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Hip replacement or femoral head surgery – what’s best for dogs with arthritis?

Home » All Posts » referral » Hip replacement or femoral head surgery – what’s best for dogs with arthritis?

No one wants to see their best friend in pain. Let’s discuss how you might know your dog is in pain. And what your options might be once hip arthritis has been diagnosed by your veterinarian. 

What is arthritis? 

Arthritis is a condition causing pain and inflammation within a joint. 

In joints, bones normally glide past each other with the help of a soft cartilage covering at the ends of their surfaces. Arthritis initially affects this smooth cartilage lining of the joint. This then starts to roughen and thin out causing the tendons and ligaments to have to work harder. Inflammation, as a result of cartilage disease, leads to bony spurs being formed and bone rubbing on bone. This ultimately alters the shape and function of the joint in a painful process; which makes it uncomfortable to be mobile and enjoy normal activity. 

How will you know if your dog suffers with it?

Symptoms your dog may be suffering with arthritis include a reduced activity level such as increased frequency walking instead of running whilst out on a walk, or they may be sleeping more. You may notice your dog avoiding jumping up. So where their favourite spot used to be on the sofa snuggling up to you in the evening or sneaking onto your bed at night, they may opt to find a quiet place on the floor instead. You may notice your dog having difficulty getting up from a laying position or you may notice a limp. 

How do you get a diagnosis if you notice symptoms in your dog?

If you ever have concerns about your pets’ health or notice a change in their normal behaviour, contact your veterinarian. Your vet will perform a clinical exam and likely recommend x-rays to diagnose your dog properly. This will allow your vet to properly assess the health of your dogs’ bones. But also plan for any surgery that is needed to restore health and eliminate pain. 

What caused your dog to develop arthritis? 

Arthritis can form due to injury, wear and tear of a joint during ageing or it can be caused by a congenital condition. (A condition where your dogs’ joint develops abnormally from birth – in the hip, this is termed hip dysplasia). 

How common is hip arthritis?

Arthritis is a very common condition. The hip is one of the most common sites of arthritis in the body; the knee is the second most common site. 

The two clinically proven and widely used surgical treatments and interventions for hip arthritis are the femoral head and neck excision (FHNE) and the total hip replacement (THR). 

What is a FHNE and why would you consider this procedure for your dog?

The FHNE is considered a “salvage procedure” with the goal of alleviating pain and restoring a degree of function of the limb. 

During this procedure the head and neck of the long thigh bone (femur) is surgically removed; therefore alleviating the pain caused by bone-on-bone contact as in arthritis. (The “ball” part of the ball and socket joint is removed). The result is a “false joint” or pseudoarthrosis being formed with the surrounding muscles taking on the load of the joint. 

The benefits of the FNHE:

This is a fairly simple surgical procedure possible at most veterinary practices and doesn’t require a specialist surgeon. It is generally therefore a lower cost procedure. A FHNE removes the problem of bone-on-bone pain by removing the offending bone.

However you should be aware that the function of the leg will not be optimal after the surgery

Generally, dogs tend to have limited athletic ability, pain after excessive exercising, stiffness in cold weather and can experience difficulty in climbing stairs or jumping. Dogs can have a persistent lameness, but it is usually not pain related but instead mechanical due to the shortening of the limb. 

Better outcomes are seen in smaller dogs, and actively seeking physiotherapy care post operatively can improve outcomes and speed up recovery, improving functionality long term. 

Clinical success of this procedure:

This varies with the weight of the patient. Those dogs over 20kg often have an unsatisfactory outcome meaning that the procedure is unsuccessful at relieving pain and returning the leg to a reasonable level of function for these dogs. It is believed that dogs over 20kg that have a larger muscle mass around the hip, become painful post operatively as the top of the thigh bone (femur) is forced to contact the hip socket (acetabulum). The outcome is fair-to-poor in dogs weighing 12-17kg. 

Operation complication rates are low at around 2-4% with the most common complication being infection.

What is a THR and why would you consider this procedure for your dog?

A Total Hip Replacement (THR) is a much more complicated procedure than the FHNE. It requires a specialist veterinary surgeon and specialist equipment. It is therefore a more expensive surgery. 

A total hip replacement involves replacement of the ball and socket parts of the hip joint. The long thigh bone (femur) head and neck is replaced with an implant mimicking the function of the femoral head and shaft components, as well, the socket is replaced with a prosthetic. 

This procedure returns the function of the joint to more of a normal state

It is a much more complicated procedure than the FHNE and requires a specialist veterinary surgeon and specialist equipment. There is a higher surgical complication rate. But 95% of dogs do very well post-surgery with an excellent outcome resulting in an excellent return to function without pain. 

There are clear benefits for larger dogs with a THR compared to the FHNE

There is no lower limit for weight in dogs since prosthetics have advanced over time to be available for all sizes. A THR is not, however, recommended in dogs that are under 9 months of age as their bones are still growing. This could lead to complications with the success of the procedure both in the short and long-term. 

Although arthritis in the hip typically affects both hips, 80% of dogs only require one hip to be replaced as post operatively, the weight is shifted to the replaced hip relieving pain on the other side. 

In all dogs’ post THR, after a period of recovery, dogs should expect to return to almost normal function. 

So, which should you choose for the best outcome for your dog?

It is important to consider the dogs’ weight, lifestyle as a whole and what as an owner you want to achieve from treatment of your dog. If you have a small dog but want them to be very active such as competing in agility or flyball for example, you might opt for a THR as its got a better chance of returning leg functionality. But if your small dog is more of a companion, it may be best to consider a FHNE; as less force will be exerted on the leg. And so the functionality requirements are much lower due to lower and less intense activity levels. A FHNE in this circumstance would likely give a good outcome and your dog be able to live a comfortable life doing what they love. 

Comparative studies of both the FHNE and the THR have not been done, however, most vets recommend THR in large dogs as it is a superior procedure with a better outcome for dogs of this size. 

Cost must be a factor of course too. 

In summary, when discussing options with your vet, consider your pet’s weight, activity level, your demands on your pet (what you want to do together) and cost of each procedure. 

Your vet will guide you as to what they believe is best for your dogs’ medical outcome given any test results and a clinical exam. But you need to work together to achieve the best outcome overall so you can enjoy your lives together. 


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