When, despite medical management, hip pain becomes problematic for your dog, hip replacement may be the best next step. Integrative veterinarian Dr. Julie Buzby explains the process so you know what to expect. Learn about the pre-operative process, the hip replacement surgery itself, and the post-operative recovery phase.
It’s true! People aren’t the only ones who can have a hip replacement. Veterinary surgeons can perform hip replacements in dogs, too!
In fact, according to a study in the Journal of Veterinary Surgery, 82% of dog parents rated their satisfaction with their dog’s total hip replacement experience as “very good.”
Is hip replacement right for your dog? By the end of this article, you’ll be better equipped to speak with your veterinarian about whether total hip replacement will put the spring back in your dog’s step.
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What is a total hip replacement?
As the name implies, a total hip replacement (THR) is a procedure that surgically removes and replaces your dog’s entire hip joint. Many orthopedic surgeons consider a THR to be the gold standard treatment for large breed dogs with significant hip disease. However, it is also an option for small breed dogs and cats, too. THR usually does a good job of providing near-normal hip function and significantly reduces pain in dogs.
Hip joint anatomy
Before we move on, let’s quickly review some basic canine hip anatomy.
The hip is a type of joint called a “ball and socket” joint. The “ball” is the head of the femur (i.e. long bone of the thigh). And the “socket” is the acetabulum (or cup) within the pelvic bone.
In a THR, both the head of the femur and the acetabulum get replaced with a synthetic implant made of plastic or metal.
Why might a dog need a hip replacement?
Several scenarios may lead to a dog requiring a total hip replacement. Trauma to the hip joint such as a fracture or dislocation, or a condition of small dogs called Legg-Calves Perthes disease (i.e. avascular necrosis of the femoral head), can both lead to a damaged, painful hip joint. However, the most common reason a dog needs a total hip replacement is osteoarthritis in dogs secondary to hip dysplasia.
Hip dysplasia in dogs
A combination of genetics and environmental factors are thought to be causes of hip dysplasia in dogs. Affected dogs are initially born with normal hips. However, as the dog grows, the hip joint develops abnormally. Specifically, the hip joint is looser than normal. Ongoing abnormal wear and tear on the joint lead to a shallow acetabulum and flattened head of the femur.
Some dogs with hip dysplasia develop symptoms when they are only a few months of age. In that case, an orthopedic surgeon may recommend a triple pelvic osteotomy (TPO), juvenile pubis symphysiodesis (JPS), or other surgical procedure. The end goal of those surgeries in younger dogs is to, hopefully, prevent more severe problems in the future as they get older.
Other dogs with hip dysplasia may look and act normal for several years. However, over time, they do eventually begin to show signs of osteoarthritis (also known as degenerative joint disease). The head of the femur and the acetabulum become rough and malformed. And the cartilage that normally cushions and protects the joint breaks down so that the bones rub painfully against each other with every step.
Management options for hip pain: Medical management or surgery
Some dogs can be kept comfortable and mobile with pain medication, joint supplements, rest, physical therapy, and weight management. This type of non-surgical treatment of hip dysplasia may potentially be effective for life in more mild cases.
However, when the disease is severe, or when your dog is in a lot of pain, medical management falls short. In those cases, surgery might be the most effective way to remove the source of pain. There are two main surgical options to address the painful hips:
- Femoral head ostectomy or FHO (i.e. removing the head of the femur)
- Total hip replacement
A femoral head ostectomy is an option for dogs of any age. On the other hand, for a surgeon to consider a total hip replacement, a dog generally needs to be skeletally mature. For the focus of this article, we’ll take a closer look at total hip replacements for dogs.
How do I know if my dog needs a total hip replacement?
If your dog is experiencing hip pain that isn’t responding well to medical management, your veterinarian may refer your dog to a veterinary orthopedic specialist. This is a veterinarian who has gone through additional years of school. He or she has passed rigorous tests to become board certified in the diseases, injuries, and treatment of the bones and skeletal system.
The orthopedic surgeon will examine your dog carefully to determine if a total hip replacement is the right choice. As part of the exam, the surgeon will watch your dog walk. Also, he or she will carefully palpate and manipulate the joints.
After finding the problem areas, the orthopedic surgeon may recommend X-rays to further evaluate your dog’s bones and joints. Unfortunately, taking X-rays can be stressful and uncomfortable when a dog’s hips are painful. To make X-rays more comfortable for your dog and to ensure the veterinary team gets good quality images of the hips, the vet may suggest administering a medication to help your dog relax. Sometimes, mild sedation does the trick. Other times, your dog may need full anesthesia.
Based on the results of the examination and X-rays, the orthopedic surgeon will make a decision about the best course of action for your dog. He or she may recommend a total hip replacement, a different surgical procedure, or modifications to the existing medical management plan.
If your orthopedic surgeon recommends a total hip replacement, numerous preparations need to be taken before the procedure. Let’s discuss this next.
What is the preparation like for a total hip replacement?
Preparation prior to your dog’s total hip replacement is a team effort between you, your dog, the orthopedic surgeon, and the surgical facility.
The orthopedic surgeon may request specific testing to ensure your dog is a good candidate for total hip replacement surgery and for anesthesia. Typically, this involves:
- Bloodwork to assess organ function, red blood cell numbers, and clotting capabilities prior to anesthesia and surgery
- Urinalysis to be sure there are no signs of a urinary tract infection in dogs
- X-rays to look for any major changes in the joint prior to surgery (if your dog doesn’t have a recent set of X-rays)
Additionally, the surgeon will advise you about any modifications to your dog’s medication and supplement plan in the days proceeding the surgery. Sometimes the surgeon also will recommend you use a special soap on your dog’s skin prior to surgery.
Surgical facility preparations
Performing a specialized surgery like a total hip replacement in dogs also requires specialized equipment and staff preparation at the surgical facility. This includes:
- Training specific to the type of THR being performed
- Specialized surgical instruments
- Advanced imaging equipment
- The highest level of sterility (including specialized surgical attire for all staff involved in the procedure)
- Surgical assistant(s) and/or veterinary nurses dedicated to your dog’s specific pre-op and post-op care
Preparing for the cost of a dog hip replacement
Based on the list above, it’s easy to see why a hip replacement is a significant financial investment. This level of expertise and equipment will definitely factor into the cost of a dog’s hip replacement. The exact cost will vary depending on multiple factors. These include your dog’s size, co-existing health issues, and the pre-operative testing and post-operative monitoring your dog requires. A staff member at the facility performing the THR should be able to give you an estimate for the procedure.
It is best to ask your veterinary care team about the cost ahead of time. Also, it’s important to discuss any questions you have prior to scheduling the THR. If you need assistance with the cost of the procedure, you may wish to ask your veterinary care team about payment options through a company like Scratchpay or Care Credit.
How is a hip replacement performed?
On the day of surgery, the surgical and anesthesia teams will examine your dog and review the surgical plan. Then the anesthesia team will give your dog a pre-op injection. This can help your dog relax and it also provides pain relief during the procedure. Then the team will put your dog under general anesthesia and carefully monitor him or her for the entire procedure and recovery period.
Now the surgical team can get to work. During the procedure, the orthopedic surgeon will remove the head of the femur. Then he or she will replace it with a new metal “ball.” He or she will also remove the acetabulum of the pelvis to make room for a new “socket.”
Your dog’s surgeon may use a cemented implant, a cementless implant, or a combination of both types, to replace the hip joint. As the name implies, a cemented implant uses a glue-like adhesive (i.e. bone cement) to attach the metal implant to the bone. On the other hand, a cementless implant fits tightly within the bone. It may have a sponge or honeycomb meshwork that the body “fills in” with new bone to anchor it in place.
There are pros and cons to each type of implant, but both options can be very successful. The orthopedic surgeon will choose a type of implant based on his or her training and your dog’s disease and anatomy.
What does the post-operative period look like?
At the conclusion of the total hip replacement, the anesthesia team will get your dog settled into the recovery suite. They will keep a close eye on your dog to ensure he or she comes out of anesthesia as smoothly and safely as possible. Part of this includes addressing any signs your dog is in pain upon waking up.
If your dog is relatively healthy, and has no pre-existing conditions, he or she may be in the hospital for just a day or two after surgery. However, some dogs need to stay in the hospital for three to four days after surgery. This time allows the veterinary team to ensure your dog is strong enough and comfortable enough to go home.
While in the hospital, your dog will have a team of people monitoring his or her recovery progress. Your dog’s veterinary team will make sure he or she is eating and that any nausea is under control. The team will also administer medications to control your dog’s pain and help him or her get outside to go potty.
How can you help your dog recover at home?
When your sweet pup is discharged from the hospital, you will receive post-operative care instructions and medications to give at home. Your dog may or may not go home with a bandage. Once the bandage comes off (or if there wasn’t one to begin with), you will need to monitor the incision for signs of redness, swelling, pain, or discharge. If you notice any of these signs, it is important to notify your vet’s office right away.
With any surgery, but especially with one like a total hip replacement where an implant is involved, it is important to keep your dog from licking the incision. Otherwise, your dog could pull out the sutures/staples or cause an infection. So keep the E collar on your dog at all times.
Preparing for your dog’s homecoming
It is also important to make your home as “recovery friendly” as possible for your dog’s return home. Consider taking the following steps:
1. Make a plan for assisting with your dog’s mobility
At first, it may be difficult for your dog to rise to a standing position or get outside to go potty. One option is to ask your dog’s care team to show you how to use a towel as a support sling. Alternatively, you may want to purchase a special mobility harness. Two of my favorites are the GingerLead® Support and Rehabilitation Harness or the Help ‘Em Up® Mobility Harness. These products are not only more comfortable for your dog than a towel, but they are also better for your back!
2. Minimize the number of stairs your dog will need to traverse
Ideally, you would minimize the number of stairs your dog must go up and down. However, that isn’t always possible. If your dog will be required to do stairs, ensure they have a non-slip surface. If the stairs are not carpeted, consider applying non-slip traction stickers.
3. Give your dog the gift of traction
Hardwood or tile floors can be difficult for a dog to navigate safely while recovering from a total hip replacement. To help your pup out, you may wish to use carpet runners or yoga mats to make non-slip pathways throughout your home.
A wonderful alternative (or addition) to creating pathways in your home is applying Dr. Buzby’s ToeGrips® dog nail grips. These rubber rings slip onto your dog’s toenails to help him or her get a grip on the floor. They go everywhere your dog goes. This means you don’t have to worry as much about what happens if your dog strays off the carpet runner pathway.
Being able to gain traction on the floors also gives your dog more confidence when moving around. Additionally, this improved grip makes it less likely your dog will fall and injure his or her healing leg.
You will also need to restrict your dog’s activity for several months after surgery. At first, the surgeon may want you to keep your dog in a confined area (like a crate) unless you are taking him or her outside on a leash to potty. You should also avoid letting your dog run, jump, rough-house with other pets, do zoomies, etc. during the recovery time.
I know this isn’t easy. But it is essential to a successful outcome. Your dog’s pain may lessen to the point that he or she wants to run and play (especially if he or she was having a lot of pain before surgery). Don’t give in!
To allow full and complete healing you must keep your dog quiet and calm until your vet gives you the ‘all clear’ to begin activity again.
When your dog is allowed to return to normal activity, it will be a gradual process. You may have a list of exercises to do with your dog at home. Alternatively, the surgeon may recommend seeing a veterinarian who specializes in rehabilitation. Your dog may have a lot of fun with his rehab visits as he or she learns to use balance balls or exercises on an underwater treadmill for dogs.
Support your dog’s joints
I like to recommend Dr. Buzby’s Encore Mobility™ hip and joint supplement to all my patients who have joint surgery. The green lipped mussel for dogs and deer antler velvet in Encore Mobility have wonderful anti-inflammatory and healing properties. Plus, it is a great way to support your dog’s joints long term.
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Be your dog’s advocate
If at any point in the recovery process, you have concerns about how your dog is doing, please don’t hesitate to reach out to the surgeon or your regular vet. You know your dog. So if something doesn’t seem right, trust your intuition.
What are the potential complications of a hip replacement?
When it comes to hip replacement complications, the good news is that serious post-op problems happen in only 5 to 10% of canine patients. The main risks include:
- Nerve damage
- Fracture of the femur
- Loosening of the metal implant
- Hip luxation (i.e. slipping out of place)
If your dog is limping after a total hip replacement, it is important to speak with your veterinary surgeon as soon as possible. Hopefully, it is something as simple as your dog having sore muscles from “over-doing it.” In that case, your dog may simply need to slow down and have a bit of extra pain relief for a short period of time. However, limping after initially walking better could also be a sign of a more serious complication. It is always best to check with the surgeon.
Total hip replacement: A great option for many dogs
The idea that your dog may need a total hip replacement surgery can be scary, and you may have many questions. But with the right preparation, an amazing veterinary care team, and a lot of TLC from you, your dog can have a wonderful outcome—returning to an active, pain-free lifestyle for many years!
It is also worth noting that while hip dysplasia typically affects both hips, approximately 80% of dogs only require one hip to be replaced in order to significantly improve their mobility and quality of life. The surgeon will work with you to determine which hip is the best one to replace.
So if you are wondering if a total hip replacement could be the right solution for your dog’s hip pain, why not talk to your veterinarian? It never hurts to get more information on something that might help your beloved dog have more good days with you!
Has your dog had a total hip replacement?
Please share your experiences below to help other dog parents who are facing a THR with their dog.