Orthopedics
Total Hip Replacement
What is total hip replacement?
In this procedure, a veterinary orthopedic surgeon replaces a painful or damaged hip joint with an artificial one, called a prosthesis. This eliminates the cause of pain and stiffness, and the patient can return to most of the activities they enjoy. Total hip replacement is an alternative to femoral head and neck excision in large and giant breed dogs (50 lbs. and over). Total hip replacement provides the best return to normal function in the limb.
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Why is total hip replacement necessary?
The most frequent reason for performing a total hip replacement is relief of pain and disability caused by severe degenerative joint disease secondary to hip dysplasia or fracture. Other reasons include chronic dislocation of the hip and acute dislocation of the hip that cannot be reduced because of hip dysplasia or soft tissue damage. Many dogs with arthritic hip joints seem to function normally. But, when a painful joint is replaced with an artificial joint, there is often a dramatic change in the dog's personality as well as a change in activity levels.
How will I know if my dog needs this procedure?
Complete patient evaluation by your veterinarian and by a veterinary orthopedic surgeon will determine if total hip replacement can help your dog.
- History: Includes questions about your dog's hip pain, medications, prior injury and current vaccinations. Also included are questions related to which leg is causing your dog the most problems, your dog's ability to walk, exercise, climb stairs, rise and sit.
- Physical Examination: Includes a complete assessment of your dog's general health and skin condition, the range of motion in your dog's hips, and observation of how your dog walks, sits, rises and moves.
- X-rays: Provide the surgeon with information about your dog's hip bones and hip joints. They also help in the precise fit of your dog's new hip.
- Laboratory Analysis: Blood and urine samples will be analyzed to help determine the state of your dog's health, and if heartworms are present.
Are there reasons why my dog should not have a total hip replacement?
Yes. If your dog has healing wounds, inflammation or infection of the skin, ears, or teeth, poor nutritional status or laboratory evidence of metabolic disease or infection, a total hip replacement will not be performed at that time. When the problems are resolved, total hip replacement can again be considered.
Other problems such as stifle joint injury, prostatic disease and spinal disorders can mimic hip joint problems. In this case, total hip replacement will not improve the condition.
If a femoral head and neck excision was performed previously, the results of total hip replacement are generally not as rewarding as cases receiving hip replacement initially.
How is total hip replacement performed?
Under general anesthesia, the surgeon replaces the damaged parts of the joint with a prosthesis. The diseased femoral head in the hip joint is replaced by a metal ball on a stem that fits inside the femur. A plastic cup is implanted into the pelvis to replace the damaged socket. The new prosthetic components are designed to allow the joint to move the same way as the normal hip.
The metal alloy and polyethylene components are very durable. Acrylic bone cement is used to anchor the implants to the bone.
Will it take long for my dog to recover?
Most dogs are able to stand and walk on the new prosthesis within the first few days after surgery. While hospitalized, exercise is restricted to cage confinement with 10 to 15 minute walks under leash restraint twice daily. Most animals undergoing total hip replacement are hospitalized for a total of 3 to 4 days.
Management at home will require supervision, and activity must be restricted to walks under leash restraint for 4 weeks. During this time, care should be taken to avoid activity on slippery surfaces, and stairs should be climbed only while the dog is under the direct control of the owner. One month after surgery, supervised exercise can be gradually increased over the next 4 weeks. At the end of 8 weeks, return to normal activity is allowed.
Radiographic evaluation and orthopedic examination are necessary at 6 and 12 months after surgery, and every 2 years thereafter. This provides a history of the patient's progress and may help to detect potential complications.
What are the risks and complications of total hip replacement?
There are risks inherent with any surgical procedure under anesthesia. You should discuss these risks with your veterinarian and/or the orthopedic surgeon. The current complication rate following total hip replacement is 2 to 5 percent. Complications are best treated when identified early. Significant complications include:
- Dislocation of the prosthetic joint is rare, and is most likely to occur in the first 4 weeks after surgery. It may be corrected manually, but another surgery is often necessary.
- Infection is a serious potential problem. If it occurs in the area of the wound, it is generally treated with antibiotics. If it occurs in the bone, removal of the prosthesis may be necessary.
- Loosening of the prosthesis is a problem which may occur. If loosening is significant or progressive, the implant may need to be replaced or removed.
What are the benefits of a total hip replacement?
The main benefit of total hip replacement is relief of pain, and this is often quite dramatic. Some soreness in the leg and hip is to be expected for a few weeks because of the surgery and because muscles around the joint are weak from inactivity. Muscle strength and motion of the joint will improve with increased activity over the next few months.
Is total hip replacement permanent?
In most dogs, the total hip prothesis will last for the dog's life. It will provide years of pain-free activity that would not otherwise have been possible. With improved surgical techniques and prostheses, the future looks promising for dogs of all ages that need total hip replacement.