Treatment Option 1:

JPS: Puppies as early as 10 weeks old can be diagnosed with abnormal joint laxity accurately (see Diagnostics) and treated surgically by the procedure, Juvenile Pubic Symphysiodesis (JPS).

• Between 10 and 18 weeks old, when a puppy is given their shots, they should be examined by the primary care veterinarian or an ACVS board-certified veterinary surgeon to determine the absence or presence of pathological joint laxity which could result in CHD.
• A recent study that reviewed many peer reviewed published scientific studies i.e. evidence based medicine stated, “JPS surgery is a method of consistently providing normal pain free hip function”.
• JPS is a minimally invasive surgery that closes a growth plate at the bottom of the pelvis. This results in selective growth of the pelvis and the hip cup (acetabulum) increasingly covering the ball (femoral head) as the puppy grows during the following 4–6 months.
• Patients may be able to go home the same day after this procedure.
• During those 4–6 growing months, following JPS surgery, leash walks are acceptable, but strenuous off leash exercise is discouraged until follow up exams at 10 months of age confirm the dog will have pain free hip function.
• Weight management and rapid growth should be managed with measured amounts of low protein dry food diets (20–21%) for rapidly growing large breed puppies from an early age and following JPS surgery until 12 months of age.
• JPS is a technique for stopping the growth of the pubis (part of the pelvis) to alter the growth/shape of the pelvis, while increasing the ball’s degree of coverage by the socket to diminish hip laxity.
• It is a relatively minor surgical procedure and puppies less than 18 weeks of age must have it performed. However, since most puppies of this age do not show symptoms of CHD, early diagnosis by way of examination and special x-ray techniques are critical.

Post Surgery:

Risk of complications after JPS are very low; almost all are minor in nature. Success rates for JPS eliminating hip laxity are high and aftercare is very brief, usually just entailing basic incision care and short-term activity restriction.

Treatment Option 2:

Double or Triple Pelvic Osteotomy (DPO/TPO) is another option for immature dogs (ideally less than 8–10 months old) with CHD but no visible radiographic arthritic changes.

• These surgical procedures involve cutting the pelvic bone in two (DPO) to three places (TPO) and rotating the segments to improve coverage of the ball by the socket and decrease hip laxity (Figure 4).
• TPO has been used successfully in dogs and children for decades.
• Recent advancements in implant (locking plates and screws) technology now allow similar results with only two cuts made in the bone (DPO), thus a less invasive procedure.
• The best time to recognize pathologic hip laxity is when the young dog is neutered (spayed or castrated) between 6–8 months old. This can often be done by the primary care veterinarian who does the sterilization procedure.
• An x-ray must be taken, and the hips can be palpated for joint laxity.
• Immature dogs with lameness and early evidence of hip arthritis are not ideal candidates for DPO/TPO, nor are dogs with very severe hip laxity, as some puppies have no functional hip joint by 6 months of age.

Post Surgery:

Reported complications after DPO and TPO include screw loosening, change in limb range of motion, and pelvic canal narrowing. However, the incidence of complications is low and reports of long-term function are expected to be good to excellent.

Post DPO/TPO and THR Surgery:

Following both DPO/TPO and THR, the dog’s activity should be restricted to leash exercise outdoors and confinement to a small area indoors until the procedures are deemed healed (via examination and X-rays), generally six and eight weeks respectively.

• • Most pets are weight bearing soon after surgery and require supervision to prevent overuse of the leg during the healing period.
  • If necessary, use a sling for initial assistance with walking.
  • The dog should avoid stairs, slippery surfaces and interactions with other dogs. To get back to normal, slowly increase activity after the initial period of restriction

Treatment Option 3:

Total Hip Replacement (THR), the third surgical option, can be used in young dogs who cannot be successfully treated with JPS or DPO/TPO surgeries.

• They must be managed medically until they are mature enough for THR, at least a year old.
• THR, based on evidence-based medicine via multiple peer reviewed publications is the second surgical method that provides the most normal pain free function in dogs with CHD.
• This surgical procedure eliminates hip pain by reproducing the mechanics of a normal hip joint with a more natural range of motion and limb function.
• As with humans, canine THR involves replacement of both the ball and socket with metal and polyethylene (plastic) implants (Figure 6).
• These components are fixated in place with bone cement, metal pegs, or “press fit” (bone ingrowth) methods

Post Surgery:

THR results in an excellent chance of markedly improved limb function. Potential complications after THR include infection, hip dislocation, “loosening” of the implants over time, nerve injury, and femur fracture.

Post DPO/TPO and THR Surgery:

Following both DPO/TPO and THR, the dog’s activity should be restricted to leash exercise outdoors and confinement to a small area indoors until the procedures are deemed healed (via examination and X-rays), generally six and eight weeks respectively.

• • Most pets are weight bearing soon after surgery and require supervision to prevent overuse of the leg during the healing period.
  • If necessary, use a sling for initial assistance with walking.
  • The dog should avoid stairs, slippery surfaces and interactions with other dogs. To get back to normal, slowly increase activity after the initial period of restriction

Treatment Option 4:

FHO: The last surgical option to alleviate the pain secondary to severe hip laxity/dysplasia is femoral head ostectomy (FHO) surgery.

• This surgical procedure can be done at any age and can provide enough comfort in a dog weighing less than 60–70 lbs to avoid the daily use of anti-inflammatory pain medication, thus avoiding costs and side effects that limit or negate its use.
• Young dogs that do not meet the criteria for DPO/TPO or JPS procedures, or dogs who do not respond satisfactorily to medical treatment alone may benefit from FHO.
• This technique involves removing the femoral portion of the hip joint (i.e., the ball) to reduce the pain produced by abnormal hip joint contact that wears away the joint cartilage, and the stretching of the soft tissues around the joint due to laxity (Figure 5).
• Following an FHO, a “false joint” develops with the muscles around the hip now transferring the forces from the leg to the pelvis during limb movement.

The goal of an FHO is to relieve the pain associated with CHD, not to maintain/recreate normal hip function.

• Two weeks following FHO surgery the puppy/adult dog is encouraged to exercise, often receiving anti-inflammatory drugs daily during the initial 1–2 months post-op. Then these drugs may only be necessary intermittently.
• FHO dogs must remain slim throughout their lives and follow a limited exercise program i.e. leash walks and confinement to the yard and house. They cannot be athletic dogs who hunt, do agility, high level obedience, run with their owners, etc.
• If those activities are what the owner wishes to do with their dog, then a THR would be necessary.

Post Surgery:

Results after FHO vary and are highly dependent upon patient size and proper postoperative physical rehabilitation.

• While many dogs will have varying degrees of lameness, function should improve when compared with preoperative status.
• After FHO, pets are encouraged to use the limb as soon as possible in a controlled manner.
• Aggressive physical rehabilitation and controlled exercise to increase hip range of motion are essential for an optimal outcome.
• It may take up to six weeks or longer after surgery for some dogs to show improvement.