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Triple Pelvic Osteotomy (TPO)

A Triple Pelvic Osteotomy or TPO is performed in young dogs with hip dysplasia that have no evidence of degenerative joint disease (DJD) or "arthritis". The goal of this procedure is to stabilize the laxity in the hip by rotating the acetabulum (cup) of the pelvis over the head of the femur (thigh bone). This goal is accomplished by cutting the pelvis in 3 places, manually rotating the "cup" portion of the hip joint to the proper angle, and applying a special plate to hold the bone in the correct position until it heals.
The goal of this procedure is to prevent or decrease the severity of pain associated with hip dysplasia as well as DJD later in life. If all goes well, your pet should have a pain-free functional limb. Occasionally, DJD develops in spite of surgery. If this is debilitating a total hip replacement (THR) or a femoral head and neck ostectomy (FHO) can be performed.

Activity and Physical Rehabilitation

STRICT CAGE REST is extremely important for your pet to heal after surgery. The cage size should be large enough for the dog to stand up and turn around, but small enough to prevent additional activity. The stainless steel TPO implants are quite strong; however, they can bend and break if they are stressed. Screw loosening is one of the most common complications after a TPO and is more likely to occur with excessive activity. Cage rest should be performed for 8 weeks or until healing of the bone is seen on x-rays. The only activity allowed during the initial 2 months after surgery should be closely supervised short trips outside (ONLY ON A LEASH) to urinate and defecate. For the third month, your dog can be allowed to roam inside your house and have short (<10 minutes) leash walks and controlled activity outside. Running, jumping, and stairs should be avoided until after the final set of x-rays are taken (generally 8 to 10 weeks after surgery).
Southeast Veterinary Specialists is extremely lucky to have a certified animal rehabilitation practitioner on staff. Robert Porter (Robby) is here to guide you through the process of physical rehabilitation after surgery. Physical rehabilitation appointments with Robby are strongly recommended after a TPO. We understand that both time and finances may be limited; however, it is our opinion that aggressive rehabilitation can greatly improve your pet's function after surgery. Swimming is wonderful exercise and will encourage the dog to move the hip through a complete range of motion and develop the muscles of the hip and thigh region.
Range of motion exercises are relatively easy to perform and should be done at home. You should not begin these exercises until 10 days after surgery. Begin by massaging your pet's limb and getting him/her used to the manipulation. After several minutes, begin to move the hip through its full range of motion. Concentrate on reaching full extension and full flexion. If this is not possible or uncomfortable for your pet, do as much as you can and try to do a little more each day. This therapy should be performed for 10 to 15 minutes 2 to 4 times daily.
Your dog should begin to use the toes for balance within the first week after surgery. Gradually, he/she will begin to use the leg for bearing weight. You should notice daily improvement. If you notice that your dog is improving but then seems to worsen, this may be a sign of screw loosening or infection and should be evaluated.

Complications

The most common complication that occurs following a TPO is implant or screw failure due to excess motion. The chances of this complication's occurrence can be lessened by strict cage rest after surgery (see above). When this occurs, the loose screws and rarely the entire plate must be removed in a second surgery. This complication is generally not life threatening, but is something that both the dog owner and surgeon would like to avoid.
Other complications happen rarely, however the consequences are more severe. As with any surgery, infection can occur. If the infection is superficial involving the wound, treatment with an appropriate antibiotic is generally sufficient for healing with no further problem. If the infection is deeper involving the bone, removal of the plate is generally required. Another complication is nerve damage. The sciatic nerve, which is a major nerve to the leg and necessary for function, can be damaged by this surgery. Although this complication is rare, amputation of the limb is usually necessary. While dogs do quite well with 3 legs and this complication is not life threatening, it is obviously undesirable.

Medication

In most cases, a non-steroidal anti-inflammatory drug such as carprofen (Rimadyl®) or deracoxib (Deramaxx®) will be recommended. This class of drugs is often helpful in relieving postoperative inflammation, pain, and swelling. This will help your pet to be more comfortable and return to normal function sooner. Do not give your pet any other medication without consulting us. Many other non-steroidal anti-inflammatory drugs available for people are often toxic in dogs.
Antibiotics are usually used during surgery and may be considered postoperatively at home. Please do not give your pet any medication without discussing it with our office first. Antibiotics given inappropriately may result in the development of a resistant infection that can be difficult to treat.
Pain medication other than a non-steroidal anti-inflammatory drug may be needed in rare cases. If you feel that your pet is unusually uncomfortable, please notify our office. Uncontrollable pain is not an acceptable complication of surgery, and methods are available to keep your pet comfortable without side effects.

Sutures

External skin sutures, when present, should be removed in 7 to 10 days. In most cases the skin is closed with internal absorbable sutures which do not require removal. If you notice your pet licking and chewing the incision area, please notify us. The ischial incision (the one near the anus) is the most likely incision to have a problem. Some swelling is normal after surgery; however, please call if you think the swelling is excessive or if you notice a discharge or foul smell from any of the incisions.