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Hip dysplasia is an abnormal formation of the hip socket that, in its more severe form, can eventually cause crippling lameness and painful arthritis of the affected joint. In affected dogs, there is laxity present between the femoral head and acetabulum resulting in incongruency of the joint. Hip dysplasia is often associated with older dogs, however the condition is present very early in development. In the early stages (6 to 12 months) there is incongruency between the acetabulum (blue concave line in figure) and femoral head (red convex line in figure) resulting in subluxation ( popping in and out) of the joint. This subluxation causes soft tissue damage, severe cartilage erosion and boney malformation resulting in osteoarthritis and degenerative joint disease. Varying treatment options exist depending on the patients age, comfort and activity levels, and stage of degeneration of the hip joint.
Double and triple pelvic osteotomy (DPO/TPO) is a surgical procedure meant to prevent the development of severe degenerative joint disease by recapturing the femoral head with the acetabulum. Since a dysplastic dog’s acetabulum is typically too shallow without adequate dorsal coverage (coverage on the top), a DPO increases dorsal coverage through a series of osteotomies (cuts in the bone). Osteotomies are performed in the ilium and pubis (yellow lines in figure) and occasionally in the ischium (for a TPO) when additional mobility is required. The acetabular segment is then rotated a defined amount and secured with bone plates and screws resulting in excellent acetabular coverage (figure below).
Selection criteria for DPO/TPO:
1) Clinical signs of hip dysplasia (lameness, exercise intolerance, reluctance to jump, etc.)
2) Hip laxity on physical exam (positive Ortoloni test)
3) Radiographic confirmation of hip dysplasia with minimal preexisting degenerative changes.
4) Typically considered more effective if performed at an early age (6 to 12 months) though in some circumstances older patients can still be candidates.
The primary complication with DPO surgery is implant loosening due to the procedure being performed in very young dogs whose bones are not yet completely ossified. Restricted activity (leash walks only) are required for 8 weeks until the osteotomies have healed. In patients with bialteral hip dysplasia requiring DPO’s on each side, the procedures can be staged 2-4 weeks apart.
The general outcome for patients undergoing DPO surgery is excellent. Though minimal osteoarthritis may develop, the hip joint is biomechanically stable and subluxation is prevented. Once healed patients return to comfortable pain free activity levels.
More information can be found at the American College of Veterinary Surgeons website.
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