Practical management of hip dysplasia (Part 1): Diagnosis and decisions (Proceedings) - Veterinary Healthcare
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Practical management of hip dysplasia (Part 1): Diagnosis and decisions (Proceedings)


CVC IN KANSAS CITY PROCEEDINGS


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 of disease.

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 osteoarthritis

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.


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