TPO (Triple pelvic osteotomy) surgery for hip dysplasia in dogs.

Hip dysplasia is a common cause of lameness in young large & giant breed dogs. If detected early before the closure of the growth plates corrective triple pelvic osteotomy TPO or Juvenile Pubic Symphysiodesis JPS surgery may be performed to improve the coverage of the femoral head by the acetabulum. This is usually done by a triple pelvic osteotomy (TPO) which for best results should be performed at 5-9 months of age and must be done before the onset of radiographic DJD or significant articular cartilage damage. The pelvis is cut in three places (osteotomy) and a plate applied to the ilial osteotomy site to rotate the acetabulum between 20-30 degrees. (Greater angles are not recommended). Some improvement is seen immediately in the post op radiographs however significant improvement is usually seen over the following 6 months as remodelling & growth  occurs.

Specialist Veterinary equipment

Stryker system 2000 autoclavable battery drills

Stryker system 2000 autoclavable ossicalating saw and reciprating saw to perform osteotomies

AO/ASIF 20– 40 degree plates– slocum

depending on the angle of rotation of the acetabulum required.

3M mini driver system

   Triple pelvic osteotomy (TPO) & hip dysplasia

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Left sided Hip dysplasia

indicating sites of osteotomy

Triple pelvic osteotomy  surgery

Good case selection:

Bilateral Triple pelvic osteotomy with good acetabular coverage at a four year follow up radiograph. Minimal evidence of DJD is visible in either hip in this case. Unfortunately no treatment will fully prevent osteoarthritis.

If early corrective surgery is not performed, particularly in large breed dogs, which may also be overweight development of severe arthritis is likely. A femoral head & neck osteotomy (FHO) may have to  performed to reduce the pain. A total hip replacement (THR) may also be considered in medium to large dogs.

Severe bilateral hip dysplasia with development of advanced DJD in a dog which did not have a triple pelvic osteotomy TPO

Femoral head & neck osteotomy FHO or Total hip replacement THR for end stage hip dysplasia HD. In dogs which have severe hip pain and the quality of life is decreased, and if conservative methods are not effective, surgical treatment should be considered

Accurate case selection is essential for a good outcome following TPO surgery in dogs. Not all dogs with hip dysplasia are suitable- dogs with mild to moderate hip dysplasia with little or no radiographic remodelling or damage to the DAR aged 5-9 months are the best candidates. Arthroscopy of the hip is useful to determine if cartilage damage is already present. A positive ortalani sign, with a deep acetabulum with minimal filling and angles of reduction of <30 and angles of subluxation of around 10 degrees are best. Dogs with more severe HD or evidence of OA are not suitable & may be more suitable for conservative management and later total hip replacement if indicated.

How to Treat Hip Dysplasia in Dogs- Video

Thanks to vetvideo for providing this educational video on treating hip dysplasia in dogs

How to Recognise Hip Dysplasia in Dogs- Video