Babylon Beacon

Pets, Pets, Pets


 

 

Hip, Hip, Hooray! This spring, two Last Hope dogs received total hip replacements, expensive state-of-the-art procedures, at the Animal Medical Center (AMC) in NYC at no charge, thanks to the hospital’s Emma and Georgina Bloomberg AMC to the Rescue Fund.

Both dogs were rescued from overcrowded Georgia shelters with no forewarning about the extent of their injuries. Even if they had been perfectly healthy, without rescue transport, Oreo, a five-year-old Border Collie mix, and Shelby, a one-year-old Lab mix, stood little chance of leaving the Southern shelter alive because dog intake in rural Georgia shelters is fast and furious. Oreo’s Last Hope adopter discovered his awkward gait, whereas the sending shelter told Last Hope Shelby had a “slight” limp. (Define “slight.”) Both dogs were probably hit by cars. Their fractures healed (incorrectly) on their own, which is more difficult to correct surgically than broken bones getting prompt attention.

Dr. Robert Hart, Director of Orthopedic and Joint Replacement Surgery at AMC, did the total hip replacements on Oreo and Shelby. The AMC is a prestigious teaching hospital. Founded in Manhattan in 1910, AMC has grown into the largest, non-profit animal hospital in the world, treating pets from those flown in by private jet to rescued orphans. As part of his vast résumé, Dr. Hart spent four years as a faculty member at Cornell University Hospital for Animals in Ithaca, NY, prior to coming to the AMC.

An x-ray of a Canine Total Hip Replacement showing the implants.

An x-ray of a Canine Total Hip Replacement showing the implants.

I was fortunate to speak to Dr. Hart about total hip replacement (THR), and the difference between THR, and a common veterinary pelvic surgery called femoral head ostectomy (FHO), where the ball (head of the femur) is removed but not replaced. Canine THRs have been performed since the 1970s, with technology and techniques progressing tremendously over the years.

THRs tend to be more expensive than FHOs. Both the ball and femur are removed and replaced with man-made implants. Performing THRs since the 1990s, Dr. Hart said, “I am biased toward the outcomes of THRs, and get on my soapbox: THR dogs are pain-free with complete mobility for the rest of their lives, so at the AMC, we’ve tried to minimize the price-gap between two hip procedures.”

 

 

Canine Total Hip Replacement is considered the gold standard treatment for large-breed patients with inherited hip dysplasia, and certain dogs (and cats) with fractures and dislocations caused by outside trauma. The goal is to restore normal function of the hip joint and alleviate the pet’s pain so the pet can return to full activity. This is done by removing the ball (head of the femur) and socket of the dog’s hip joint, and replacing them with a combination of metal (titanium or a three-metal alloy) ball and a special plastic with a glide metal liner socket.

These implants are either cemented into the bone, cementless and press fit, or a hybrid of cemented and cement-less. Dr. Hart explained this decision is usually made when the pet is on the operating table, saying young Shelby’s procedure was hybrid. Her thigh was cemented and her socket was not. Dr. Hart said, “New bone grows in two ways: when growing to full size and when healing breaks. Over time the pet’s bone will grow into the nooks and crannies of the implants helping to fixate them.”

 

 

After THR, the pet should be confined or be on crate-rest approximately three months. During that time, the caretaker gradually increases the dog’s walks from five minutes to 20 minutes. Formal physical therapy is not needed. The implants should function for the dog’s lifetime.

The newest THR technology for people (also available for dogs, though superfluous) lasts up to 40 years. Doctors used to advise their younger human patients to wait before having a hip replacement because they might need another operation in 15 to 20 years. Previously, veterinarians would postpone THRs on puppies until they were 10 months old, or later in large breeds, to ensure their bones growth plates had closed. Now with better implants, dysplastic puppies as young as six or seven months old have gotten THRs, giving them a long time of painless mobility. Dogs have an advantage over people during recovery because they can distribute their weight over four legs.

THRs are performed more often on dogs than cats. As a comparison, Dr. Hart said throughout his career, he’s probably done feline THRs numbering into the twenties while over the last seven years, he’s most likely performed 500 or more on dogs. The smaller the pet, the more difficult it is to work within a confined pelvic area. Pets as tiny as two to three pounds have had THRs. Representatives from biotechnology companies may consult during surgeries. These reps remark how much harder it is for veterinary surgeons than our orthopedists to perform THRs. Dr. Hart likened a Great Dane THR size-wise to replacing a person’s hip.

Femoral Head Ostectomy (FHO) is a less expensive procedure often used on dogs with hips hit by cars. The femoral head (ball) and neck are removed and put back into the socket creating a false joint. Over time the dog’s muscles and scar tissue help restore mobility. This operation generally relieves chronic pain, but requires physical therapy such as the underwater treadmill to build up strength. The leg is not as normal post-op as after a THR.

The Emma and Georgina Bloomberg AMC to the Rescue Fund provides subsidized specialty care to animals currently cared for by rescue groups in the New York metropolitan area, whose health is an obstacle to their adoption. Five other Last Hope pets have benefited through AMC to the Rescue in the past. In 2013, Frankie, a kitten found in Baldwin, had eyelid reconstruction via AMC to the Rescue. Later AMC invited Frankie to the NASDAQ closing bell. His new eyelids were projected on the giant NASDAQ screen in Times Square for everyone to admire.

Dr. Hart explained he is not a member of the AMC to the Rescue selection committee but he is peripherally involved by evaluating the prognosis for total hip replacement candidates. Dr. Hart said, “The cases I’ve done for AMC to the Rescue pets have been my hardest cases because the pets have long-standing broken hips. Their injuries challenge me to get better and better at helping dogs like Shelby, and, ultimately, all companion animals that will benefit from total hip replacement.”

By the way, Shelby is smart, sweet and needs a forever home. Call 631-671-2588, for more info.

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