For young dogs with hip dysplasia, triple pelvic osteotomy (TPO) is a surgery that improves upon the poorly shaped hips dealt out by Mother Nature. The results can be life-changing, which is amazing news for a pup with a life of fun ahead of them. But not all dogs are good candidates for TPO surgery and there are drawbacks so it's important to get the facts straight.
TPO Surgery 101
The words 'triple pelvic osteotomy' (TPO) are science speak for "Cutting the bone of the pelvis in three places." Of course, there's considerable skill involved in knowing where to make the cuts and then how to hold the bones in their new position!
The aim of TPO surgery is to create a better, more stable hip joint by changing the position of the cup that the head of the thigh bone sits in. This helps the hip move smoothly, places less strain on the thigh muscles, and in the long run reduces the risk of early onset arthritis.
For certain young dogs, TPO surgery is a great option. Once the bones are healed in the new position (which takes around six weeks) it makes a world of difference to their mojo.
However, TPO surgery isn't the answer for all dogs with hip dysplasia. This is a preventative treatment, which aims to make the hip move more smoothly and prevent dramatic deterioration in the future. If the damage is already done, such as arthritis has set in, then TPO won't help.
Which Dogs might Benefit from TPO Surgery?
In a nutshell, those pups best suited to TPO surgery are:
- Large breed dogs, weighing over 20kg at the time of surgery
- Young dogs around 8 - 10 months of age
- Pups with loose hips but no bone damage
Why is this?
This is a purely practical point due to the size of the metal plates used to fix the bones in place. These implants only come in a limited range of sizes, the smallest of which is too big to fit smaller dogs. In the future, purpose-made plates for small pups may be possible...but not at present.
TPO surgery is only right for young, growing dogs. This is because their bones need to grow and reshape in their new position. Also, its important the hip joints are still 'clean' and not damaged by arthritis, otherwise the hip still grates - but in a new position.
No bone damage
TPO surgery is the equivalent of realigning the hinges on a badly fitting door so that it closes properly. This surgery works because it changes angles to make the hip fit better. It simply doesn't work if the 'door' is already damaged.
Is Your Pup a Candidate for TPO Surgery?
You have a large pup and are worried about hip dysplasia, how do you know if they are a candidate for TPO surgery?
First, know the factors and know what to look for.
A big risk factor is owning a dog from a breed prone to hip dysplasia. Sadly, the poster-dogs for this condition include popular breeds such as:
- Labrador retriever
- Golden retriever
Clues that a pup may have a problem include:
- Persistent lameness of a hindleg
- A low carriage of the rear end
- A peculiar 'rolling' gait on the back end
- Difficulty jumping up
- Reluctance to exercise
If this ticks boxes, next on the list is a trip to the vet. They will watch how the dog walks, feel their joints, and if things point towards hip dysplasia suggest examining their legs under deep sedation or anaesthesia in order to x-ray the hips.
Examination under sedation is crucial to find out had much movement there is in the hips. Too much movement hints at hip dysplasia and then x-rays give a 'picture' of how the joint sits together. The vet can measure certain angles on the radiograph, which predict if the dog is likely to have problems in later life. It is this information is used to judge whether TPO surgery is right for that individual pup.
What are the Advantages of TPO Surgery?
TPO surgery allows the hip to move smoothly and reduces the bump and grind that leads to arthritis. Thus, TPO is a preventative surgery and helps protect the long term good health of the hips. Surgery is done at a young age, whilst the bones are growing, which means the forces on young bone are lower and the bones grow less misshapen.
Many dogs with suspected hip dysplasia that have TPO surgery go on to lead normal active lives (however, they should not be breed from, as this is a hereditary condition which can be passed onto the next generation.)
What are the Risks of TPO Surgery?
No surgery is without risks. Complications for TPO surgery are rare but include:
- Nerve damage: Major nerves pass close to the surgical site. If the nerves are accidentally damaged during surgery this could result in paralysis or incontinence.
- Implant failure: Growing bones are soft, and if the dog is over-active after surgery the metal implant supporting the bones during healing could bend or be dislodged
- Infection: Licking the surgical site could result in infection, which in the worst cases could track down to the bone.
What are the Other Options?
Not all pups with signs of hip dysplasia will have problems in later life. The risks of developing arthritis can be reduced by sensible exercise, a good diet, dietary supplements that nourish the growing joint, and the use of pain relief and physiotherapy.
For those that do develop arthritis in later life, surgery such as total hip replacement is a life-changing option.
What Does TPO Surgery for Dogs Cost?
TPO surgery requires a great deal of skill, plus the patient spends around two days in hospital for care and pain relief. This is reflected in the TPO surgery for dogs cost.
A typical TPO surgery for dogs cost is around $3,500 - 4,000. Most surgeons operate on both sides of the pelvis in the one surgery, so this is a one-off cost. This is compared to total hip replacement surgery, where one side is done and then the other some time later.
Although this is a considerable amount of money to outlay, the TPO surgery for dogs cost should be balanced up against repeated visits to the vet, long term pain relief, and screening blood tests to check organ function for dogs on long term meds. In the long term, this one-off cost become competitive when balanced against these other life-long expenses. Remember, for the right dogs TPO surgery keeps them on their paws for a long and active life.
The article was written by Pippa Elliot, BVMS