Hip Dysplasia: FAQ on THR

Central Texas Veterinary Specialty Hospital

ANSWERS TO QUESTIONS ABOUT CANINE TOTAL HIP REPLACEMENT

What is a total hip replacement (THR)?

Both the ball (head of the femur) and socket (acetabulum) of the hip joint are replaced with prosthetic implants. The new ball is made from a cobalt-chromium metal alloy and the new socket from high molecular weight polyethylene plastic.

Can you tell from my dog's x-rays (radiographs) if he/she is a good candidate for THR?

Radiographs show abnormalities in the hip joint and are used for choosing the proper size prosthesis, but they are only part of the picture. To decide what is best for your pet, the surgeon must evaluate your pet's history. The surgeon will perform a complete physical examination, evaluate your pet's radiographs, and interpret laboratory data. Many factors must be evaluated before your pet is considered a good total hip candidate.

How do you determine if my dog is a candidate for a THR?

A painful hip(s) that is affecting your dog's comfort, locomotion and activity levels is the primary indication for a THR. Stiffness, lameness and reluctance to exercise are often signs of problems. Your pet must be in good general health. There must be no other joint or bone problems, no nerve disease, and no other medical illnesses. Your dog must be skeletally mature; that is, he/she must be finished growing. Generally this occurs by 9 to 12 months of age. This is determined by x-rays of the hips. The size of the bones as determined by x-rays must be large enough to fit the available sizes of prosthesis. Total hips can generally be placed in dogs weighing 30 pounds or greater. A dog with arthritic hips that has pain-free, normal function is not a candidate for THR.

What is the earliest age my dog can have this procedure done?

In most dogs, nine months old is the earliest the procedure will be done. There are only a few giant breeds where it is necessary to delay surgery for 1 or 2 months while the dog's skeleton reaches maturity.

What can I expect from this surgery?

The goal of the surgery is to return your pet to pain-free, mechanically sound, normal hip function. Generally, dogs are found to be more comfortable and have an improved quality of life. Many owners report that their pet can do things they have not done since they were a puppy. Increase in muscle mass, improved hip motion and increased activity levels have been observed in most patients. Working dogs have returned to full activity. Some mean dogs have even developed a pleasant personality when the pain was eliminated from their hip(s). We have found that 95% of the hips that have been replaced by surgeons at CTVSH return to normal or near normal function. More than 95% of owners feel that their dog's quality of life is improved or markedly improved.

Since the expertise of the surgeon is very important, what experience do the surgeons at CTVSH have with the procedure?

Drs. Kerpsack, Beardsley and Schaefer are Board Certified specialists in surgery.  Dr. Kerpsack and Dr. Beardsley trained at The Ohio State University, which has the largest hip replacement program in the country. Dr. Schaefer trained at Michigan State, which also does many THR's.  They have also trained surgical residents and other surgeons in this procedure.

My dog is on medication. Should I stop giving it?

Medication for health problems and conditions such as diabetes or low thyroid function should not be stopped. Medications for hip pain should be stopped prior to the initial examination. Oral steroids (even for skin conditions) should be stopped I week before the exam while other anti-inflammatory drugs including aspirin should be stopped 3 days before the exam.

Is surgery performed the day of admission?

No. Your pet must be carefully screened before surgery. This entails a complete history and physical examination. X-rays of the hips will be taken pre-operatively. A complete blood count and chemistry profile (if indicated) will be obtained to screen your dog for evidence of infection, anemia or problems with internal organs before surgery is performed. Your pet's skin will be carefully examined for signs of infection. Abnormalities noted on these examinations may indicate that your dog is not a good candidate for a THR. If the preoperative evaluations reveal no abnormalities, surgery is usually scheduled for the next day.

How long will my pet stay in the hospital?

The routine length of hospitalization for patients with THR is 3 to 7 days, including the day of the initial examination. If it is determined that your pet is a good candidate for the procedure and you agree to have the procedure done, he/she will be admitted to the hospital at the initial examination for surgery to be done the next day.

What is the success rate of THR?

In reviewing the records of patients that have had THR, a little over 95% of dogs have had good to excellent function with this procedure. These patients have normal pain free function, increased muscle mass, no limping and increased activity.

What are the complications with this surgery?

As with any surgery, total hip replacements have their own set of complications. The complications that have occurred since 1976 when the first THR was done include: dislocations, fractures of the femur, infections, loosening of the implants and nerve damage. Some complications seen in the early stages of development of the technique have been greatly reduced. Methods of treating the few complications that do occur are also being developed and evaluated. Most complications can now be successfully resolved, preserving the THR. Thus, in the unlikely event your dog does have a complication, it is best to have it dealt with by a surgeon at CTVSH.

What is the postoperative care for my dog?

The post-operative care for your dog is critical. The surgical incision must be monitored daily for redness, swelling or discharge. Your dog must be discouraged from licking the incision. This sometimes requires placement of a special collar which prevents your dog from reaching the incision. Your dog 's attitude and appetite should be monitored daily while the incision heals. Ten to fourteen days after surgery the sutures may be removed from the incision. This may be done by your referring veterinarian or at CTVSH. An appointment for suture removal is required at CTVSH.

The activity level of your pet must be strictly controlled. For the first month after surgery your dog should only be allowed outside on a leash to urinate and defecate, and may take short walks. Your pet should be immediately returned to the house afterwards. Inside the house your pet should avoid stairs and slippery floors. If your pet must go up and down stairs, you should go with the pet using a leash or your hand on the collar to control the speed of your pet on the stairs. Good footing is important. Absolutely no running, jumping or playing is allowed in the first 2 months after surgery. When your dog is not under your direct control, he/she should be kept confined to a small room. Some owners find that a large cage or airline crate is an ideal place to confine their pet when they are not at home.

For the second post-operative month, similar restrictions apply but you may begin to take your pet on longer leash walks. The length of the walk will depend on your dog's abilities. After the end of the second month, you may return your pet to full activity.

Do I have to bring my pet back to CTVSH for a check up?

If possible we would like to re-evaluate our patients at CTVSH. We understand that people come to us from all over Texas, so if it is not convenient for you to return to CTVSH, we ask that you have your veterinarian x-ray your dog at 3 months after surgery and annually thereafter. We also ask that those x-rays and a report on your pet's function be sent to us so that we may record that information in your pet's medical record.

Both of my dog's hips are affected. Will both need to be replaced? How do you decide which hip to replace?

Four out of five dogs or 80% of the patients with arthritis in both hips only require one side be operated upon to return them to a satisfactory and comfortable life. The decision on which hip to replace is based on the owner's observations, the physical examination findings and the hip x-rays. Your knowledge of your pet's disability is important in making this decision.

Now much does the procedure cost?

At present (2011-2012), the average cost ranges from $4000.to $4500. This includes the examination, laboratory work, x-rays, hospitalization, antibiotics, anesthesia, surgical fees and the cost of the implants (which accounts for about 40% of the fee). Charges for follow-up evaluations are not included in this estimate. These costs vary, depending on what needs to be done. We at CTVSH are doing everything we can to keep the costs of this procedure low. However, as manufacturers increase their charges, we may have to raise ours, thus the fees given above are subject to change without notification.

How do I make an appointment for THR?

In many cases, your veterinarian will have recommended a THR. Your veterinarian may have already consulted with CTVSH about your pet. An appointment is made with a surgeon at CTVSH by calling (512) 892-9038. The day of the week for your appointment will vary depending on the surgeon's schedule.

Is THR the only treatment available for my pet?

No, besides THR, other possibilities for treatment of your pet include non-surgical therapy and several other surgical options. Which treatment should be used on your pet depends on many factors. The best treatment option will be discussed with you after we have taken a history, evaluated x-rays and completed an orthopedic examination of your pet.