Hip replacement can have a dog acting like a puppy again
By Bruno Massat, DVM, DACVS, DECVS, CCRP
Friday, July 10, 2009
Published in the "Your Pet" column of The Nashua Telegraph.
The column runs on the second and fourth Fridays of each month.
I am ready to bet that the majority of readers know of at least one person who has received an artificial prosthetic joint. But how many readers know that dogs also can have a hip replacement? And just as Grandma will dance again with her new hip, a dog will run again with his.
In fact, joint prosthesis – or total joint arthroplasty, in medical jargon – is one of the fastest growing fields in veterinary orthopedics. Although veterinary surgeons have performed total hip replacement in dogs for more than two decades, today's level of sophistication really brings the discipline to a new level. Due to a larger selection of implant sizes and constant improvement in implant design and fixation, practically any dog, and even cat, can now benefit from THR with risk of complications as low as ever.
Why would a person want his dog's hip replaced with a prosthesis? Because in case of a severely arthritic hip not controlled by medications, THR is the best option for recreating a pain-free and fully functional joint. Arthritis from hip dysplasia is by far the most common indication for hip replacement, but some hip fractures or dislocations also are better treated with a THR rather than a primary repair.
In order to be a candidate for the surgery, the patient must pass a few tests. No infection can be present anywhere; common bad teeth and urinary infections need to be treated first. Systemic diseases, such as diabetes or any type of cancers, also need to be controlled. The deficit in the leg – pain, lameness, muscle atrophy, impaired mobility – needs to be clearly caused by a diseased hip and not by another orthopedic or neurologic condition. The dog cannot be too young, but old age does not matter, as long as the patient is in good health. And finally, the remodeling of the diseased hip cannot be so extreme than the residual amount of bone is insufficient to receive the prosthesis.
The procedure consists of three parts. First, the head of the femur, the "ball," is cut off. Second, bone is removed from the pelvic acetabulum, the "socket," and from the cut femur to make roam for the implantation of the implants, the third step of the procedure.
A complete set of implants has three components: the plastic metal-backed acetabular cup, the metallic femoral stem and the metallic femoral head. Implants are impacted within the prepared bones, and definitive fixation is provided by new bone proliferation within the porous sections of the prosthesis. Alternatively, bone cement can be used. If possible, my preference is to use biologic bone fixation for first-time THR and reserve cement for revision of certain failed THR. After surgery, controlled exercise and rehabilitation is required for two to three months.
What kind of result can be expected after a successful hip replacement? I will simply quote the owner of a past patient: "My old friend feels like a puppy again." Simply put, the improvement in mobility provided by the pain free hip really results in a better overall quality of life. Patients regain a happy attitude and resume activities abandoned for years, even if only one hip is replaced. Athletic and working dogs have successfully returned to their past level of activity.
If necessary, the second hip can be operated on, once healing of the first is advanced enough. Contrary to humans, most dogs will live their entire life with the same prosthesis.
As it is always the case in surgery, complications – such as infection, fracture, dislocation and implant loosening – are unfortunately possible. Meticulous surgical technique and strict adherence to post-operative care and rehabilitation make the risk of complications minimal.
It is not every day that orthopedic surgeons can give their patients a new lease on life. Total hip replacement is truly a different type of surgery, the most satisfying type. I fell in love with this procedure years ago, and it has been a great relationship ever since.
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