Dear Pet Docs,

Our Newfoundland, Angus, has recently been diagnosed with a severe case of hip dysplasia. He weighs 165 pounds but is really not overweight. It has gotten so bad that we need to help him get up.

He is only 6, and otherwise healthy, so we want to do something for him. We were recently referred to a clinic, which informed us that to get a hip replaced, we would have to take him to a university, or we could do a procedure called an FHO with them. We would do whatever is best for him. Please offer suggestions.

Richard C.

Dear Richard,

We have been successfully performing total hip replacement surgeries at our Mount Pleasant facility for nearly a decade. Of the available procedures, total hip replacement is the least painful, has the fastest recovery and provides the most complete restoration of normal mechanical function. Yet, it remains in the minority in terms of hip surgeries performed. Why?

One reason is the existence of an alternative procedure, known as the femoral head and neck ostectomy. This surgery is like stopping half way through a hip replacement. The “ball” portion is excised, and mother nature takes it from there. The site is filled in and heals with a fibrocartilagenous band of tissue that acts as a “false joint.” This will provide more than adequate weight support, and good mechanical function. Most dogs will return to approximately 85 percent of normal function, which means they will run, jump and play and, to the untrained eye, they appear close to normal. The function is more than adequate for the average family pet.

There are other surgical procedures aimed at preserving the natural hip in cases of traumatic hip dislocations, and in early cases of hip dysplasia. But when these fail, or are not considered viable options, the remaining choice is generally between full replacement or ostectomy.

Due to the unfortunate publication of a flawed study in the 1970s, a belief has persisted to this day that ostectomy surgery is inappropriate for dogs larger than 45 pounds. Sadly, this has led to the prolonged misery, or euthanasia, of many hip dysplastic dogs, whose owners could not afford the full surgery. In our practice, ostectomy surgery, often performed simultaneously on both sides, is commonly done on patients weighing more than 100 pounds, with excellent results.

Since we have established that size is not necessarily a limiting factor for ostectomies, and the outcomes are predictably good, the decision between this technique or a total hip replacement comes down to weighing the pros and cons of each. We have already stated that total hip gives the best mechanical outcome, approaching 100 percent. It also is the least painful and provides the quickest return of function. By these criteria, the total hip takes an early lead in the decision process. However, there are other factors to weigh.

 

Total hip has a serious complication rate of approximately 5 percent. This sounds low, but it means that 1 in 20 will have a complication that is serious enough to require surgical intervention, and potentially removal of the implant altogether. The serious complication rate for ostectomies, in the hands of a competent surgeon, is almost incalculably low.

After-care for total hip replacement is of a shorter duration than for the ostectomy, but it involves rigid activity restrictions and support, as the risk of dislocation or fracture is real. The post-op care for the ostectomy actually encourages early activity, and restrictions are only imposed during the first week. There is little one could do to botch an ostectomy; not so for the replacement. Finally, the cost of the ostectomy is a fraction of that of a replacement.

If replacement is being considered, it is best to have a full and open discussion with a surgeon who is versed in the full range of hip procedures.

In my (Henri Bianucci) discussions with owners of hip replacement candidates, it really boils down to whether the high cost and potential risks are outweighed by a quick and less painful recovery, and a functional result that is moderately superior to the ostectomy. Neither procedure is the “best.” But, after careful discussion and consideration we can determine which is the best for a particular client and patient.

Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to petdocs@postandcourier.com.

 

 

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