HIP REPLACEMENT

Many factors enter into the decision to have a total hip replacement performed on your pet.

You may have questions about the procedure.  The answers to the most commonly asked questions about total hip replacement follow.  You will find this information helpful and your vet would be happy to answer any other questions you might have to ask.

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 density polyethylene plastic.  Special bone cement is used to hold these implants in place.

How does the vet determine if my dog is a candidate for a THR ?

A painful hip(s) that is affecting your dog's comfort and locomotion 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 12 months of age.  This is determined by x-rays of the hips.  The size of the bones must be large enough to fit the available sizes of total hips.  Again, x-rays are needed to determine this.  Total hips can generally be placed in dogs weighing 25 kilograms or greater.  A dog with arthritic hips that has pain-free, normal function is not a candidate for THR.

What can I expect from this surgery ?

The goal of 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).

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, anaemia 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.

How long will my pet stay in the hospital ?

The routine length of hospitalisation for patients with THR is 5 to 7 days.

What is the success rate of THR .9

In general, a little over 95% of dogs have had good to excellent function with this procedure.  These patients have 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.  These complications include dislocations, fractures of the femur, infections, loosening of the implants, and nerve damage.  The risk of a complication occurring is low, but has to be considered.  Some complications seen in the early stages of development of the technique have been totally eliminated, while the risk for other complications has been greatly reduced.  Methods of treating the few complications that do occur are also being developed and evaluated.  Sixty percent of complications can now be successfully resolved, preserving the THR.  In the unlikely event your dog does have a complication it is best to have it dealt with by a specialist small animal surgeon skilled in the Total Hip Replacement technique.

What is the postoperative care for my dog ?

The postoperative 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 to prevent your pet 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 will be done by the specialist and it will be necessary for you to arrange for this appointment.

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 for a short walk.  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 some 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.

or 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, after consulting with your veterinarian.

Do 1 have to bring my animal back to the specialist for a cheek up ?

If possible it would be preferable for the surgeon to re-evaluate your dog after surgery, but the surgeon understands that some people have to travel long distances and may find this inconvenient.  If it is not convenient for you to return to the surgeon you can arrange for your veterinarian to x-ray your dog at 3 months and 6 months after surgery.  It will then be necessary for those x-rays and a report on your pet's function to be sent to the surgeon so that the information may be recorded in your pet's medical record.  The long-term evaluation of the results of THR will only be able to be determined if the surgeon has the co-operation of you the owner and the referring veterinarians.

Both of my dog's hips are affected.  Will both need to be replaced ? How is it determined 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.

How much does the procedure cost ?

This is an expensive procedure and should be discussed with your specialist surgeon.

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 a specialist surgeon about your dog and in many cases will make an appointment for you for a specialist consultation if you so wish.

Is THR the only treatment available for my pet ?

No, besides THR, other possibilities for treatment of your pet include conservative therapy and several other surgical options.  Which treatment should be used on your pet depends on many factors and this should be discussed with your specialist surgeon.

In general, it is not possible to have a Total Hip Replacement performed if the femoral head and neck (Femoral head and neck excision arthroplasty) have been already surgically removed.  It is important, therefore to carefully consider THR prior to having other surgical options carried out.

The best treatment option will be discussed with you, after having taken a history, evaluated x-rays, and completed on orthopaedic exwnination of your pet.

This will answer most of your questions about THR.  If you do have other questions, please be sure to ask them at the time of your appointment.

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Arthur Webster & Associates Pty Ltd

PO Box 438, PYMBLE NSW 2073 Australia