There is no specific treatment that is best for CHD. The recommended treatment will depend on multiple factors which include: age, size, amount of pain and dysfunction, X-ray and examination results, your expectations and budget. However, it is not always necessary that a pet diagnosed with CHD receives treatment. Many younger dogs with CHD are able to function acceptably well into maturity without any crucial signs of hip pain. There are both medical and surgical options for dogs with CHD. The initial treatment for most dogs is usually medical management.
Medical treatment aims to improve your pets comfort without having to surgically intervene. This method includes: aggressive weight loss and management, consistent participation in low-impact activities such as walking or swimming, anti-inflammatory drugs that do not contain steroids, physical rehabilitation, supplements containing fish oil and osteoarthritis drugs. Dogs in group 1 may not have the same positive results from medical treatment as dogs in group 2. Thus, it may be necessary for early surgical intervention with juvenile pubic symphysiodesis or a proceduure (JPS) such as pelvic osteotomy.
JPS aims to alter the shape that the pelvis grows into by stopping the pubis (portion of the pelvis) from growing further as well as diminishing hip laxity through increasing the ball’s coverage by the socket. The surgical procedure is relatively minor and should be performed while the puppy is less than 18 weeks of age. However, symptoms of CHD are rarely visible at this age and thus examination and X-rays are needed.
Alternatively, an immature dog can undergo a double or triple pelvic osteotomy (DPO/TPO), regarded they are less than 10 months old and have CHD without arthritic changes. In these procedures, the pelvic bone will be cut in two (DPO) or three (TPO) places and the segments will be rotated in order for the ball to have more coverage by the socket, thus decreasing hip laxity. TPO is a common procedure that has been used for decades. With the recent improvement in technology of implant (locking plates and screws), only two cuts in the bone will allow for similar results.
If the immature dog has evidence of hip arthritis or an extreme case of hip laxity, TPO/DPO is not recommended. In order to determine if the dog will benefit from the procedures, it is important that they undergo examination and X-rays beforehand. If candidates are not fit for the procedure, they should be medically managed until they are able to have a total hip replacement (THR) or a femoral head ostectomy (FHO).
FHO can be a beneficial treatment for dogs who do not meet the criteria for specific treatments or are part of group 2. This process requires the femoral portion of the hip joint to be removed which reduces the pain caused by abnormal hip contact and the stretching of soft tissue caused by laxity. After FHO, there will be development of a “false joint”, which is the muscles around the hip putting pressure on the pelvis rather than the leg during limb movement. FHO is aimed more at relieving the pain associated with CHD rather than maintaining or recreating normal hip function. Thus, the FHO procedure is less desirable for larger dog breeds.
THR is an option for both group 1 and 2 dogs. This procedure both eliminates hip pain and mechanics similar to that of normal hip joint, it also allows for a more natural limb motion and function. The THR procedure is similar to that of humans as it involves replacing the ball and socket with metal and polyethylene substitutes. These components will be fixed in place with either “press fit” methods, bone cement or metal pegs.
TPO was previously performed on younger dogs with hip dysplasia to reorient the positioning of the acetabulum/socket over the femoral head/ball. This procedure proved to be quite successful, however, complications and discomfort post-operation were much higher compared to other procedures. Thus, it was modified into a double pelvic osteotomy. The difference with this procedure is that only two incisions are made and a bone plate is used to secure the osteotomy. The discomfort post-operation is minimized as a portion of the pelvis is left intact.
There are multiple factors to consider when deciding if a patient will benefit from DPO. It is important that patients fit the criteria for outcomes to always be good to excellent. The criteria is:
- A patient must be younger than 8 months of age
- Not be diagnosed with osteoarthritis
- A normal sized and shaped femoral head
- Femoral head falls into the right place of acetabulum without extra force or angulations