double pelvic osteotomy (DPO)
What is a Double Pelvic Osteotomy (DPO)?
Your dog’s hip joints are made up of several different bone and tissue segments. When these segments are properly formed, and situated, your dog’s hips move freely and without pain. In some cases, the femoral head that makes up the top of your dog’s system of leg bones does not fit fully into the acetabulum, (the circular-shaped pocket that forms a close-fitting cup over the femoral head). This condition is commonly referred to as hip dysplasia. Triple pelvic osteotomy (TPO) and double pelvic osteotomy (DPO) are two related surgical procedures that can be used to improve coverage of the femoral head and correct hip dysplasia.
Other, non-surgical, rehabilitative methods may be used to strengthen supporting muscles or otherwise correct hip dysplasia, however, the best results will occur if the surgery is performed as soon as possible before arthritic changes in the bone structure have begun to occur. Once this has happened, your dog is no longer a good candidate for surgical intervention.
Double Pelvic Osteotomy Procedures in Dogs
Before surgery, your vet will perform several tests to confirm that your dog is a good candidate for the procedure. X-rays will need to be taken and your dog’s gait will need to be observed and their legs manipulated by a skilled orthopedic veterinarian. As with any major surgical procedure, your vet will ask for a complete blood profile prior to undergoing anesthesia. Once cleared for surgery, your dog will be admitted to our veterinary hospital and will be placed under general anesthesia. A tube will be placed in your dog’s throat to allow for proper ventilation during surgery.
During the operation, your vet will make a careful incision in the hip area to expose the femur and pelvis. In a TPO, three separate bone cuts are made using a surgical saw. These bone pieces are repositioned so that more complete coverage of the femoral head is obtained and your dog’s bone fits nicely into a reconstructed hip socket. The three fragments are resecured with the use of metal plates and screws. In a DPO, two cuts are made in the bone and the pelvis is rotated slightly to create a better angle for femur positioning. The bones are also secured with the use of specialty plates and screws. The next step in both procedures is to carefully close up the wound using stitches to reconnect underlying tissues and skin. Your dog is then carefully woken up from anesthesia and allowed to rest comfortably, at least overnight, for observation.
Efficacy of Triple or Double Pelvic Osteotomy in Dogs
The effectiveness of a TPO or DPO will depend on many factors. Following proper rehabilitation protocols including confinement, rest, and gradual reintroduction to exercise, will be critical elements in achieving long term success. Most patients will be able to move without pain or discomfort and the hip dysplasia upon recovery and will be corrected permanently.
Expected recovery from Triple or Double Pelvic Osteotomy (TPO / DPO) surgery in Dogs
As with any major joint surgery, proper rest, aftercare, and rehabilitation will be critical to your dog’s recovery. When released to home, your dog must be kept calm and quiet and movement should be restricted, strictly following your veterinarian’s instructions. Your veterinarian may prescribe pain and anti-inflammatory drugs to help provide for your dog’s comfort and to reduce postoperative swelling which aids in the healing process.
After your dog’s incision has healed, you will be given instructions for returning gradually to normal exercise and movement. Your dog should be limited to on-leash walks only for at least several weeks. During recovery, rehabilitative exercises, such as swimming and slow stretching, may aid in returning to a normal range of motion and can help strengthen the surrounding muscles.
Canine Triple or Double Pelvic Osteotomy (TPO/DPO) surgery considerations
Surgery to correct hip dysplasia is not recommended for very young dogs under the age of five months as bone growth can continue for some time. For larger breeds that continue to grow well past a year, surgery may be postponed and supportive therapy may be offered until an accurate confirmation of hip dysplasia can be made once the structure of the joint is permanent.
Surgery should not be postponed for an extended period of time as hip dysplasia can cause arthritic changes in the hip structure, which may make the dog a poor candidate for surgery. As with any major surgery, complications from infection or improper healing can occur in rare instances. Strict adherence to healing and therapy protocols are important for long term recovery.
Triple or Double Pelvic Osteotomy (TPO / DPO) Prevention in Dogs
The exact cause of hip dysplasia is not well known, however there are multiple likely contributing factors. In young dogs, quality nutrition is an important tool in preventing hip dysplasia. Overfeeding and excess weight can put undue stress and strain on developing bones and joints and young puppies should not be fat or overfed.
Triple Pelvic Osteotomy (TPO) & Double Pelvic Osteotomy (DPO)
For dogs that have just had pelvic surgery to correct the conformational abnormalities associated with hip dysplasia (i.e. hip “looseness”). The TPO procedure, when performed in a young dog, will rotate the acetabulum (“socket” of the hip joint) to better cover and contain the femoral head (“ball” of the hip joint), thus providing improved support for the hip. Three separate skin incisions and cuts in the bone of the pelvis are made to allow rotation; these cuts are then stabilized with bone plates and screws. These implants are surgically attached to the bone, bridging the main cut to provide stability until the bone heals to its original strength. Healing time is required before the bone is strong enough to accept normal activities. The majority of patients will have their implants for their entire life, and do not have long term activity restrictions.
ACTIVITY RESTRICTION x 8 weeks
- Your pet may be groggy for a few days. He or she may whine or appear more anxious than usual; this may indicate pain/discomfort or side-effects of the medications. Please call your veterinarian for assistance with medication adjustments or return for exam and additional pain medications as needed.
- Please keep your pet in a small area with secure footing (small room or penned off area with carpet) for the next 2 weeks or until he/she is very secure on his/her feet. Thereafter, he/she may be confined to one level of the house with no free access to stairs. Use baby gates, etc. to prevent access to stairs. Do not allow jumping on/off furniture. Confine to a small area/room/crate when unattended. Please do not allow any playing, running or jumping. Use a short leash when going outside to urinate/defecate.
- For the first 1-2 weeks, your pet may need assistance when walking on slippery floors; use a belt/band under his/her belly to prevent slipping. Continue this protective measure until he/she is very strong on all legs.
- Your pet should start touching his/her toe down within the first 2 weeks. Thereafter, leg use should steadily improve each week. By 6 weeks, he/she should be 90% recovered. If he/she suddenly deteriorates or does not appear to be progressing well enough, please return to your veterinarian for exam; x-rays may be needed to diagnose the problem.
- Your pet will feel like fully using the leg before the bone is healed. Please continue the restrictions during this difficult time when he/she is feeling “too” well! Failure to do so may cause serious healing problems; plate and screw problems are directly related to the amount of activity the patient has during this recovery period.
- Please look at incisions twice daily. They should be dry, slightly red along the margins, and slightly swollen/thick on the edges. Over several days, they should lose redness and swelling. Problems to call your veterinarian about: discharge, gapping, excessive swelling.
- Do not allow your pet to lick or chew the incision. Dogs tend to want to lick early in the healing period and this can compromise the incision and predispose to infection. During the first 2 weeks, please use an E-collar to prevent incision damage, if you must leave your pet unattended.
- Return to your veterinarian in 10-14 days for a progress exam. Skin healing and leg function will be evaluated, sutures will be removed, and any physical therapy questions will be addressed.
- If your pet is doing well, the next visit will be 6-8 weeks after surgery. Leg function will be evaluated, x-rays will be taken of the surgical site to judge healing, and physical therapy recommendations will be adjusted.
- Your pet may need to be seen again at 12 weeks if healing was incomplete at the second visit.
Do not make any adjustments to your pet’s diet until he/she has resumed normal attitude, appetite, energy level and bathroom habits. In the first few days of recovery, encourage eating with supplements like meat babyfood and canned dog food as treats. Be aware that the above activity restrictions may cause weight gain. To prevent this, you may feed 3/4 of the usual amount of food during the next 2 months. Your veterinarian will re-weigh your pet at the progress exams to monitor weight.
(We can also recommend professional physical therapy assistance in the Twin Cities. Studies have shown that a formal program can decrease post-operative recovery time. Please let your veterinarian know if you are interested in a referral.)
- Our lives are often very busy, so if you must err, err on the “do less” side of these instructions. Less physical therapy will result in a slower return to function, but more aggressive physical therapy by a non-professional too early may result in failure of the implants and surgical repair.
- Week 1: Range of Motion (ROM) Exercise– Have your pet lie on his/her good side. Grip the foot with one hand and slowly and gently push the foot up into flexion of all joints. Slowly pull the foot and push the leg down and back into full extension of all joints. Repeat this motion 5 times once daily. This exercise should not be performed to the point of pain or resentment. After ROM, apply ice packs (wrapped in thin cloth) to the incision area twice daily for 10-15 minutes. Baggies of frozen peas work well for this, or make an ice pack by freezing 2 parts isopropyl alcohol to one part water in a ziplock bag.
- Week 2: Expanded ROM Exercise– Have your pet lie on his/her good side. Apply a warm compress to upper hip incision area. Grip the foot with one hand and slowly and gently push the foot up into flexion of all joints; hold for 5 seconds. Slowly pull the foot and push the leg down and back into full extension of all joints; hold for 5 seconds. Repeat this motion 10 times twice daily. This exercise should not be performed to the point of pain or resentment. Apply ice packs after ROM (as above). Continue 4 weeks.
- Week 3: Sit/stand Exercise (for dogs)—Have your pet repeatedly sit and stand for 10-15 repetitions twice daily. Use small treats to encourage participation. Do not push down on his/her rump. Continue 4 weeks.
- Week 6: Stairs Exercises—Have your pet walk up and down a flight of stairs on a leash, in a slow, controlled manner such that your pet uses every step. Repeat 5 times once daily. Continue 4 weeks.
- Week 8: Active exercise (for dogs)– Place your pet on a short leash and have him/her walk at your side. Walk outside on even/solid footing for 10 minutes twice daily. Continue 4 weeks.
- Week 8: Hip Stretch Exercise—Perform this exercise on carpeting with 2 people. If you have a large exercise ball (2-3ft diameter), place the front end of your dog across the ball. Slowly roll the ball forward so the hind quarters are stretched to the point when your pet takes a step forward with his/her hind feet. Slowly roll the ball backward so he/she steps backward. Repeat this slow-motion stretch for 15-20 repetitions twice daily. Continue 2 weeks.
- (If you do not have an exercise ball but can safely lift the front end of your dog, use this technique. Kneel in front of your pet and lift his/her legs up to your shoulders; support his/her front end. Slowly rock backwards so your pet’s hind quarters are stretched to the point when your pet takes a step forward with his/her hind feet. Slowly lean forward so he/she steps backward with the hind feet. Repeat this slow-motion stretch for 15-20 repetitions twice daily.)
- Swimming is wonderful rehabilitation exercise (for some dogs) when performed correctly. You may allow controlled swimming after week 8. Controlled swimming requires that your pet not jump or leap into the water; walking into the water until it is deep enough to swim is required. Throwing balls to fetch often results in sudden jumping and lunging, which can cause serious problems in the healing phase. Do not over extend your pet; start with short excursions (5 minutes) and increase duration and frequency gradually.
LONG TERM LIFESTYLE
- After the bones have healed, there are no restrictions on activities for your pet. A gradual return to full function should occur, to allow for a smooth return of muscle function and strength following the restricted period.
- Once bones are well healed, there is minimal risk to that site in the future. The plate and screws do not create any problems in the vast majority of patients. Occasionally these metal implants can become infected; it is believed these infections originate from bacteria normally found in the blood stream in patients with infections elsewhere in the body or from dental disease. Implants can also loosen or create bone pain caused by cold temperatures. On occasion metal implants will have to be removed months to years after the original surgery if they cause the patient problems. Please have your veterinarian evaluate any lameness or pain you notice associated with the operated leg. This implant removal is rarely indicated, but will require a second surgical procedure that is not accounted for in the original surgery fees.
- If indicated, the opposite hip can be operated as early as 4 weeks after the initial procedure. This decision will be made based on patient age, x-ray findings before first surgery, and progress after the first surgery.