Management of total hip replacement luxation with triple pelvic osteotomy

Abstract

Objective To report the outcome of dogs treated with triple pelvic osteotomy (TPO) for dorsal luxation after total hip replacement (THR). Study design Retrospective clinical case series. Animals Seventeen client‐owned animals. Methods Medical records were searched at a single institution for dogs that had been treated with TPO for dorsal THR luxation. The angle of lateral opening (ALO), version angle (VA), and inclination angle (IA) were measured from radiographs after THR and TPO and corrected for pelvic rotation. A paired t test was performed to compare cup orientation after THR and TPO. Functional outcome was assessed at follow‐up examination and during telephone interviews. Results Eighteen TPOs were performed in 17 dogs, and radiographs were available for 15 cases. Open and/or closed hip reduction with additional stabilization was attempted unsuccessfully in 6 dogs prior to TPO. Triple pelvic osteotomy reduced the ALO by a mean of 23.0 ° ± 10.9 ° (P ≤ .001), increased VA by 9.0 ° ± 4.9 ° (P < .001), and increased IA by 2.9 ° ± 5.8 ° (P = .126). An excellent or good outcome was achieved in 12 dogs. Ventral luxation occurred in 3 dogs, and dorsal luxation occurred in 1 dog after TPO. Triple pelvic osteotomy excessively reduced ALO in 2 dogs with ventral luxation. Conclusion Triple pelvic osteotomy with cup retention is a viable alternative to cup revision for treatment of dorsal luxation of cemented and cementless THR. Triple pelvic osteotomy significantly reduces ALO and increases VA. Careful patient selection is recommended because excessive ventroversion can lead to ventral luxation. Clinical significance Triple pelvic osteotomy offers a revision option that preserves the implant–bone interface and significantly reduces ALO. This technique may be appropriate in dogs with high ALO, luxoid hips, and prior failed revision attempts.

Poor success rates with double pelvic osteotomy for craniodorsal luxation of total hip prosthesis in 11 dogs

“…Our first hypothesis was confirmed: DPO's median decrease in ALO obtained in this study was 11°. This was lower than the mean value of 23° obtained by TPO in another study 12 . Two main factors may explain this difference in ALO reduction between the two studies.…”

“…It could be assumed that the ALO recommended values were insufficient to eliminate the risk of luxation. After TPO, cases of recurrence of THR luxation have been reported, particularly ventral luxation (3/18 cases) 12 . These complications were attributed to impingement between the cup and the stem; this was related to the decrease in ALO with an increase in VA and inclination angle (IA) or even an excessive decrease in ALO 12 .…”

“…When combined with an iliofemoral suture, the TPO appears to be a suitable treatment option. Thus, this additional procedure could also be useful for DPO 12 . In case of abnormally high ALO, higher than the values correctable by TPO, a repositioning of the cup (+/− iliofemoral suture) should be considered.…”

“…The management of craniodorsal THR luxation can be achieved by revision surgery, which can include using a dual mobility cup, modification of the cup (size or position), and an increase in femoral neck length or femoral head size 10,11 . Revision surgery without revising the acetabular implant has also been described, such as use of an iliofemoral suture or improvement of acetabular coverage (ventroversion) with triple pelvic osteotomy (TPO) 11–13 . Among these techniques, only modification of the cup position or TPO allows alteration of the ALO.…”

Outcomes and complications reported from a multiuser canine hip replacement registry over a 10‐year period

“… 15 , 20 Most other published studies to date on canine THR have also only reported cases from a single center. 26 , 27 , 28 , 29 …”