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FAQ: Total 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. We hope you find this information helpful and would be happy to answer any other questions you might have.
Q: 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 molecular weight polyethylene plastic. Special bone cement is used to hold these implants in place.
Q: Do you use a cementless or a cemented total hip replacement?
We have been doing cemented total hip replacements at The Ohio State University College of Veterinary Medicine since August of 1976. We have gained considerable experience with this procedure and have a high success rate. The prosthesis we use has many of the design features found in hip replacements used in people. It is commercially available and in wide use through out the world. Total hip replacements that do not use cement are commercially available for dogs. To date, these commercially available cementless implants confer no significant advantage to the patient in the short or long term. In future it is possible that technological advances in cementless THR will allow us to recommend such implants, or a hybrid combination such as a cementless cup and cemented stem.
Q: Can you tell from my dog's x-rays (radiographs) if he/she is a good candidate for THR?
Radiographs show abnormalities in the hip joint and are used for choosing the proper sized prosthesis but they are only part of the picture. To decide what is best for your pet, the surgeon must evaluate your pet's history, perform a complete physical examination, evaluate your pet's radiographs and interpret laboratory data. Many factors must be evaluated before your pet is considered a good total hip candidate.
Q: How do you determine if my dog is a candidate for a THR?
A painful hip(s) that is affecting your dog's comfort, locomotion and activity levels 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 of 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 9 to 12 months of age. This is determined by x-rays of the hips. The size of the bones as determined by x-rays must be large enough to fit the available sized of prosthesis. Total hips can generally be placed in dogs weighing 40 pounds or greater. A dog with arthritic hips that has pain-free, normal function is not a candidate for THR.
Q: What is the earliest age my dog can have this procedure done?
In most dogs 9 months old is the earliest the procedure will be done. There are only a few giant breeds where it will be necessary to delay surgery for 1 or 2 months while the dog's skeleton reaches maturity.
Q: 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). We have found that 95% of the hips that have been replace by surgeons at OSU return to normal function or near normal function. More than 95% of owners feel that their dog's quality of life is improved or markedly improved.
Q: Since the expertise of the surgeon is very important, what experience do the surgeons at Ohio State have with the procedure?
In 1976 surgeons from Ohio State began evaluating the effectiveness of this procedure. This evaluation continues today. Since the first hip was put in, over 2,000 total hip replacements have been performed by surgeons from Ohio State. More canine total hips are done at Ohio State each year than at any other university or private practice in the world. Surgeons at Ohio State have been leaders in developing and writing about total hip replacement surgery. Owner and referring veterinarian cooperation in providing follow-up information has been invaluable in the effort to evaluate and continually improve this procedure.
Q: My dog is on medication. Should I stop giving this?
Medications for health conditions such as diabetes or low thyroid function should not be stopped. Medications for hip pain should be stopped prior to the initial examination. Oral steroids (even for skin conditions) should be stopped 1 week before the exam while other anti-inflammatory drugs including aspirin should be stopped 3 days before the exam.
Q: 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, anemia 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. If the pre-operative evaluations reveal no abnormalities, surgery is usually scheduled for the next day.
Q: How long will my pet stay in the hospital?
The routine length of hospitalization for patients with THR is 3 to 5 days including the day of the initial examination. If it is determined that your pet is a good candidate for the procedure and you agree to have the procedure done, he/she will be admitted to the hospital at the initial examination for surgery the next day.
Q: What is the success rate of THR?
In reviewing the records of patients that have had THR, a little over 95% of dogs have had good to excellent function with this procedure. These patients have normal pain-free function, increased muscle mass, no limping and increased activity.
Q: What are the complications with this surgery?
As with any surgery, total hip replacements have their own set of complications. The complications that have occurred since 1976 when the first THR was done at Ohio State include dislocations, fractures of the femur, infections, loosening of the implants and nerve damage. Because surgeons at Ohio State have been continually evaluating and improving this procedure, the risk of a complication occurring is low. 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. Most complications can now be successfully resolved, preserving the THR. Thus, in the unlikely event your dog does have a complication, it is best to have it dealt with by a surgeon at The Ohio State University.
Q: What is the post-operative 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. The sutures may be removed 10 to 14 days after the surgery. This may be done by your local veterinarian or at Ohio State. An appointment for suture removal is required at Ohio State.
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.
For 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.
Q: Do I have to bring my animal back to Ohio State for a check up?
If possible we would like to reevaluate our patients at OSU. We understand that people come to us from all over the United States, so if it is not convenient for you to return to OSU, we ask that you have your veterinarian x-ray your dog at 3 months after surgery and annually thereafter. We also ask that those x-rays and a report on your pet's function be sent to us so that we may record that information in your pet's medical record. We have been able to follow some dogs for more than 12 years. We will only be able to evaluate long-term results of THR if we have the cooperation of owners and referring veterinarians.
Q: Both of my dog's hips are affected. Will both need to be replaced? How do you decide 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.
Q: How much does the procedure cost?
At present (2013), the average cost ranges from $4,400 to $4,700. This includes the examination, laboratory work, x-rays, hospitalization fees, antibiotics, anesthesia, surgical fees, special surgical drapes and the cost of the implants (which accounts for about 35% of the fee). Charges for follow up evaluations range from $200-$300. These costs vary, depending on what needs to be done. We at Ohio State are doing everything we can to keep the costs of this procedure low. However, as the costs of the implants and materials we use in the procedure increase, we may have to raise our fees, thus the price range given above is subject to change without notification.
Q: 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 Ohio State about your pet. An appointment is made with an orthopedic surgery service at The Ohio State University Veterinary Medical Center. These can be made by calling the small animal appointment desk at 1-614-292-3551. Appointments are for mornings only, Monday through Thursday. These appointments may take 2 to 6 hours. The day of the week for your appointment will vary depending on the surgeon's clinic schedule.
Q: Is THR the only treatment available for my pet?
No, besides THR, other possibilities for treatment of your pet include non-surgical therapy and several other surgical options. Which treatment should be used on your pet depends on many factors. The best treatment option will be discussed with you after we have taken a history, evaluated x-rays, and completed an orthopedic examination of your pet.
We hope we've answered your questions about total hip replacement. If you do have other questions, please be sure to ask them at the time of your appointment. Your veterinarian is welcome to call OSU to discuss case management with an orthopedic surgeon.