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



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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


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


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


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.


Open Access Peer Reviewed


Bayer, K., Matiasovic, M., Steger, H. & Böttcher, P. (2019). Complications and Long-Term Outcome in 16 Canine Cementless Hybrid Hip Arthroplasties. Veterinary and Comparative Orthopaedics and Traumatology.32(1), 73–78. DOI:

Bergh, M. S. & Budsberg, S. C. (2014). A Systematic Review of the Literature Describing the Efficacy of Surgical Treatments for Canine Hip Dysplasia (1948–2012). Veterinary Surgery.43(5), 501–506. DOI:

Budsberg, S. C., Chambers, J. N., Lue, S. L. van, Foutz, T. L. & Reece, L. (1996). Prospective evaluation of ground reaction forces in dogs undergoing unilateral total hip replacement. American Journal of Veterinary Research. 57(12), 1781–1785.

Dueland, R., Bartel, D. L. & Antonson, E. (1977). Force-plant technique for canine gait analysis of total hip and excision arthroplasty [proceedings]. Journal of the American Animal Hospital Association. 13(5), 547–552.

Duff, R. & Campbell, J. R. (1977). Long term results of excision arthroplasty of the canine hip. The Veterinary Record. 101(10), 181–184.

Fitzpatrick, N., Law, A. Y., Bielecki, M. & Girling, S. (2014). Cementless Total Hip Replacement in 20 Juveniles Using BFX™ Arthroplasty. Veterinary Surgery.43(6), 715–725. DOI:

Ganesh, T. N., Siobhan Bridglalsingh & Legall, C. (2017). Femoral head and neck excision arthroplasty in 38 dogs: a two-year study with special reference to surgical indication and outcome. Indian Journal of Veterinary Surgery, 38(2), 77-80. [online] Available from: [Accessed ]

Gemmill, T. J., Pink, J., Renwick, A., Oxley, B., Downes, C., Roch, S. & McKee, W. M. (2011). Hybrid Cemented/Cementless Total Hip Replacement in Dogs: Seventy-Eight Consecutive Joint Replacements. Veterinary Surgery.40(5), 621–630. DOI:

Guerrero, T. G. & Montavon, P. M. (2009). Zurich Cementless Total Hip Replacement: Retrospective Evaluation of 2nd Generation Implants in 60 Dogs. Veterinary Surgery.38(1), 70–80. DOI:

Massat, B. J. & Vasseur, P. B. (1994). Clinical and radiographic results of total hip arthroplasty in dogs: 96 cases (1986–1992). Journal of the American Veterinary Medical Association. 205(3), 448–454.

Off, W. & Matis, U. (2010). Excision arthroplasty of the hip joint in dogs and cats. Clinical, radiographic, and gait analysis findings from the Department of Surgery, Veterinary Faculty of the Ludwig-Maximilians-University of Munich, Germany. 1997. Veterinary and Comparative Orthopaedics and Traumatology.23(5), 297–305.

Olmstead, M. L., Hohn, R. B. & Turner, T. M. (1983). A five-year study of 221 total hip replacements in the dog. Journal of the American Veterinary Medical Association. 183(2), 191–194.

Parker, R. B., Spencer, C. P., Bloomberg, M. S., Bitetto, W. & Rodkey, W. G. (1984). Canine total hip arthroplasty: a radiographic correlation of clinical results in 20 cases. Journal of the American Animal Hospital Association. 20(1), 105–113.

Rawson, E. A., Aronsohn, M. G. & Burk, R. L. (2005). Simultaneous Bilateral Femoral Head and Neck Ostectomy for the Treatment of Canine Hip Dysplasia. Journal of the American Animal Hospital Association. 41(3), 166–170. DOI:

Vezzoni, L., Vezzoni, A. & Boudrieau, R. J. (2015). Long-Term Outcome of Zürich Cementless Total Hip Arthroplasty in 439 Cases. Veterinary Surgery. 44(8), 921–929. DOI:

Vol. 7 No. 1 (2022): The first issue of 2022

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /