FHO or THR for my dog's bad hip?

I have lived with dogs with multiple different skeletal and autoimmune disorders.  Based on that history, recovery, money, access to a good surgeon, after care etc.....I would look for a strong recovery plan and access to a safe water for hydro therapy.   I would lean the dog down to less weight.  I can not imagine a BC weighing that much, even with a mix.  Now height may make a difference but I would want a lean dog going into surgery.  I would also look for (beware spelling) proprofall for anestesia.  I would also research the use of laser surgery for the procedure.  I would also work on weight reduction for the benefit of recovery.  I would go FHO.

MMEK's Mom

Also, are glucosamine and chondroitin supplements really helpful?  Do they improve joint health or are they for pain?  Studies in humans have shown glucosamine has no benefit for treatment of osteoarthritis:

You can "study" out the ying yang but the reality is that it's very individual.  First you need to understand how glucosamine/chondroitin work -- they are **HYDRATORS**.  That's all.  They simply "plump up" the cartilage that is there with moisture so the cartilage is more resillient and therefore cushions better.

BUT if the individual (dog or human) has little cartilage LEFT between those two pieces of bone (and a joint IS partly bone) then there is nothing TO hydrate and it's not going to do a thing.

"arthritis" is inflammation -- when you get LONG TERM inflammation in soft tissue it will actually cause that cartilage to ossify (turning to a bony substance) so it isn't "cushiony" any more and can't be *made* cushiony.  So if the "test subjects" are old enough to have had osteo arth for a while then probably they don't have much cartilage that can be hydrated.

But one of the bottom line "rules" with glucosamine/chondroitin is that IF you stop taking it it will stop helping because it's a temporary 'hydration' -- it's not permanent.

Now Knox Nutra Joint actually puts the material at the body's disposal so NEW cartilage is created.  Again, it's also going to depend on how worn, or how damaged the joint itself actually is but if it does help create "new" cartilage the change is pretty darned long-lasting. 

I've had rheumatoid arthritis my entire life.  But I've also done a lot to try to help the joint tissue and avoid severe inflammation.  So my joints aren't huge (and I'm in my mid-50's).  My mother, on the other hand, has always just taken NSAIDs for pain -- and her joints are huge and gnarled and they HAVE BEEN since she was my age (and younger).

 You can help the healing with the Knox NutraJoint -- but honestly, whichever surgery you opt for (and talk to Outdoorschik -- she's been in the same situation altho with a much younger dog) I would recommend you use acupuncture during the healing process.

http://www.tcvm.com -- there's a locator on the left and I've had super good luck helping folks locate a GOOD acupuncturist.  Acupuncture not only helps pain management, but it is probably the *best* at helping injuries/surgeries heal. 

Thank you both for the advice.  I will look into NutraJoint.

 Marlin is actually very lean and at a good weight.  The surgeon agreed.  I had his DNA tested back when there were only 35 breeds on the list, and the only one that came up was Border Collie "in the mix," not even primary or secondary.  I should get more results back in the next couple of weeks as I resubmitted his DNA for the more extensive test with 100 breeds.  Others have said Black Lab or even Greyhound.

Water will be a challenge as it's all frozen and scarce in Santa Fe but I have a couple of ideas once it warms up a bit.

Now I see what the surgeon meant when he said the supplements weren't doing any good now.  The situation now is bone on bone.  It amazes me though that other than not always putting full weight on the leg, you couldn't tell he's got this major hip problem.  He doesn't wimper.  He still jumps and runs. 

 I've heard great things about acupuncture so I will look into that over long term pain meds.

 I'll make a decision next week.  Thanks again for your input!

I just added a couple of photos of Marlin.  Other breed guesses???

Have you joined the CanineHD yahoo group? If not, you'll find archives galore for this sort of thing. Also, there is a very beneficial e-book full of stories of what owners did and why.

That said, I believe in conservative management to a point, but I'm also not afraid of ortho surgery. I really have seen the miracles from ortho surgery--both in people (my neighbor has two titanium hips and he's so agile and happy), and in dogs.

I have one dog who had an FHO and another who had a THR. I won't bore you with which I think is better. Trust me, there is a pretty big difference there. Like night and day, quite frankly.

My female, who had the THR, weighs about 48 lbs (she's thin) and my male, who had the FHO, weighs about 44 lbs (he's thin, too, down from 60 lbs (!!!) when I first adopted him).

I have to admit I'm feeling a higher level of distrust with the veterinary industry due to my experience with my dog Emma, who died a few months ago.  She was 5 years old, a SharPei-Chow-Akita-Italian Greyhound (according to the DNA test).  She had mast cell cancer and over 10 months I threw everything at her that the vet and oncologist suggested.  She had 3 surgeries and 5 different types of chemo.  In the end the oncologist suggested Gleevac as a last resort but potentially a miracle cure.  I went for it and it cost $2000 for a 30 day supply from a “human” pharmacy.  She was on it 4 days and went into liver failure.  Online I looked at human dosages and for Emma, who was 35 lbs, she was given a dose 7 times higher than appropriate for a human.  I fell for it and she died a very painful death I’ll never forget.  Before I put her on Gleevac I had researched it online and there were some short term miracle cases but it was so rare to use Gleevac that I had a hard time finding dosage information.

It helps me to hear from real dog owners who’ve been through the treatments.  I used to blindly follow vet advice but I’ve learned (the hard way) that I need to reach out more to hear feedback from the patients and think more clearly what is best for my dog.  Thanks for your feedback.

I hear all the time from owners who are scared of THR recovery. I guess I totally prepared for any event. And to be honest, I figured we'd be a failure. However, one thing I did do, on purpose, was to choose the type of implant we had. I went with one that is screwed in. There are three types out there, but one is rarely done these days (cemented) and of the two cementless ones, I chose the screwed in one (aka Kyon) because I hadn't heard enough about the BioMedrix one that is simply pressed into place.

In the Yahoo group, most people have the pressed in one--it's more popular (good marketing BioMedrix). I interviewed 3 surgeons and knew that the last one was my man. He's done thousands of hips and knees. But, I know what you mean about trust, about trying things, etc.

One thing I don't quite understand from Marlin's story is why his hips are suddenly bad but weren't earlier. Why do the knee and not even know the hips are a potential (or at least a future) issue? Andy maybe you did. Actually, my ortho vet says that knees first, then hips, if both are an issue.

In my case, the recovery was not easy, but it wasn't the worst thing either. Quite frankly, I crated her all the time. About 95% of the failures I read about were because a dog wasn't crated. Because he/she had the run of a small room. I had 3 crates and ramp for my deck and my female was crated all the time.

And then we began rehab and it was great and went well.

And yes, you know her THR is the best one. My FHO guy is OK (he has more issues than hips, unfortunately, and I adopted him later, so it's hard to say which is caused by compensation and which is what he came with), but he has limited range in that leg. It's tighter and even though I stretch him and he uses it, it's different. It is shorter for one thing, and it's different.

Not to discourage FHO at all though. My male is in less pain than he was, and he is mobile and he struggled to be mobile before. He's not as strong as my female--she's stronger on the THR than her real hip, but her THR has picked up so much that I can no longer notice anything. Her THR leg is bigger than her her leg, and my male's FHO leg is smaller. And I can see, now, why THRs are considered the "gold standard." I can only see this because I've done one of each.

PS--so sorry about your Emma. I have to say that soft-tissue situations scare me a lot more than orthopedic issues. I'm with Callie for most orthopedic issues--I do acupuncture, massage, stretching, and use herbs with my male dog. I know someday he'll need more (NSAIDs, Tremadol, etc) but for now, I'm keeping things as natural and safe as I can. He's in no shape for a THR or a second FHO, given that he has bad elbows and a bad back to boot, but I'm becoming more comfortable at managing his orthopedic issues. I wouldn't feel this way had we been dealing with soft-tissue issues. My beloved hound died of cancer and I tried a few things, too. It felt very unpredictable where my dogs' issues now feel not only predictable but manageable.

Hello nfowler,

 Thank you for the reply.  It's very helpful hearing your experiences. 

5 years ago Marlin's regular vet thought he needed hip surgery so referred me to the orthopedist.  When the orthopedist saw Marlin he xray'd his knee and said the knee was likely the cause of the limp and he needed immediate surgery.  Back then he said Marlin might not need hip surgery once the knee was fixed and to keep him on gluc/chon.  So he had the TPLO surgery which went fine and all seemed good until a couple of months ago I noticed he wasn't putting weight on the leg so got more xrays and was referred back to the same orthopedist. 

I''ll have to find out if there are other orthopedists in my area who do THR.  At the time the orthopedist who did the TPLO was the only vet in New Mexico who did THR and TPLO (or there may have been one other).  Currently this vet comes up to Santa Fe twice a week I assume because there aren't other orthopedists in Santa Fe, but I'll check around.

The vet didn't offer the "pin" option.  He said the implant is held in place by friction.  I found a post-mortem study of dogs with hip replacements using cement and 63% of the implants had loosened.  Maybe the pin and friction type are too new to publish results.  Have you seen any studies on this?  http://www.jbjs.org.uk/cgi/content/abstract/87-B/1/120

 As for recovery, that is my biggest fear.  With my job I often have to leave town for the day (a long day) for a meeting in another part of New Mexico which means I can't come home at lunch to let him out if I have to crate him.  There's no 2 or 3 month window where this won't be the situation.  My dogs have a doggy door and go in and out when I'm working long days, but that of course won't work after surgery.

I had an accident 20 years ago where the bones in my arm broke in 8 places and into a few pieces and I had it plated and screwed back together.  It was never casted and I immediately went into physical therapy.  I don't have full range of motion in my elbow, and it gets stiff, but loosens up easily and is generally painfree.  I guess that's how I've been viewing the FHO surgery. It's not perfect, but I hardly notice it.  Of course I don't need my elbow to walk.

How much does your FHO dog weigh?

Thanks so much for your insight!  Julie

The link you sent seems to be a discussion for a cemented hip, which is rarely done these days. Cemented hips are BioMedtrix (at least in the US) and they're the ones doing cementless ones now. Heck, everyone is these days. Even people. It used to be that people waited (and so did dog owners) untiil they'd done everything else before doing a replacement because replacements don't last more than 15 years. My ortho vet said most every single cemented hip dog he's seen have loose hips but they (the dogs) didn't seem to to notice. Have you seen BioMedtrix's site: http://www.biomedtrix.com/ and there is the Kyon one, too: http://www.kyon.ch/.

My male dog weighed about 60lbs at his surgery. Yes, he was just taken from a neglect situation and he was on a horrific diet and had been getting zippo exercise. So, yes, at 58lbs he had his FHO. And, because his leg had atrophied prior to surgery, it was difficult for him to recover. Quite frankly, he was in a fair amount of pain. But, slowly by slowly, he did recover, just not as well as my female did post-op. Heck, she was 95% weight bearing the day after surgery! He toe touched only.

That e-book details the various types of hip surgery and how the recoveries went. Most people are happy with an FHO, including me. But I'm thrilled beyond belief at my female's THR. It truly has given her a completely normal life. It stopped compensation issues and she can do anything any other dog can do.

That said, THR recovery is a Big Deal--and you know that already since you've gone through TPLO recovery. And if Marlin is already extremely active, he would most likely said through FHO recovery. With an FHO, you'll want him on his legs pretty quickly following surgery. He'll need to be walked a lot. (You'll see that on the HD board and in the e-book--just Google "my poor dog" and you'll find it.)

PS--too bad about your elbow! I've never had anything broken and I worry that I'm not a good gauge at managing my male dog's pain.

Hello nfowler,

 I think I found a good vet in Santa Fe for a second opinion so I'll call him next week. 

You've opened up a lot of doors for me and I really appreciate all you've shared.  You're one of the few people out there having gone through both surgeries. 

I'll keep you posted!

 Julie

Good luck and maybe I'll see you on the other board.

I could post this as another blog, but don't feel like broadcasting this right now, but it's nagging at me.  Is it common to put a dog down for being senile? 

A dog I knew since she was a puppy drowned in a pond a couple of days ago while being dog sat.  She was 17 years old and still ate OK and waited to go to the bathroom outside, but paced the house all day starting at dawn, had not wagged her tail in a year, her head cocked to the side all the time.  The dog had a couple of close calls in the last year, having fallen down the stairs once and wandered off on a walk falling down a snowy hill.  It was tough to tell if the dog still had enjoyment in life. The owner had been thinking of putting her down for a few months. When the owner asked me my opinion I couldn't see myself putting a dog down unless the dog was in a lot of pain and had failing vital organs.  There's a lot more to the story, but I wonder if I gave the right advice.  Thinking of this dog struggling to survive in that pond is so painful to think about, although the owner doesn't think she suffered since she wasn't in her right mind.  I was told the dog didn't usually venture into the area with the ponds and as she was slowing down more it was assumed, apparently, she wouldn't get out that way.  I can't stand to think of an animal struggling.  It breaks my heart.

 J

How very sad and heartbreaking.  This is one of those things that no one can really second guess.  I will say that quality of life to me also means being aware of surroundings and able to enjoy life, but there is no one definition that everyone can agree on. I consider the brain and it's functions to be the most vital organ.  Again, I try not to make judgements in these cases as I have been in this position myself and no one but the person who lives with the dog really knows the full situation.  I'm sure the owner is heartbroken and she loved her dog and I hope she finds comfort in believing the dog didn't suffer.  It's all you can do sometimes to get through the pain.

Jackie,

Thank you for being the voice of reason.  The owner (my sister) has a 3 year old child and another on the way and soon will be going through morning sickness and sleep is at a premium.  She had travelled cross country with this dog when she was younger, and this dog had been to 49 of the 50 states.  I know she loved her.  Thinking of a dog suffering brings back some terrible memories.  My sister was visiting me about 3 years ago.  At the time I had 3 dogs and 2 fosters from Katrina.  The 5 dogs had been together for 4 months with no problems.  We went shopping and when we came home they had killed my 12 year old dog who I'd done everything with - everything, she was always there.  Anyway, the thought of a dog suffering and struggling to survive breaks my heart.  In either situation I can place blame, but I have to keep remembering maybe there was neglegence or ignorance but it wasn't intentional, it was an accident, it wasn't necessarily predictable. The dogs were loved and it's not a perfect world and I'm not perfect and there is going to be suffering.  I categorize myself as a wimp.  I put together a photo memorial that I'll frame and send to her today.

J