Treatment decisions – If, when and how
Once sufficient information has been gathered, treatment recommendations must be made. This will also be tempered by the expectations
and capabilities of the owners. The initial question is whether treatment is needed or not, followed by the question of whether
the treatment should be medical or surgical or a combination of the two. After those questions have been answered, the management
becomes more complicated.
Treatment is recommended when the patient is showing clinical signs of morbidity or when a viable option exists to prevent
likely disease progression. In most cases, I do not recommend treatment on animals that are asymptomatic. The exception might
be cases that are candidates for juvenile pubic symphysiodesis as these cases are usually too young to display clinical signs
Conservative management is recommended when a viable surgical option does not exist, when waiting for appropriate timing for
surgery, or when owner economic concerns preclude surgical management. The selection and incorporation of the various components
of conservative management will be discussed most fully in the next session and in the session on management of osteoarthritis.
Both the decision to pursue or avoid conservative management and the decision about which surgical procedure to pursue hinge
on an understanding of when each surgical procedure is indicated. A large number of surgical procedures have been advocated
to address hip dysplasia. In the simplest terms, the indications for the most common procedures are outlined below.
Total hip replacement: Indicated for cases with severe clinical signs when good function is the primary concern
Triple pelvic osteotomy: Indicated for young animals without obvious osteoarthritis but with significant risk of developing
Femoral head ostectomy: Indicated when relief of pain is the primary goal and conservative management has failed
Pelvic denervation: Indicated when finances are a concern and conservative management has failed
Juvenile pubic symphysiodesis: Indicated in puppies considered to be at high risk of developing hip dysplasia and that are
not intended as breeding animals
These basic premises will serve as the foundation for discussion in this session in order to build a framework upon which
to make surgical decisions. Specific examples that follow the general indications will be given as well as examples that illustrate
exceptions. Emphasis will be placed on practical steps that general practitioners can utilize.