A total hip replacement (THR) procedure replaces both the head of the femur (‘ball’) and the acetabulum (‘socket’) of the hip joint (‘ball-and-socket’ joint) resulting in a complete arthroplasty. At AVES we use state of the art surgical implants, BioMedtrix total hip arthroplasty. These prosthetic implants are designed to function in the same manner as a healthy pain free joint, all while minimizing post-operative complications. THR is performed by surgeons who are board certified though the American College of Veterinary Surgeons (ACVS) and who have received specialized extensive training and certification in performing total hip arthroplasty, giving your pet the best chance for an excellent pain-free and functional outcome.
WHEN IS A THR RECOMMENDED?
Total hip replacement (THR) is used for dogs and cats of all ages. The THR procedure is commonly performed to treat pain and disability associated with hip dysplasia and degenerative osteoarthritis conditions. Less common conditions that can also be well managed by a THR procedure include traumatic coxofemoral luxation, developmental anomalies, femoral head or acetabular fracture malunions, avascular femoral head necrosis, and feline capital physical separations. Essentially, any patient (feline or canine) experiencing non-infectious joint pain affecting their comfort, mobility, and quality of life may be a candidate for this procedure.
WHAT IS HIP DYSPLASIA?
Hip dysplasia is an abnormal development and growth of the hip joint. Both hips are usually affected but symptoms may be more severe on one side. Hip dysplasia is manifested by varying degrees of laxity (‘looseness’) of the hip joint with instability resulting in malformation of the joint components. These malformations cause abnormal pressures on the cartilaginous surfaces of the joint which leads to abnormal wearing, erosion, and boney deposits. The shape and fit of the bones and the joint change as osteoarthritis develops over time. These changes result in pain and loss of joint and limb function.
The signs of hip dysplasia can be seen from a few months of age and often become more obvious with growth. The common clinical signs of a painful hip due to dysplasia or osteoarthritis (OA) may include:
- Limping and stiffness after exercise/activity
- Difficulty walking, rising, jumping, running, climbing stairs, or squatting. Reluctance to jump, climb stairs, or get in and out of the car.
- Avoiding physical activity (lying down or sitting during exercise). Less active, reluctant to exercise, or gives up on activity quickly
- Decreased range of motion – especially hip extension and abduction
- Muscle atrophy in the rear limb(s)
- A “bunny-hop” gait
- Tarsal (‘ankle’) joint hyperextension (young dogs)
- Pain on manipulation of the hip joint
- Weight shift to forelimbs (noticed by large forelimb muscles and thin hind limb muscles)
The signs of hip dysplasia may range from subtle to severe. While a physical exam by your primary care veterinarian may indicate hip dysplasia, radiographs (‘x-rays’) of your pet’s hips are necessary to provide a formal diagnosis. Radiographic imaging also helps determine the extent and severity of the condition, which guides treatment recommendations.
The degenerative bony remodeling changes and soft tissue adaptations that can occur in young patients with severe dysplasia can be dramatic. Earlier surgical intervention may be indicated versus waiting until the patient is older. The THR procedure is highly successful at restoring normal joint function and eliminating pain and should not only be reserved until the patient is geriatric with advanced hip disease.
ARE CERTAIN BREED MORE LIKELY TO GET HIP DYSPLASIA?
Yes. In dogs, hip dysplasia is especially common in larger breeds. German Shepherds, Golden and Labrador Retrievers, Bernese Mountain Dogs, St. Bernards, Newfoundlands, Rottweilers, and Great Danes are commonly affected. Smaller breeds can be affected as well, including Pugs and French Bulldogs, or even hybrid breeds such as doodles. In cats, the incidence runs as high as 20% in purebred cats, particularly the Maine Coon, Persian, and Himalayan breeds.
WHAT OPTIONS ARE THERE FOR HIP ISSUES?
If hip issues aren’t severe, the nonsurgical (‘medical’ or ‘conservative’) options for treating them include:
- Weight optimization to decrease stress on joints and lessen the inflammation associated with excess body fat
- Medications, including NSAIDs, to reduce pain and inflammation
- Modifying exercise to maintain activity and movement but not cause severe pain
- Joint supplements and injections to help slow the progression of osteoarthritis and improve joint lubrication
- Rehabilitation therapy to improve joint movement and flexibility, and limb function
- Acupuncture may be helpful for decreasing pain
If your pet is a candidate for surgery, below are three common treatments that may be offered:
Double or triple pelvic osteotomy (DPO/TPO): In this procedure, the pelvis is cut in two (DPO) or three (TPO) locations to laterally and ventrally rotate the acetabular segment to improve the overall coverage of the femoral head and stability of the coxofemoral joint. It is only an option for young dogs (usually <8 to 10 months of age) where the joint structures are near normal, there is limited to no evidence of degenerative osteoarthritis, and the severity of subluxation is not extreme.
Femoral head ostectomy (FHO): This procedure converts the bony ‘ball-and-socket hip joint’ to a muscular joint or pseudoarthrosis. Although relatively simple to perform, it should be considered a salvage procedure and reserved for patients where this is the only option for addressing an abnormal hip joint. Studies have confirmed that return to function following an FHO is not guaranteed. Recovery can take several months and often results in limb shortening, loss of hip joint range of motion, persistent muscle atrophy, and persistent hip pain.
Total hip replacement (THR): THR is considered the most effective surgical treatment (‘gold standard’) because specially designed implants replace the damaged or arthritic joint, thus restoring normal function to the hip joint and alleviating the pain and discomfort associated with hip dysplasia, osteoarthritis, and other hip conditions. This enables your pet to return to a pain-free and active lifestyle. More than 90-95% of dogs undergoing THR are expected to regain normal function and maintain it for the rest of their lives.
WHAT IS TOTAL HIP REPLACEMENTY SURGERY?
For over three decades, total hip replacement has been the gold standard treatment for pets with severe hip dysplasia and/or osteoarthritis, especially when conservative measures like medication or rehabilitation therapy are no longer working. A THR involves replacing the abnormal hip joint surfaces with a new prosthetic ‘ball and socket’ joint. These implants are made from specific metals, polyethylene plastic, and ceramics, each of which has been uniquely designed for cats and dogs of all sizes. The prosthesis is designed to fit precisely and mimics the anatomy of the original joint.
BioMedtrix proudly introduced the CFX® (Cement Fixation) Total Hip System in 1990, and the BFX® (Biologic Fixation – non-cemented) system in 2003. Since then, over 85,000 joint replacement procedures have been performed. The implants in each system are interchangeable and are prepared to a common surgical preparation with a set of specific instruments, providing greater versatility in the clinical options for total hip replacement. THR can be performed on dogs ranging from 4 through 170 pounds, and on cats.
When performed by a skilled THR surgeon, a THR procedure can have a 90-95% success rate for excellent hip function for the rest of your pet’s life. With advances in technology and techniques, today’s THR implants are designed to last for the lifetime of the pet.
WHAT DOES THE TYPICAL SCHEDULE CONSIST OF FOR A THR?
Initial Consultation – The THR surgeon will perform a physical exam on your pet and discuss THR with you in greater detail. If THR is recommended during the initial consult, the next appointment will be for sedated THR digital templating radiographs (‘x-rays’) +/- blood work, urine collection, and preparation of the limb for surgery. A medicated shampoo +/- oral antibiotic with be provided for treatment leading up to the day of THR surgery.
Surgery – You should expect your dog or cat to stay in the hospital throughout the day prior to being discharged for at home care the same day. However, there are rare instances it may be recommended they stay overnight prior to being discharged to your care.
WHAT DOES THE THR RECOVERY PERIOD LOOK LIKE POSTOPERATIVELY?
Your dog or cat typically will be hospitalized throughout the day or possibly even overnight following a THR surgery. Pets usually can begin putting weight on their new hip on the day of surgery and use their leg quite well within a couple of weeks – but just as with humans, a slow and gradual return to activity is key to the long-term success of the procedure.
Pain medications and antibiotics (+/- sedative) are typically provided for 1 to 2 weeks following surgery. Activity restrictions are significant during the initial 8 to 12 weeks of recovery. For the initial eight weeks following surgery, your pet should not be allowed to be off leash, run, or jump. In addition, your pet should be monitored closely and should be strictly confined to a small indoor area with non-slippery floors or in a crate, pending size and dog or cat. This is imperative for a successful outcome and recovery and is the best way to limit post-operative complications. At the end of the eight weeks, radiographs will be performed and evaluated by your pet’s surgeon for approval to slowly start normal activity again. Most pets are ready to resume regular exercise and activities after 12 weeks of recovery.
In most cases, the replaced hip will last for your pet’s lifetime. In fact, studies show more than 90-95% of dogs have good to excellent function with THR – providing years of pain-free activity that otherwise would not have been possible. Generally, peak recovery time is 4-6 months following the surgical procedure.
WHAT ARE THE MAIN RISKS AND COMPLICATIONS ASSOCIATED WITH THE THR PROCEDURE? Total hip replacement is among the most advanced surgeries in veterinary medicine. Our surgeons are well trained, but as with any surgery, complications can occur. Surgery in of itself, no matter the procedure, carries some risk of unsuccessful outcomes and complications. While complications are the exception, a total hip procedure is not risk free.
The typical overall complication rate following a THR varies with a report overall average complication rate of 5 to 10%. The more commonly reported complications include postoperative luxation (often associated with a fall or excessive activity during the initial 2 to 3 weeks following surgery), femoral fissure or fracture, sciatic nerve neuropraxia, and infection. Most complications are manageable, but may require additional surgery and incur associated costs. As with any surgical procedure, anesthesia can pose some risks.
IS THR THE BEST OPTION FOR MY PET?
Medical therapy may be effective for some patients, but may have limitations and is not without some potential risks. Medical therapies are aimed at reducing the symptoms of joint pain, but do not address the underlying disease. Over time, osteoarthritis is expected to be progressive, resulting in a loss of joint function, reduced patient mobility, and worsening discomfort. It requires the pet parent to comply with lifelong and potentially costly medications, diet recommendations, and therapies. Certain patients may be difficult to effectively treat medically, such as cats and patients with underlying comorbidities. In addition, some medications over time may cause liver and/or kidney damage.
While medication, physical therapy, or FHO surgery can provide some pain relief for a pet with hip dysplasia or osteoarthritis, these treatments do not prevent these conditions from worsening. Furthermore, these treatments do not provide a completely functional recovery that enables your pet to play and move freely. In practical terms, total hip replacement is the best solution (‘gold standard’) to restore your pet’s full mobility and quality of life. THR surgery is typically a one-time procedure that restores a pain-free joint with normal function. After a complete recovery, patients can resume regular activities, even return to agility, work, and sporting activities. Over the lifetime of a patient, the cost difference between a single surgical procedure and a lifetime of medical therapies and diagnostics may be comparable.
HOW MUCH DOES THR COST?
THR is an investment in your pet’s quality of life. The cost of a THR procedure depends upon many factors: geographic location, implant configuration used, specific hospital surgical practices, plus additional costs related to diagnostic workup, rehabilitation therapy, dispensed medications, etc. It is one of the most advanced orthopedic procedures performed in veterinary surgery and typically costs around $8,000 to $10,000 per hip. Keep in mind that alternative treatment options, such as life-long pain management/medications/diagnostics, can also result in significant expenses and/or damage to vital organs (liver and kidneys) over the years.
Insurance is often a great option to help with costs. Much like your own health insurance, for a low monthly fee, a pet insurance policy may help cover some of the costs of your pet’s healthcare. With pet insurance, vet bills are paid out of pocket upfront, then submitted for reimbursement; many companies offer up to 90% reimbursement. The cost of one major incident in the life of your pet would likely pay for a lifetime of pet insurance premiums. It is worth researching what types of procedures are covered, reimbursement rates, wellness care, and possible discounts for multiple pets are available.
Russell Kalis, DVM, DACVS
Since AVES inception in 2014, Dr. Kalis has been performing advanced soft tissue, orthopedic, oncologic, and neurologic surgery. Even prior, his interest in total hip replacements dates to 2011 when he started contributing to peer reviewed scientific literature regarding a variety of THR indications and clinical outcomes. Having the required advanced, specialized orthopedic training and knowledge, equipment, and instrumentation, Dr. Kalis will determine the most appropriate type of procedure for your pet’s condition. By performing THR surgeries regularly, Dr. Kalis has the level of expertise required for the procedure being recommended, which has been proven to improve successful patient outcomes.