Are dogs with hip dysplasia in less pain after total hip replacement than femoral head ostectomy?

Erica Rehnblom,Wanda J Gordon-Evans

doi:10.18849/ve.v7i1.388

Erica Rehnblom, Wanda J Gordon-Evans

Open Access

https://doi.org/10.18849/ve.v7i1.388

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Abstract

PICO question In large breed juvenile dogs with hip dysplasia and radiographic bilateral osteoarthritis, is a total hip replacement superior/inferior/or equivalent to bilateral femoral head ostectomy at reducing the severity of long-term hip pain?  Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Twelve papers were critically appraised. One paper was a systematic review. Six papers were prospective case series. Five papers were retrospective case series Strength of evidence Weak Outcomes reported Besides one systematic review, there are no other studies available that directly compare pain reduction with total hip replacement and femoral head ostectomy for the treatment of hip dysplasia in large breed juvenile dogs with radiographic evidence of secondary osteoarthritis. In one study, 12/12 (100%)of owners that responded to an owner outcome questionnaire reported no hip pain with femoral head and neck ostectomy. In this study, owners assessed pain based on activity level of the dog (running, playing, jumping, using stairs normally), gait abnormalities (only when running or after strenuous exercise), and duration of postoperative medications. In eight studies, 91–100% of cases had no hip pain with total hip replacement reported via clinical examination and/or owner outcome questionnaire Conclusion There is evidence suggesting that both total hip replacement and femoral head ostectomy may be capable of reducing long-term pain as a result of osteoarthritis, secondary to hip dysplasia, however, based on the current literature, it is challenging to say whether total hip replacement is superior to femoral head and neck ostectomy at reducing long-term hip pain. It is important to recognise that other factors considered as outcomes (i.e. range of motion, ground reaction forces, force-plate analysis, etc.) may contribute to differing outcomes overall for total hip replacement vs femoral head ostectomy, but this paper focused specifically on pain. While there is a systematic review that provides evidence supporting that total hip replacement is superior at returning dogs to normal function, evaluating return to normal function was not the focus of this Knowledge Summary  How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care. 

Highlights

A third prospective case series (Olmstead et al, 1983) analysed 221 THRs in 190 dogs performed predominantly as a result of hip dysplasia using physicals, radiographic examination, and owner histories in pre- and yearly post-operative patient evaluation. 136/149 (91.2%) of THRs had satisfactory function at time of follow-up suggesting that THR may reduce the severity of long-term hip pain as a result of hip dysplasia, the subjective outcome of clinical evaluation and owner assessment weaken the evidence of this study
The LOAD score is a standardised tool for collecting data from owners, and in this case supported the subjective clinical examination findings and outcome determined at the final follow-up visit that THR is efficacious at reducing the severity of long-term hip pain associated with hip dysplasia
No significant difference in peak vertical force in the hindlimbs of these four dogs was detected

Summary

Conclusion

There is evidence suggesting that both total hip replacement and femoral head ostectomy may be capable of reducing long-term pain as a result of osteoarthritis, secondary to hip dysplasia, based on the current literature, it is challenging to say whether total hip replacement is superior to femoral head and neck ostectomy at reducing long-term hip pain. Clinical Scenario You diagnosed a 1 year old female Golden Retriever with bilateral hip dysplasia and persistent hip pain despite appropriate non-surgical management She shifts her weight forward, bunny hops and has radiographic osteoarthritis. There is one systematic review that addresses both total hip replacement and femoral head ostectomy, return to normal function was their main outcome measurement rather than pain. Because there is only one paper with a small population size directly addressing the present clinical question, the other included literature does not directly compare total hip replacement and femoral head ostectomy for long-term hip pain reduction, and because the current studies all use differing outcome measures and a direct comparison cannot be made, it is impossible to draw a meaningful conclusion as to which procedure is more efficacious at reducing longterm hip pain by comparing these studies

Summary of the evidence

Findings

Methodology Section