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 Commonly asked questions regarding the indications, procedure and success of Total Hip Replacement.
Total Hip Replacement (THR) is designed to eliminate the discomfort by replacing the arthritic hip joint with an artificial joint. Replacement of the hip joint is a state of the art procedure, very similar to the procedure performed in humans. The arthritic femoral head and neck are removed and replaced with a metal implant made of stainless steel and titanium. The arthritic socket is removed and replaced with a silicone cup. Both components are held in place with sterile bone cement. The metal head and silicone cup fit and function like the original ball and socket joint providing a pain-free, mechanically functional joint. A Total Hip Replacement is performed to relieve pain, improve hip function and allowing your dog to return to an active life style. The arthritic joint is replaced with the implant, eliminating the pain of bone rubbing on bone in the arthritic joint. The decreased range of motion associated with the arthritic joint is corrected allowing a good range of hip motion. If your dog is over 12 months of age, weighs more than 45 pounds and has clinical signs associated with hip arthritis or dysplasia, or has had a traumatic hip luxation, your pet is a potential candidate for a hip replacement. A thorough examination to rule-out other orthopedic, oncologic or neurologic problems is always an important part of the pre-operative examination. Surgery to replace the hip joint is recommended when pain or limping are present. Radiographs of the hips are performed to confirm the diagnosis of degenerative arthritis. Surgery is generally recommended if conservative therapy via pain medication is not adequate in relieving the limping or pain associated with the arthritis. Only one hip can be done at a time. The most painful hip should be replaced first. If pain is present on both sides, both sides should be replaced. The interval between surgeries is at least two months. However, over 80% of dogs do not need a second surgery despite the presence of arthritis in the other hip. The surgery takes 90 to 120 minutes. They are under continuously monitored isoflurane general anesthesia. Vital parameters, such as heart rate, heart rhythm, tissue perfusion, respiratory rate and pattern, temperature and blood pressure are monitored. The surgery is performed with extensive precautions to prevent infection. Much attention is paid to preoperative preparation of the patient, instrument preparation, aseptic technique, and environment control in the operating room. Pain medication is administered preoperatively and maintained as long as needed. The patient is hospitalized with 24-hour patient care. Most dogs routinely support some weight immediately postoperatively. They are generally released from the hospital on the second postoperative day. Exercise restriction (i.e. no running or jumping) must be followed for two months following the surgery to allow all tissues to heal around the implant. Vigorous activity is to be avoided during this time period. Most dogs walk on their new hip immediately after surgery. Most pet owners report their dog’s personality improves and that their dog feels great. Gradual return to normal function is allowed between 8 and 12 weeks after surgery. A long term study found THR to be a very effective method of treating disabling conditions of the canine hip. The majority of dogs displayed marked improvement in walking, sitting, climbing stairs, standing, running, getting into the car, playing, and exercise following surgery. THR's have been performed in both pet and working dogs with equal success. Yes, however, the incidence of complications is very low. Risks exist just as they would for the same surgery on humans. Complications from infection or technical problems can never be completely eliminated. Extreme precautions are taken to minimize problems with infection or technical problems. The chance of a complication is less than 5%, with well over 95% of dogs achieving an excellent result. Yes, a femoral head and neck ostectomy (i.e., removal of the ball part of the joint) can be performed as an alternative procedure. The ball part (femoral head) is removed allowing a "false-joint’ to form. Eventually, new tissue fills in between the bones allowing support and function of the limb. This surgery has a variable success rate with 20-25% of owners reporting low-grade gait abnormality or trouble jumping. The procedure is not as optimal as a hip replacement, however, results over all are satisfactory to good. A Triple Pelvic Ostectomy (TPO), hip rotation procedure, can only be performed on young dogs (<12 months of age) with hip dysplasia prior to the development of arthritis. This surgery preserves the dog's hip joint and prevents the progression of hip dysplasia. Results following the surgery are good to excellent. |
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