What is Open Reduction and Stabilization?
Hip dislocation represents 90% of all joint luxations in the dog. This is most commonly the result of being struck by a car or falling from a great height. Fresh dislocations can occasionally be replaced by 'closed' reduction. This is when the joint can be manipulated back into place without opening into the joint. However, the long-term results of closed reduction are often disappointing. Often the leg quickly dislocates again due to the loss of stabilizing ligaments which hold the joint in place.
The alternative is 'open' reduction. This involves surgery to open into the joint, remove debris, reposition the femoral head, and stabilize it in place surgically with an implant which mimics the ligaments. This is complex surgery. It can be undertaken in first opinion practice by a skilled orthopedic surgeon but referral to a veterinary orthopedic specialist is often required.
Open reduction is often undertaken several days after the initial trauma, without detrimentally affecting a successful outcome.
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Open Reduction and Stabilization Procedure in Dogs
The dog is first stabilized after the initial trauma. Once shock and blood loss is no longer a concern, the patient is given a general anesthetic and radiographs of the hips taken. This helps identify the direction of the dislocation and whether any fractures are present.
The fur is clipped from over the affected hindquarter and the skin aseptically prepared for surgery. The surgeon makes an incision over the hip joint and dissects down to expose the hip joint itself. Retractors help to make visualization of the acetabulum possible. Debris such as blood clots, torn soft tissue or bone chips are removed.
A hole is drilled through the acetabulum.. A corresponding tunnel is drilled through the femoral head, which is then realigned into the hip joint. A special orthopedic toggle is passed the aligned tunnels, such that the toggle is deployed within the pelvis. The long end of the toggle are secured on the top side of the femur. This replicates the round ligament of the hip to hold it in place. The joint capsule is repaired to aid the strength of the joint.
The skin wound is sutured and the patient woken.
Efficacy of Open Reduction and Stabilization in Dogs
Open reduction and stabilization is a highly successful technique, especially in small to medium sized dogs. Not only does it hold the joint back in place, but it offers the surgeon a chance to remove debris which could cause delayed healing when left in place (such as with closed reduction.)
Alternative surgical techniques include femoral head excision or total hip replacement. Of these, the gold standard is total hip replacement, but this can be prohibitive in terms of cost ($6,000 to $15,000). Femoral head excision is considered a salvage procedure, but it can offer a functional limb when the remaining option to alleviate pain is amputation.
Open Reduction and Stabilization Recovery in Dogs
Pain relief is essential in the early stages, and the incision must be protected from licking. A special sling is applied to the leg for two weeks following surgery. This sling prevents the dog putting weight on the limb, which allows the repair to gain strength before stress is placed on it. The skin sutures are removed at the two-week point.
Careful, staged lead walks and physiotherapy take place for 8 weeks, at which point follow-up radiographs are taken. When all goes well the dog should be sound by 12 to 16 weeks after surgery. However, a long-term complication may be arthritis in the joint, which shows itself as stiffness after rest or heavy exercise.
Cost of Open Reduction and Stabilization in Dogs
Hip toggle surgery starts from around $2,500 at a specialist center, but can be as much as $8,000.
Dog Open Reduction and Stabilization Considerations
For surgery to be successful, the dog requires careful home management during the protracted recovery period.
Whilst open reduction is highly successful, complications such as nerve damage or infection can occur. This may necessitate repeat surgery or long courses of antibiotic. In extremely unfortunate cases, especially where nerve damage means the dog no longer has sensation in the leg, amputation of the limb may be required.
Open Reduction and Stabilization Prevention in Dogs
The main indication for replacement of a dislocated hip is trauma. Thus the owner should supervise their dog at all times near roads and be sure their pet is safely fenced in a yard. It is also essential to obedience train the dog in order to minimize the risk of the dog being uncontrolled near vehicles.
Open Reduction and Stabilization Questions and Advice from Veterinary Professionals
My dog had toggle surgery on his dislocated hip 4 days ago. I have him crated consistently but sometimes when I carry him out to the toilet rather than letting him walk, he yelps in pain. Is it better to allow him to walk to the toilet on a lead rather than carry him? i’m just mindful that he isn’t meant to be placing any weight on it post surgery, particularly for the first 10 days before his follow up with the veterinarian. Also, how easy is it for the toggle surgery to come undone. I guess (I hope) i’m stressing for potentially nothing but because he’s yelping, i’m worried I’ve unintentionally caused harm to him.
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