What are the treatment options?
A range of treatment options are available. The best treatment option for any one dog should be made based on a detailed assessment of patient age, size and lifestyle, severity of symptoms and x-ray interpretation.
1. Non-surgical management
Non-surgical management may allow some improvements in lameness or pain in the short term, particularly in patients with only very limited disease development, with approximately 60-80% of younger dogs showing good improvements. Four basic methods are usually recommended:
Body weight management
Exercise modification, physiotherapy and hydrotherapy
Anti-inflammatory / pain relief medications
Nutraceutical supplements (e.g. glucosamine, chondroitin sulphate, pentosan polysulphate, Green-lipped Mussel extract)
However in some patients with hip dysplasia, even those as young as 7-10 months old, the cartilage damage and osteoarthritis is so severe that medical management cannot achieve a good enough quality of life and further intervention is indicated.
2. Juvenile Pubic Symphysiodesis (JPS) and Triple Pelvic Osteotomy (TPO)
JPS is a procedure that may be performed in dogs with hip dysplasia if it is recognized at a very early age. It is a relatively minor procedure that may result in a more stable hip in the very young animal. For maximum effect the surgery should be performed at approximately 4-5 months of age while significant growth potential remains.
Joint stabilization can be performed in patients aged approximately 5-7 months old using TPO but we seldom perform this procedure as many patients in this age group either have pre-existing arthritis which could preclude a positive outcome, or can be managed equally effectively with less aggressive treatment. Arthroscopic inspection is recommended.
3. Femoral Head and Neck Excision
This operation is a salvage procedure only normally considered in cases where Total Hip Replacement cannot be performed (e.g. for financial reasons or due to variations in individual anatomy that could preclude Total Hip Replacement). In this technique, the femoral head and neck (the “ball” part of the joint) are completely removed allowing a “false joint” to form. Pain is relieved by elimination of bony contact between the femur but the resulting “false joint” is typically limited in its function. This operation has been performed numerous times here in Jersey and in our opinion, and certain leading orthopaedic surgeons carries a favourable outcome, even in larger dogs. A lot of the first investigations into this procedure lead to non favourable outcomes; however, this was prior to the advent of physical and hydrotherapy. Physical therapy is therefore considered mandatory.
4. Total Hip Replacement (THR)
Total Hip Replacement is an advanced surgical procedure and is usually only performed by specially-trained orthopaedic surgeons. It involves cutting out the whole of the diseased hip joint. The “ball” is replaced with a metal implant, and the “socket” is replaced with a plastic and metal implant. The implants can be attached to the bone using bone cement, or may have a porous coating into which the bone can grow.
Although most of the dogs we treat with Total Hip Replacement are larger dogs, the surgery can be performed in smaller dogs, and Total Hip Replacement has been performed in cats where treatment for other hip conditions had failed. Although some patients will need the surgery performed on both hips, both hips are never operated on at the same time as this could increase the risk of possible complications. The success rate for THR is approximately 90-95%, and most dogs are more comfortable within a few days of surgery. Many patients will return to full levels of activity.