364 Canine Sports Medicine and Rehabilitation
coverage of the femoral head. This is achieved
by making two or three osteotomies around the
acetabulum, manually rotating the acetabulum
over the femoral head, and stabilizing it with a
plate and screws (Figure 14.12). It is ideally
performed in dogs less than 5–8 months of age
with an angle of relocation <25–30 degrees and
a quality of Ortolani sign that suggests no ero
sion of the dorsal acetabular rim. Dogs with
clinical lameness are less likely to be optimal
candidates for TPO/DPO, but there is under
standable reluctance to perform corrective
osteotomy on dogs with hip laxity that is an
incidental finding on physical examination.
Patients typically bear weight on the surgical
leg immediately following surgery. The most
common complications with this procedure are
implant loosening and pelvic canal narrowing
(Whelan et al., 2004; Doornink et al., 2006). The
recent use of locking implants has decreased
the complication rate with this procedure (Rose
et al., 2012). Postoperative exercise restriction is
imperative until radiographic evidence of bony
union is present, at which time therapy aimed
at building muscle mass can be initiated. Range
of motion is typically preserved with this
procedure, though gait kinematics reveal a base
narrow stance that is usually permanent.
The progression of OA remains possible with
both the JPS and TPO procedures, particularly
in patients that already have damage to joint
ligament or cartilage (Manley et al., 2007;
Holsworth et al., 2005) (Figure 14.13).Salvage procedures
Total hip replacement
Total hip replacement (THR) is routinely used
to target lameness caused by HD/OA that is
refractory to medical management. Other indi
cations include chronic femoral capital physeal
or femoral neck fracture, complicated luxation
(e.g., chronic luxation, fracture luxation, or lux
ation of the previously dysplastic hip), and
avascular necrosis of the femoral head. THR
involves surgical removal of the patient’s ace
tabulum and femoral head and replacement
with a polyethylene cup and metallic stem and
head. The expected outcome is restoration of(A) (B)Figure 14.12 (A) Triple pelvic osteotomy aims to increase dorsal acetabular rim coverage of the femoral head by
making two or three osteotomies around the acetabulum, manually rotating the acetabulum over the femoral head, and
stabilizing it with a plate and screws (B).