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Don't wait too long for hip dysplasia surgery

I saw a case last week, that was an 8 month old female dog that had hip dysplasia. One hip had minimal to no signs of arthritis on the radiograph. This side had a fairly crisp reduction of the hip while doing an Ortolani sign, but the angle of reduction was quite high, close to 75 degrees. The other side had some remodeling and filling in of the acetabulum on the radiograph, and some "grinding" while doing the Ortolani maneuver, and the angle of reduction was almost 90 degrees! The owner really wanted to try to perform triple pelvic osteotomies on both hips, even if we needed to do an additional procedure on the worse hip, such as "tightening" the joint capsule, or moving the insertion of the gluteal muscles to increase the tension to help hold the hip in place better (transposition of the greater trochanter). We told them we would try, but...

Surgery went well on the first side with less severe hip dysplasia. But even with the most angled triple pelvic osteotomy plate, there was still an Ortolani sign, although the angle of Ortolani reduction was only about 20 degrees -- much improved, and we hope that this will eventually tighten up. But, with this knowledge on the good side, we counseled the owner that trying to do a similar surgery on the worse side would, in all likelihood, fail and we should consider doing conservative management of that hip, with an eye to a salvage procedure in the future, such as a femoral head and neck excision.

So the point of this blog? Don't wait too long for any corrective surgery for hip dysplasia. Arthritis and hip remodeling occur very rapidly in dogs. This dog was just 8 months old, and the hip changes were already too advanced to expect an optimal result from surgery.

Thumb rules:

In dogs under 5 months of age, consider a relatively minor surgery called JPS, or juvenile pubic symphysiodesis. Hip laxity can be determined using a technique called PennHip as early as 4 months of age to diagnose the likelihood of developing hip arthritis, and the decision can be made to perform this procedure.

In dogs 6 to 10 months of age, consider a triple pelvic osteotomy. Do not wait too long for this surgery because dogs can literally go from a good candidate to a questionable candidate in 2 weeks

For total hip replacement, although I favor a period of conservative management to see how dogs will respond, again, don't wait too long because the constant rubbing of the ball of the femur (femoral head) on the cup of the hip joint (acetabulum) may cause too much wearing away of the bone, resulting in not being able to put a total hip in place.

If you are considering surgery for your dog with hip dysplasia, think in terms of days to make a decision, not weeks. Unfortunately, I have seen too many owners be disappointed when their dog is no longer a candidate for a particular surgery.

Not familiar with some of the terminology in this blog or have other questions, please use the comment section. Also, you may be interested in getting a copy of the Dog Owner's Guide to Hip Dysplasia, available from Amazon for Kindle, to help determine if your dog may have hip dysplasia, and what treatment options are available.

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