Triple pelvic osteotomy (TPO) (canine and feline)
| Triple pelvic osteotomy (canine and feline) | |
|---|---|
| File:Triple pelvic osteotomy new.jpg | |
| Specialty | Lua error in Module:WikidataIB at line 665: attempt to index field 'wikibase' (a nil value). |
| Symptoms | Abnormal gait, limping, bunny hop ambulation, inactivity after exercise |
| Causes | Inherited |
| Risk factors | Anaesthetic, infection, device wear, obstruction of the urethra, hip arthritis |
| Diagnostic method | X-rays, physical examination |
| Treatment | Surgery |
| Frequency | Lua error in Module:PrevalenceData at line 12: attempt to index field 'wikibase' (a nil value). |
Triple Pelvic Osteotomy (TPO) is a surgery used to treat hip dysplasia,[1] an abnormality of the hip joint in which the hip socket doesn't fully cover the femur head/ball, causing joint looseness and leading to degenerative joint disease.[2] TPO works by changing the alignment of the acetabulum in relation to the femoral head in order to force the head more deeply into the acetabulum as the animal walks.[3] TPO is currently the most popular and successful operation for minimizing arthritis and pain caused by hip dysplasia.[3]
Anatomy[edit]
From the perspective of anatomy, the pelvis consists of four bones: the ilium, acetabulum, pubis, and ischium.[4] In young animals, the bones are separate; as they age, the bones fuse together into one confluent bone.[4]
The hip joint is made of a femoral head which is at the top of the femur.[4] The joint connects the hind limb to the pelvis and is held together by the round ligament (ligamentum teres). Hip dysplasia occurs when the femoral head disconnects from the round ligament.[4]
Hip dysplasia symptoms[edit]
Symptoms like limping, gait abnormality, "bunny hop" ambulation, and inactivity after exercise can be due to hip dysplasia. Those symptoms being present can by caused by some type of joint damage. Radiographs at an early age are necessary to pre-emptively determine whether the hips are developing normally, or whether hip laxity is present, as there can be hip dysplasia cases where no symptoms are present.[5]
Young growing animals who have the relevant genetic defect will have abnormal development and growth of the hip joint, resulting in hip dysplasia.[1] This can cause pain and lead to arthritis and the loss of function of the legs. The disease is normally present on both sides of the hip.[1]
Cause[edit]
Hip dysplasia is more common in dogs than cats, and it is more common in heavy/large-boned breeds.[2] It is thought to be inherited and both parents must carry the corresponding disease genes.[2] Animals may carry and pass on the genes to their offspring without exhibiting the condition themselves.
Diagnosis[edit]
Normally, physical examination and x-ray imagery are used to evaluate the hip joints.[2] The examinations involves checking the range of the motion from the feet to the hip joint.[2] X-ray imaging is performed while under general anesthetic[2] and may then be evaluated by a veterinary radiologist to assess and grade the hips.[2]
Suitable age and type[edit]
Treatments are generally different between immature and adult animals. The difference is that immature animals have usually not developed arthritic changes and cartilage damage
Ideal candidates for triple pelvic osteotomy (TPO) are young (8–10 months old) animals that have minimal signs of arthritis and damage to the articular cartilage within the joint.[6][3]
The weight and size of the animal is also important. TPO cannot be easily performed on animals less than 20 kg in weight due to the relatively fixed size of the available implants.[3] Fortunately, the non-sugical management of hip dysplasia in small breed dogs is much easier compared to larger breeds.[3]
Purpose[edit]
Using triple pelvic osteotomy (TPO) aims to increase function of the leg for dysplastic animals, and prevent or minimize possible joint disease like hip arthritis.[6] In doing this, and thereby cover the femoral head and increase the joints by rotating the bones. The contact surface reduces the pressure at each point, thus increasing stability.[clarify][6]
Procedure[edit]
Triple pelvic oste literally means cutting the pelvis in three places. Three cuts are made so that the ball of the femur lines up better with the socket of the hip joint.[7] The cuts enable the pelvic socket to rotate into a better position to cover the head of the femur, stabilizing the hip joint.[1]
The location of the three surgical incisions is in the groin, on the rump, and over the side of the hip region.[4] After the cuts are made, bones[which?] will be rotated to the desired angle and a plate and screws will be used to fix the pelvis in the desired position.[4][8] Bone is sometimes taken from other parts of the hip joint to strengthen the connection between the bone pieces.[9] The procedure usually takes about two to three hours.[8]
Recovery[edit]
During the recovery period, animals are restricted to a small area to minimize discomfort, damage, and problems with the implanted plates and screws. During the first two weeks after surgery, animals may vocalize more and exhbit anxiety. By six weeks, 90% recovery should occur. Suggested restrictions during the first three months include no off-leash activity like running, no stairs, no slick floors, and no playing with other pets.[9][4]
Potential Complications[edit]
Complications related to triple pelvic osteotomy include infection, failure of the implanted parts, loss of some range of motion of the hip, narrowing of the pelvic canal, sciatic nerve injury, and obstruction of the urethra.[4] Another unusual, but usually temporary complication could be the loss of function of the limb, which could be due to the bruising or damage of the inner side of the pelvic bone and the sciatic nerve.[4] TPO can lead to a severe and rapid progression of hip arthritis, potentially requiring correction with total hip replacement surgery.[4]
Prognosis[edit]
Research show that 90% of the dogs who had the TPO or DPO[definition needed] surgery have largely improved.[4] Some animals may have mild arthritis over time, but until they are geriatric (13-15+), it usually does not cause stiffness or lameness.[4]
Evaluation[edit]
Triple pelvic osteotomy became very popular by the mid-1990s. One veterinary surgical center reported that it was one of the most common plastic surgery procedures they performed. and claimed a success rate of 95%. Because of advances in other techniques, including NSAIDs like carprofen, demand for the procedure has declined substantially. There was also a substantial amount of bad press related to the increased incidence of arthritis as the animals aged. This higher incidence was possibly due to performance of the surgery on unsuitable candidates, like older animals that had already developed joint damage.[10]
Alternative surgical procedures[edit]
Juvenile pubic symphysiodesis[edit]
Juvenile pubic symphysiodesis is a simple technique that prevents the development of hip dysplasia in adolescent animals.[11] It is considered suitable for dogs between 12 and 16 weeks of age with hip laxity and no signs of arthritis.[11] The procedure closes the symphysis pubis early by thermal destruction, resulting in increased rotation of the pelvis on the femur during growth.[11]
Femoral head and neck ossification (FHO)[edit]
Femoral head and neck ossification (FHO) is a salvage operation (last resort), designed to eliminate most of the pain caused by hip relaxation or secondary arthritis.[12] It does this by reducing bone-to-bone contact between the femoral head and the diseased acetabulum.[12] This is a good procedure when lameness and pain do not respond to other interventions like pain relief or weight loss. Smaller animals are more suitable candidates for this procedure.
Total hip replacement[edit]
The availability of many implants of different sizes makes this the best choice for most animals with severe hip problems.[13] The goal of THR is to restore normal or near-normal function to long-limping animals that do not respond to medication.[13] It is suitable for animals over 6 months old.
External links[edit]
References[edit]
- ↑ 1.0 1.1 1.2 1.3 "Triple Pelvic Osteotomy Services in Manassas, VA". The Veterinary Referral Center of Northern Virginia. Retrieved 2020-02-09.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Wilson, Julia (November 7, 2018). "Hip Dysplasia in Cats". Cat-World. Retrieved 2020-02-17.
- ↑ 3.0 3.1 3.2 3.3 3.4 Takeuchi, Akira (July 1, 2014). "World Small Animal Veterinary Association World Congress Proceedings, 2003". VIN.com.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 "Hip Dysplasia in Dogs – Triple and Double Pelvic Osteotomy". Animal Surgical Center of Michigan. Retrieved 2020-02-17.
- ↑ "Triple Pelvic Osteotomy". Global Vet Specialists. 2017. Retrieved 2020-02-10.
- ↑ 6.0 6.1 6.2 "Treatment of canine hip dysplasia using triple pelvic osteotomy" (PDF). Vet. Med. 2003 (1–2): 41–46.
- ↑ Khuly, Patty (June 22, 2009). "Hip dysplasia (part 3): The real cost of treatment". PetMD. Retrieved 2020-02-10.
- ↑ 8.0 8.1 "Triple Pelvic Osteotomy in Dogs – Procedure, Efficacy, Recovery, Prevention, Cost". WagWalking. Retrieved 2020-02-10.
- ↑ 9.0 9.1 "Post-operative Information: Triple Pelvic Osteotomy (TPO)" (PDF). Retrieved 2020-02-10. Unknown parameter
|url-status=ignored (help) - ↑ "The Triple Pelvic Osteotomy". Chesapeake Veterinary Surgical Specialists. Retrieved 2020-02-23.
- ↑ 11.0 11.1 11.2 "Juvenile pubic symphysiodesis--a simple, affordable surgical solution to canine hip dysplasia (Proceedings)". DVM 360. Retrieved 2020-02-10.
- ↑ 12.0 12.1 "Hip Dysplasia (Canine) – an overview | ScienceDirect Topics". www.sciencedirect.com. Retrieved 2020-02-10.
- ↑ 13.0 13.1 "Total Hip Replacement Surgery (THR) in Dogs and Cats". Willows Veterinary Centre and Referral Service. Retrieved 2020-02-10.
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