Pet Surgery Topics

When we talk about dog hip dysplasia treatments, they are generally divided into treatments for immature dogs and treatments for adult dogs.  This is because immature dogs have usually not developed arthritic changes and cartilage damage when we are addressing the hip with surgery whereas adult dogs tend to have moderate to severe arthritis and cartilage damage at the time of treatment.

Triple pelvic osteotomy, or TPO as it is commonly called, is a treatment used in immature dogs to potentially give them a more normal hip.  The idea behind the surgery is to rotate the acetabular portion (pelvic side) of the hip joint outwards to give better coverage of the head of the femur.  To accomplish this, requires cutting the pelvis in three locations, hence triple pelvic osteotomy, then rotating it outwards and securing it in the new position with a bone plate while it permanently heals in this new position.  In the end, this procedure stops the subluxation of the hip joint do to the laxity of the structures holding the hip joint together.

The best candidates for triple pelvic osteotomy are young dogs, usually under 1 year of age and ideally closer to 6-8 months, with no signs of arthritis on radiographs.  These dogs are the best candidates because chances are they have minimal damage to the articular cartilage within the joint, which will give them the best outcome long term with the procedure.  These dogs should also have a good solid “clunk” or pop when their hip is checked for an Ortalani sign, or the ability for their hip to subluxate.  Determining if a dog is a good candidate is usually done with a combination of palpating the hip and radiographs.

Commonly dogs will have hip dysplasia in both hips.  Performing triple pelvic osteotomies is still indicated even if both hips are involved.  The determination of whether to do one hip at a time, usually waiting about a month in between the two surgeries or doing both hips at the same time is a surgeon’s preference.  Doing both hips at the same time can result in more complications but does reduce costs for the owner and healing time for the dog.  With the advent of stronger bone plates used for doing the surgery, complications with doing both hips at once have dramatically decreased from years ago.

Complications associated with triple pelvic osteotomy include infection, implant failure, loss of some range of motion of the hip, narrowing of the pelvic canal, sciatic nerve injury, and if both hips are done at once, possible urethral entrapment.  Implant failure, meaning breakage of the screws or plate or the screws pulling out of the bone, occurs because immature dog bone is softer than mature dog bone and thus doesn’t hold the implants as well.  Infection can occur any time that an implant like a bone plate and screws are placed within the body.  Usually the infection can be controlled by appropriate antibiotic therapy and the osteotomy will go on to heal okay.  Sciatic nerve damage and urethral entrapment are both rare complications with triple pelvic osteotomies.

Recovery from triple pelvic osteotomy, in most cases, takes approximately three months.  During this time, once the dog feels comfortable walking on the surgery leg, they can start taking controlled, short leash walks.  If the follow-up radiographs taken at around 4-6 weeks show the bone is healing well and the implants are all holding up okay, then these leash walks are increased to help build up the muscles of the hind legs which were lost as a consequence of the surgery.  Physical therapy done early in recovery can also help speed up recovery and help maintain more muscle after the surgery.  Restrictions during the first three months are no off-leash activity like running, no stairs, no slick floors, and no playing with other pets.  Activity level around the house can be confinement to a crate or confinement to one area of the house, depending on the surgeon’s preference.  If both hips are done at the same time, the dog will usually need to be walked with a sling under their belly to help them get up and around for the first one to two weeks.

Prognosis with the triple pelvic osteotomy procedure depends largely on selecting the appropriate candidates but with the right dogs, they should have good to excellent long-term function.  Studies do show that the majority of dogs will radiographically progress with arthritis over time but the majority of dogs are never clinical for this arthritis.  Costs for triple pelvic osteotomy procedures varies greatly but in general run somewhere between $2000-4000 for one side and $4000-7000 for both sides at once.

Technorati Tags: canine hip dysplasia surgery, canine triple pelvic osteotomy, dog hip dysplasia treatment, dog hip dysplasia treatments, dog tpo, dog triple pelvic osteotomy, hip dysplasia surgery, hip osteotomy, hip osteotomy surgery, pelvic osteotomy, treatment for hip dysplasia in dogs, treatment hip dysplasia, treatments for hip dysplasia in dogs, triple osteotomy, triple pelvic osteotomy, triple pelvic osteotomy cost, triple pelvic osteotomy dogs