Triple Pelvic Osteotomy - Help

[CooperRR]

Hi everyone,

I'm just after some personal experience stories from people whos dogs have had a TPO (triple pelvic osteotomy). I'm after any soft of infomation, procedure, recovery etc

Our Rhodesian Ridgeback boy Cooper has just officially been diagnosed with Hip Dysplasia

We have know form 12 weeks that this could be the case but had to wait until he was fully grown to have it confirmed.

Our Vet has referred us to Dr Chris Preston @ Pet emergency Melbourne (emailed off xrays etc) he has advised us that Cooper is a great candidate for a TPO as he is still in the stages of growing & has no signs of arthritis.. yet.. They want to do the operation in the next 2 months.

If we don't get this done he will need a full Hip replacement in the future.

Also we are in Tasmania & no one down here can do the operation.. We would have to go across on the Spirit of Tasmania & then come home on the Spirit. The surgeon said he should be able to go home the next afternoon after the op & then he would have to be put into one of the crates on the Spirit for the 12 hour journey home.

We are a so torn about what to do, Cooper doesn't seem to be in any pain yet, So we are not sure if we want to put him through the operation as we have been told that it is pretty brutal. Also the fact that he will need to be confined to a crate for 6 weeks. He is crate trained, but as he is 12mo he is very energetic (also very lazy at the same time haha) & I feel like he would be very sad to be confined to a crate for so long.

We have googled & searched forums for information but we are still so confused about the procedure & recovery, any info/help would be appreciated :)

Sorry about the long post..

[Brookestar]

I cannot give specific advice about the condition, I have never had a dog experience it. But have had dogs on crate rest.

This book would help you to plan some things out in relation to the crate rest:

"no walks, no worries" http://www.amazon.com/walks-worries-Maintaining-wellbeing-restricted/dp/1845846052/ref=sr_1_1?s=books&ie=UTF8&qid=1425005567&sr=1-1&keywords=no+walks+no+worries

Walks provide things for dogs, much of it mental stimulation. It is about trying to provide a stimulating environment without the walks. If the crate can be put in front of a window where they can look at, they can at least see the world going past. If it is in the lounge/living room, they have more contact with other family members, they have the TV going on, music, etc. Even if the dog is not watching TV, just listening to all the sounds, has the brain ticking over, saying what is this sound, what is this sound. Train the dog to love kongs and feed ALL meals via kongs, preferably frozen, so they last longer. Also consider nyla bones or other purely chew toys that they can simply lie and chew on, to keep them occupied. Have a few different nyla bones and change them over during the day, so it is like they got a new one given to them.

While the dog will need to be largely crated, they will once the stiches come out at least be doing some very small walking, even if just one or two minutes at a time. Doing that multiple times during the day, also provides them with stimulation.

In terms of recovery generally. If the dog is the slightest bit overweight now, beginning to reduce that weight will help the dog. Most dogs have a healthy weight range of 5 kg, you want them at the lower end of that weight range. Also want to do as much work now on obedience as you can. The more trained the dog is, the easier the recover will be. If the dog is pulling on the lead, it makes doing the small walks you can do, difficult, as they are not walking properly to begin with and so more damage can be done. Want to ensure the dog is on a healthy diet, that you have appropriate bedding - recommended by animal physiotherapists, etc. Want to make sure you have non slip surfaces and that non slip mats are put on any non slip floors. Want to make sure the dog does not jump up on people and that they do not jump on furniture, etc. The more work you can put into this now, the easier it will be later. Need to talk to your vet about arthritis now, as most dogs with HD develop it early. I would begin catrophen injections now and also put them on glucosamine supplements now.

Given that you are travelling, I would be asking them to keep him hospitalised for an extra day, to ensure he really is better to go home. This is not taking a dog home up the road in the car. I would also make sure you have appropriate cushioned bedding, which is firm, but cushioned to place in the crate on the spirit of Tasmania. Animal physiotherapists can guide you in relation to that.

I'm not sure that there are any animal physiotherapists in Tasmania, but there are many in Melbourne. I would be inclined to consult with one, while you are there, to get them to draw up a rehabilitation plan for the dog. The best results are seen when phsyio's are involved. In an ideal world they see the dog regularly, but even once would be better than simple advice from a surgeon. There are physio's that now do consultations via Skype and other online means. One big animal physio group in Melbourne is dogs in motion. Or online you can try this: http://www.holisticanimalphysio.com.au/online-consultation.htm

In terms of rehab, this book might help: http://www.amazon.com/Physical-Therapy-Rehabilitation-Animals-professional/dp/0989275000/ref=sr_1_1?s=books&ie=UTF8&qid=1425006882&sr=1-1&keywords=physical+therapy+and+rehabilitation+for+animals

[espinay2]

I am sorry to hear this. How old is your dog? Have the X-rays been sent to a radiology specialist or for scoring with PennHIP? Is your dog showing actual signs of problems or was this just determined through vet diagnosis?

The reason I ask is that while TPLO is a useful operation in the right circumstances, it is also the latest 'money spinner' for many vets. So I am always cautious when I see it has been recommended in a young dog. If your dog is showing severe signs of mobility issues already, then it certainly may be the right course of action for you. If this is not the case and any issues are currently minor or it is something your vet has raised, then I may be erring on the side of caution and getting a secondary opinion from a radiology specialist such as Rawlinson is SA.

Note that PennHIP has even gone to the extent of releasing a statement about it and including it in their FAQ (http://info.antechimagingservices.com/pennhip/navigation/general/frequently-asked-questions.html ) :

"My vet has advised a surgical procedure to avoid the development of arthritis in my dog later in life based on the results of his PennHIP examination. Should I have my dog operated on?"

Answer:

Until appropriate randomized and controlled clinical trials are designed and conducted, it is premature to use the Distraction Index as an indication for hip surgery, either remedial or preventive. At present several different surgical procedures (Triple pelvic osteotomy, Juvenile symphysiodesis) have been advocated by some veterinary surgeons to prevent the development of arthritis (degenerative joint disease) later in life in dogs with excess joint laxity (loose hips). None of these procedures have undergone scientific clinical trials that have proven THEIR EFFICACY in preventing the onset or slowing the development of arthritis in dogs with hip dysplasia. Although WE ARE not fundamentally against the use of preventative surgical management of dogs with excessive hip laxity, WE FEEL THE WHOLESALE CLINICAL USE OF PURPORTEDLY PREVENTIVE SURGICAL PROCEDURES BEFORE ADEQUATE TESTING IS CONDUCTED, IS UNJUSTIFIED. WE ADVISE CAUTION! It may be that in the future when good evidence exists to support the efficacy of these procedures their use will be encouraged.

[CooperRR]

Thanks so much for all the great advice :)

Cooper has is 12.5 months old. He is a purebread Rhodesian Ridgeback with no reports of HD in his Partent or any other puppies in his litter.

We have him on 4cyte a supplement for dogs with osteoarthritis, he also has monthly pentasan injections & metacam with his food every 2 days.

Luckily he is very well trained (we go to weekly dog obedience classes)& is generally a very well behaved dog.

We are so isolated here in Tassie, so I will definitely look into organising a consultation with a animal physiotherapist when in Melbourne. I'm sure the vets will be happy to keep him a little extra before the long journey home as they have been so helpful with everything so far.

I have had the x-rays sent off to 2 surgeons (including Chris Preston) and they have both come back with the same prognosis. I have also been to 3 vets in our area and they have all looked at his x-rays and all have think he has hip dysplasia in the RH hip and no signs of arthritis as of yet.

How would be go about getting him PennHIP scored?

He is currently on a diet for veges and raw wallaby meat to lose 5kg so he has the best possible outcome (he is totally not happy about this,we are getting alot of sad eyes)

When i get home from work i will attach a copy of his x-rays.

[The Spotted Devil]

Sorry if I missed it but what were the symptoms at 12 weeks if he isn't currently in pain?

[CooperRR]

He walked with a waddle and when he canters his back legs go together like a rabbit. Our vet noticed this when we went for our 12 week vaccinations.

I don't offically know that he isn't in pain as I cant ask him haha (wish i could).

He doesn't make it known that he is pain with limping, soreness in getting up / jumping etc.

He is quite active but also very lazy at the same time. He loves laying in the sun inside all day if he was allowed.

[sheena]

I'm not exactly sure what you mean, by like a rabbit....but I thought a lot of dogs canter with their two back feet together (going forward at the same time) I can't say ALL dogs, as there are probably some out there that canter different.

[bianca.a]

Firstly I'm sorry you are faced with this My own Cooper who is now a 3 year old German Shepherd has had bilateral total hip replacements.

If you can contact Dr Ray Ferguson (Melbourne)at Monash Veterinary Clinic, he is involved with Pennhip scoring. I visited him and he agreed that Dr Pete Laverty at http://www.melbvet.com.au/ was the best! I was also told by numerous vets and specialists that on a dog of Coopers size (he was 32ish KGS) that a TPO was not a good idea. Therefore we went with the THR twice.

Anywhoo, I wish you all the best, it's shocking to receive that kind of news.

[Bullmastiffmum]

Hey there CooperRR,

We went down the path of tpo about 7yrs ago. I still feel that it was an uncertain decision we made, that we had no experience in making and we left it completely in our specialists hands.

Don't know if it was the right or wrong thing, but our boy is now 8, and is getting around fine.

We were highly recommended David lidbetter in Sydney, and I would continue with the recommendation. He is amazing.

Briefly.... Our boy developed a slight limp, xrayed,very bad hips, vet then specialist "David ",quick decision req due to age and growth, went ahead with it, I think 4weeks between each side done.Had to keep rested, clean etc, even put ice packs on him to reduce swelling, he was an amazing patient and seemed to understand. Limited /monitored in everything, alot of car trips to give him a change of scenery :-)

But all went well, kept it slow and steady for the next 12monthes, didn't do physio, but that is a great idea though, if available.

It is invasive, and there is large risks, so make sure you are comfortable with the decision.

[Xyz]

"I am sorry to hear this. How old is your dog? Have the X-rays been sent to a radiology specialist or for scoring with PennHIP? Is your dog showing actual signs of problems or was this just determined through vet diagnosis?

The reason I ask is that while TPLO is a useful operation in the right circumstances, it is also the latest 'money spinner' for many vets. So I am always cautious when I see it has been recommended in a young dog. If your dog is showing severe signs of mobility issues already, then it certainly may be the right course of action for you. If this is not the case and any issues are currently minor or it is something your vet has raised, then I may be erring on the side of caution and getting a secondary opinion from a radiology specialist such as Rawlinson is SA."

I think you may be getting TPO and TPLO mixed up.

I think rather than looking at it like a 'money spinner', you may find they are suggesting it as a preventative to the dog requiring a THR (total hip replacement) as the dog ages. The vets (if you think are doing it for the money, then woukd be better waiting and suggesting a THR, much more expensive (so profit for them.....)

Edited February 27, 2015 by Xyz

[persephone]

that 'bunny hopping' can also be a symptom of pelvic fracture - or past pelvic fracture ....

[Dogsfevr]

I wouldn't be putting my dog on the boat unattended after such surgery .

What is your dogs hip score ??

What has the breeder said about the score ??

I would be asking for a second opinion before rushing ,don't be made to feel you have too,be your dogs advocate & think things through & ask lots of questions,why is this the best,what does it have to offer over other methods etc etc.make them talk to you ,not them blinding you with info & feeling rushed.

Many dogs do fine without the surgery & owners use physio.bowen & other methods to keep the body fit ,obviously each case has to be assessed on how bad .

[CooperRR]

Thanks so much for all your info and advice everyone :)

After weeks or toing and froing we have finally made a decision to not go ahead with the surgery.. We don't feel that our boy would cope well with such a major operation and recovery.

We don't want people to think we are bad owners (Cooper really is our whole world) by choosing this path, as we are going to do everything to keep our boy pain and hopefully arthritis free.

[espinay2]

I certainly won't be thinking you have bad owners. I have managed a dog with severe HD before. She had a hip score of 29:36 and an elbow score of 2:2. We managed her progressively with catrophen injections in the beginning, progressing to asprin for a while and then onto a non steroidal anti inflammatory when she needed it (progressive management ensured that she had what she needed when she needed it, but we did not start things too soon to limit side effects or the reduction in their efficacy when they were truly needed). She also received nutritional support with glucosamine and fish oil etc. She received plenty of exercise at her own pace to maintain muscle and ligament support for the joints (important - I recommend swimming if you can). She lived until 10 years of age (within the average for her breed - which is a giant breed) and was mobile until her death from a completely unrelated cause.

In relation to hip scoring, your dog is old enough to send for AVA scoring as opposed to Pennhip (which is the only one that can be reliably done on puppies, but involves additional x-rays performed by only a specially trained vet and sending the x rays to UPenn in the US). I find hip scoring useful as they are providing a report based on a strict system and it is something they do every day. The average vet will often get it wrong just looking at the x-rays (had a good example of this recently when a vet and I were speculating over some x-rays which ended up coming back with a very different score than the vet thought it would).

Here is Rawlinson's web page: http://www.robrawlinson.com/

This is a good site which explains the hip scoring system: http://www.online-vets.com/hipscore_1.html

[Jumabaar]

CooperRR It might be worth looking into PenHip scoring because it gives a different value to traditional X-rays. I would also discuss what about the X-rays indicated HD and if the vet was able to luxate the hip while your dog was sedated. Are there any changes to muscle quantity or tone?

I know you have decided agains the TPO but these few bits of information will help you with the 'What ifs' that you might have in the future.

This is a link to some great information on the different hip scoring methods as well as the different procedures. http://www.asecvets.com/wp-content/uploads/2011/06/PennHIP-and-JPS.pdf

Also have you desexed your dog or is it possible to wait till Cooper is fully grown?

Regardless of your chosen path spending time exercising all the muscles around his rear end. There is a Facebook group called Canine Conditioning and Body Awareness Exercises which has some great resources on this, although seeking professional advise regarding the specifics would be ideal if it is in any way possible. My other suggestion is to always keep him very very skinny!