gait abnormalities and conformation are severe, or in an adult patient who is no longer responsive to medical management of the subsequent osteoarthritis. There are currently two broad categories of hip replacement. One involves the use of bone cement, which binds the implant to the bone. The other is a “cementless” system, which requires bone integration or growth into the implant. There are advantages and disadvantages to each type of system, and not every

Example of a cementless hip replacement

Example of a hybrid hip replacement (cementless cup, cemented stem) in a dog with severe hip dysplasia

and
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Clean Run - March 2012

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