- Hip dysplasia is a very common disease that affects larger breed dogs. This disease is caused by the abnormal development of the hip as a puppy grows. Bad genetics are a major contributing factor. Sometimes the mother and father of the affected puppy are negative for the disease. If this is the case, the parents may have hidden genes for the disease.
- Hip dysplasia results in looseness of the hip joints. Because the joints are loose the head and socket of the hip become deformed. The socket becomes shallow and the head of the femur gets flattened. Arthritis develops in the joint and causes pain.
- Clinical signs of hip dysplasia can be seen as early as 4 months of age, however, many dogs are 8 to 12 months of age. Some dogs seem to experience signs of hip dysplasia when they are a couple of years old and others in the geriatric years. The clinical signs of a problem may first start out as exercise intolerance. Bunny hopping, stiffness on rising after a rest, lameness on a limb, and atrophy of the muscles of the hind limbs are typical clinical signs. Occasionally the hip joint will be very loose and it will become dislocated with minimal trauma. This usually causes the pet to become suddenly lame. Replacement of the hip back in the joint is generally unsuccessful as the geometry of the joint is so abnormal.
- The diagnosis of hip dysplasia is made based on a combination of history, clinical signs, physical examination findings, and radiographs. We do not base a decision to perform a total hip replacement solely on the radiographs. A dog may have very degenerate hips and does not show any clinical signs. Another dog may have profound clinical signs of hip dysplasia and have milder degenerative changes as seen on a radiograph.
- Selection of the patient to do a hip replacement must therefore be done carefully. Dogs that are not candidates for hip replacement include
- dogs less than 10 months of age (we usually wait until the dog matures)
- successful medical therapy
- chronic infections of the bladder, skin or elsewhere
- concurrent significant neurological disease
- diseases that increase the risk of blood clots (nephrotic syndrome and Cushing's disease)
- bone cancer
- Dogs that are totally spastic and uncontrollable, may also be less desirable candidates as the complication rates after surgery will be increased.
- Fig 1 shows a dog's pelvis afflicted with hip dysplasia of the left hip joint (your right) Note the extensive bone spurs that are surrounding the joint in comparison to the opposite normal hip joint.
Total Hip Replacement Surgery
- Total hip replacement requires a preoperative evaluation. Blood work is generally done to ensure health of the internal organs. Urine testing is done to ensure that no bladder infection is present. The body is checked over for obvious infections such as skin infection. Two radiographs of the hips are taken in order to determine the size of the femoral implant and plastic cup that will be needed for your pet. Your pet should be bathed at home and completely dried the day before surgery. Your pet should not be allowed to go outside except for elimination purposes so that he/she does not get dirty.
- Just before surgery the entire leg will be shaved. An epidural will be given for pain control after anesthesia is induced. Once in the operating room, special sterile plastic drapes are glued to the limb. An incision is made over the region of the hip. The ball of the femur is removed and the marrow cavity is cleaned out. The acetabulum (socket) is reamed out and a plastic cup is cemented in placed. A cobalt-chrome femoral implant is cemented into the femur bone and the hip is put back in place. We use the BioMedtrix hip prosthesis to perform a total hip replacement (most surgeons in the USA use this type of hip as it is an adjustable system).
- Below in Fig 2 hip dysplasia is found on only one side (your right - which is the dog's left hip); note that the hip does not fit nicely in the joint like the opposite one does; in Fig 3 total hip replacement has been performed to correct the problem.
After Care and Convalescence
- After surgery has been completed intensive care is provided.
- Pain control after surgery is maintained with an epidural at the time of the surgery and morphine is given in the postop period as needed. While at home, oral pain medication may be needed and a prescription of Tylenol #4 will be given to you at the time of discharge of your pet.
- The incision is covered with a bandage for about 1-2 days. The bandage should be kept clean and dry if still in place at home.
- It is important to support the hind limbs with a sling to prevent slipping and falling. The SupportRx Harness by TopDog Rehabilitation is an affordable and effective option. (link to http://topdoghealth.com/therapy-support-products/support-rx/)
- Antibiotics must be given after surgery to help prevent against infection.
- Exercise restriction must be continued for 3 months. During the first 2 months the pet should be kept in the house on good footing (avoid slippery flooring). During the third month exercise is gradually increased.
- Rehabilitation therapy is very important after surgery to maintain muscle mass and range of motion of the operated hip. An excellent guide is TopDog Home Rehabilitation Instructions for Total Hip Replacement.
- Most dogs will start to bear some weight on the limb within a couple of days after the surgery. Within 2 weeks your pet should bear a moderate amount of weight on the limb. By 2 months after surgery full weight-bearing resumes.
- Your pet should be examined 2 weeks and 6 weeks after surgery to ensure that the hip is healing well. At 4 months after surgery and annually, examinations and radiographs should be done to ensure that the hip is still stable and the implants are not loosening.
- As with any surgery, complications may arise. Even though rare, anesthetic death can occur. With the use of modern anesthetic protocols and extensive monitoring devices (blood pressure, EKG, pulse oxymetry, inspiratory and expiratory carbon dioxide levels, and respiration rate), the risk of problems with anesthesia is minimal.
- Infection is an unusual complication, as strict sterile technique is used during the surgery and antibiotics are administered. When infection occurs it usually is very devastating, as it is usually impossible to clear the infection with antibiotics. This is because bacteria migrate into the bone cement and the antibiotics cannot penetrate the cement very well. If infection occurs removal of the implants is usually needed. Infection of the hip prosthesis can also take place if the dog develops an infection elsewhere in the body. The infection from another site may enter into the blood stream and migrate to the hip. Therefore skin, mouth, bladder, and other types of infections must be treated as soon as possible.
- Another unusual, but reported complication is sciatic nerve damage. If this occurs it usually is temporary.
- Excessive activity or exercise within the first 2 months can also lead to complications. The femoral prosthesis could dislocate from the acetabular cup. Another complication is loosening of the cement from the bone or loosening of the implants from the cement. Both of these conditions require surgery to correct the problem.
Frequently Asked Questions After Surgery
When should my dog have the first bowel movement after surgery?
- Many dogs will not have a bowel movement for the first 4 to 5 days after surgery
- Reasons that a dog will not have regular bowel movements after surgery include:
- The dog has been fasted prior to surgery
- Dogs do not eat well during the hospital stay
- They frequently do not eat well when they go home
- They are fed highly digestible food that produces little stool
- Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating
- If a pet does not have a bowel movement on the 5th day of being home, a stool softener such as metamucil can be fed
- Dose of metamucil is 1 tsp per 25 Kg mixed in with each meal (canned dog food); feed immediately after mixing, as the metamucil will gel the food and may make it less palatable
My pet had surgery and will not eat. What can be done?
- Most pets will not eat their regular dog food after surgery, especially if it is kibble.
- Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source. The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked). The carbohydrate can be pasta, potato or white rice.
- Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
- Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal
- Try Hill's A/D diet available at most veterinary hospitals
- Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
- Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
- Remember that most pets will not eat the first day or two after they get home from surgery
- Offer smelly foods that contain fish such as tuna or smelly cat foods
- Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
- Hand feeding: with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
- Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
- Some cats will only eat dry food, try kibble if your cat normally has been fed that food
- Petting and stroking your cat frequently will help to stimulate appetite
- Remember that most pets will not eat the first day or two after they get home from surgery
- Appetite stimulants such as cyproheptadine may be helpful
- If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop
My pet is vomiting. What can be done?
- The first thing for you to discern is whether your pet is vomiting or regurgitating. Both will result in fluid or food being brought up. Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus. Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled. Usually the regurgited material will be clear or brown colored fluid.
- Next is to identify the cause of the vomiting or regurgitation.
- Causes and treatment of vomiting after surgery
- When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
- Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery. In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart. Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to. The antibiotic in some cases may be changed to a different one, or may be discontinued.
- Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days.
- An uncommon cause of vomiting after surgery is internal organ failure. Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
- If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present. Do not ignore this sign.
- Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days. In order to decrease the acidity of the stomach, Pepcid AC 0.5 mg/kg can be given by mouth twice daily for 5 days. Metoclopramide and Cerenia are good anti-vomiting medications for dogs and cats. You should always consult a veterinary healthcare professional before administering medication.
- Causes and treatment of regurgitation after surgery
- The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia. Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis. This results in poor motility of the esophagus, therefore water and food will accumulate in this structure. In most cases, esphagitis is self-eliminating and will resolve within two or three days.
- If the esophagitis is severe the esophagus may develop one or more strictures. A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week. This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope). If an esophageal stricture is chronic surgery is needed.
- Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other). Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.
How do I know that my dog is in pain following surgery?
- Signs of pain include
- biting if you get near the surgical site
- grimacing (lips are pulled back and the the dog looks anxious)
- tragic facial expression
- restlessness and unable to sleep; pacing
- if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
- the worst pain will be for the first 2 to 3 days after surgery
What can I do to control my dog's pain?
- Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
- Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
- If an orthopedic surgery has been done cold packing the surgical site may be helpful
- A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack. An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern. Cooling the surgical site helps to numb the area.
How do I know that my cat is in pain following surgery?
- Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
- Signs of pain in a cat include the following:
- biting if you get near the surgical site
- growling or deep cry
- not wanting to eat
- hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)
What can be done for pain at home for my cat?
- Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
- Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
- Anti-inflammatories can be used, but the dose is much less than dogs
Is it okay for my pet to lick the incision?
- If a dog licks the incision, the healing process may be delayed.
- Licking can remove stitches and cause the incision to open
- Licking can become a severe habit that is difficult to break
- Licking can cause infection as the mouth has many bacteria
- Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.
- To stop your pet from licking the following can be tried:
- Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
- Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
- A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
- A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
- Bitter apple can be applied around the incision; many dogs will continue to lick after application of this topical
- Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
- Antipsychotic medication in some cases is needed