Breakthrough For Severe Canine Dysplasia

Would this breakthrough procedure improve a young Lab’s severe dysplasia?
By Mark J. Knapik MEd, CPDT-KA, October 2015
X-ray of hip centerline out of place.

X-ray of hip centerline out of place.

Montilius (Monty) Tiberius is our two-year-old yellow Labrador best friend and faithful companion. On March 12, 2015, he became just the 15th dog in the world to undergo a groundbreaking procedure that, we hoped, would reduce his severe bilateral hip dysplasia and give him a chance at a normal life.

How difficult was the procedure? “On a scale of one to 10, the operation was a 12,” said veterinary orthopedic surgeon Dr. Loïc Déjardin of Michigan State University Veterinary Medical Center in East Lansing, who performed it. Dr. Déjardin is regarded as one of three surgeons worldwide able to execute this delicate operation.

The surgery on Monty’s right hip took nearly four hours. “There were some difficult areas through the surgery, finding just the right depth and shaving some bone away so Monty can access total mobility. Now, we wait and see,” Dr. Déjardin told us afterward. Monty would be closely monitored at six-week intervals for six months post-op.

Taking it slowly was key to Monty’s healing process. As Dr. Déjardin pointed out, “It’s up to you to make sure Monty heals properly, and having him take it easy is important.” My wife Ann and I took his advice seriously. For the next 10 weeks, Monty went outside on a leash to “get busy” as often as necessary; otherwise, he stayed in and rested. During the first four weeks in particular, we handled Monty oh-so-carefully, and our other dogs were kept away so they wouldn’t jump on or play with him.

 

A New System

Dr. Déjardin had given Monty a Centerline BFX Prosthesis. This trademarked prosthetic biologic fixation “hip system,” created by BioMedtrix Company of Boonton Township, N.J., uses an implant that is approximately eight inches long and made of steel (picture a skinny, steel ice cream cone with a scoop on top).

Unlike standard canine hip replacement implants, which are inserted down the central axis of the femur itself, the Centerline-BFX is hammered into the center of the femur neck; its base protrudes from the bone, allowing it to be secured at the top, attached without being cemented into the pelvis. It’s described as a lever (femur) and fulcrum. In order for Monty to regain complete range of motion, the prosthesis had to be inserted in exactly in the right spot, which required shaving off bone in the pelvic region.

This prosthesis and the procedure required to insert it are so new that they have not yet been fully documented in medical journals. Veterinarians with patients who are candidates for such a procedure would certainly review and study Monty’s case. Particularly if the operation was completely successful, which wasn’t a given.

 

No Guarantees

What made Monty’s individual case special was the fact that he had severe dysplasia in both hips. The femoral head (the “ball” of the ball-and-socket joint) and pelvis area were seriously deteriorated, and he was almost completely lacking a hip socket (the acetabulum).

Before the surgery, when Monty walked, his left back leg dangled and flapped; when he ran, it was as if both hind legs vibrated. On his right side, his leg moved in an awkward semi-circle, like a leaf dangling from a branch. The right hip had the severest degree of lameness and, we were told, made Monty an excellent candidate for the procedure.

The regular prosthesis used for canine hip replacement wouldn’t work for Monty. Rather, in time, it would render him totally lame. During our initial September 2014 consultation with Dr. Déjardin, he explained Monty’s rare condition. He also made it clear that there was no guarantee of complete success. The specialized prosthetic implant would need to be precisely angled into the bone and secured around muscles that had already formed, which was risky. Additionally, the depth of the implant couldn’t be known until the actual surgery, another risk factor.

Before the surgery, Proto-Med Company in Colorado made 3D models of Monty’s hip (pelvis) and femur from CT scans. Dr. Déjardin practiced on the models, rehearsing the surgery to reduce the margin of error.

 

A Setback

In weeks five to eight after his surgery, Monty was walking very short distances, which we were told was appropriate in order for him to begin strengthening the muscles in his right leg. But during week nine, something seemed to be amiss. One morning, he was fine when he went outside to get busy, but in the afternoon, when it was time for his short walk up and down the driveway, I noticed that he was seriously limping on his right hind leg. When Ann came home from work, I told her about it. She asked me if he’d done anything unusual, and I made what I thought was a joke: I said he ran around the neighborhood and seemed fantastic, which nearly put me outside in our decorated antique doghouse. In reality, I took this development very seriously, and myriad “what-ifs” raced through my mind.

I immediately made an appointment with Monty’s veterinarian, Dr. Thomas Frankmann, at the Animal Clinic of Chardon, who took X-rays. “It’s not good,” were Dr. Frankmann’s first words after he looked at them. “The Centerline implant has completely moved out of the pre-made socket [acetabulum] and is rubbing against bone. This, I suspect, is causing the limp and some discomfort.”

Dr. Frankmann said that he’d never had seen anything like it. “It’s not supposed to do that—these implants are secure. It’s bewildering.”

Dr. Frankmann called Dr. Déjardin for a consultation. Over the next few days, Dr. Déjardin spoke only to Dr. Frankmann. He also scheduled Monty for emergency surgery at MSU to reattach his implant. Needless to say, Ann and I were both sick with worry. We didn’t know what to expect or what would happen to Monty—would he be permanently disabled, or worse, would he even survive another operation?

We never did find out what might have caused this problem. Prior to Monty’s surgery, we heard only from the MSU nursing assistants and Dr. Frankmann, who detailed the severity and risk of the reattachment; Monty’s decaying bone structure and pelvic deterioration raised a concern that the repositioned prosthesis might not hold.

After the nearly eight-hour surgery Dr. Déjardin finally spoke with us directly. As it turned out, he could not save the implant; as Dr. Frankmann warned, it could not be readjusted or replaced. He immediately began a second operation while Monty was still sedated, performing an FHO (femoral head ostectomy), removing the head and neck of the femur to alleviate pain. The FHO is  a salvage procedure intended to prevent total incapacitation; it basically allows Monty’s femur to “float” unattached, supported only by scar tissue that creates a false joint. Through physical therapy, he would build up muscle that would help secure the bone somewhat in place.

Two days later, during the five-hour drive to pick up Monty at MSU, I envisioned his feeble body after his first surgery two months prior and reflected on the pain he had endured. I also thought about how many pills he would now need to take; he was up to five medications at one point.

Upon seeing me, Monty couldn’t restrain himself. He tried to jump up but couldn’t because of the weakness in his right leg. He had been shaved, again of course, and seeing him was disheartening. I decided that the operations were finally over; no matter what miraculous cure/invention/procedure was discovered, I would not subject Monty to any more.

 

Then and Now

Monty has traveled a difficult path to get where he is today. He was diagnosed with “hip problems” as a puppy, but the severity of his condition wasn’t seriously investigated until shortly before he was a year old. Discarded and abused, he had at least three different owners before I adopted him from Joanne Dixon, president of Providing for Paws of Garden City, Mich., a nonprofit rescue organization helping animals in need. Patrons of PFP raised nearly $6,000 during the year leading up to Monty’s first surgery to help with its cost.

We received other financial help as well. Dr. Déjardin waived some of the charges associated with the first operation, and suggested Monty for MSU Veterinary Hospital’s Lucky Fund, which provides resources for specialized cases of dogs in need. The Lucky Fund donated $1,000 toward Monty’s cause.

Nonetheless, next to our home, Monty is our biggest investment, albeit a loving one, and well worth the sacrifice.

As he neared the completion of his weekly physical therapy sessions at Pawsitive Results Animal Rehab Center in Auburn Township, Ohio, his rehab vet, Kathy Topham, was absolutely astounded by Monty’s recovery and his ability to walk almost normally. “He probably won’t be great for search and rescue, but he’ll run, play, jump and maybe make a great therapy dog,” she said.

During our summer beach trip to North Carolina, Monty walked, jogged, swam and was eager to greet every beach-goer who meandered within petting distance. He has a marvelous outlook on life. As Ann said at one point, “He really has made adjustments to compensate for all his ailments; it’s amazing to witness how he moves around.” Monty plays like a normal, healthy, juvenile dog but close observation reveals his physical idiosyncrasies, the split-second adjustments he makes when he walks, runs, squats and lies down.  

Monty has changed my outlook on life. We have that dog-human telepathy that most dog people have with their companion animals. However, he’s also “training” me to meet his needs, for which I couldn’t be more grateful.

Humans are ambivalent about life, but dogs are not. Our canine companions befriend us for our greater happiness, making us better people. They elevate our quality of life (teaching us to wag more and bark less, as the saying goes), and love us unconditionally without regard to the situation they’re dealt.

 As Ann observed, he follows me everywhere, and watches and waits for me constantly. Now, she says, I owe Monty. I wouldn’t have it any other way. He’s the faithful companion every dog owner dreams about, and that’s my good fortune in this life.

Mark J. Knapik is an adjunct professor of English/creative writing and communications at Lake Erie College in Painesville, Ohio. As a Certified Professional Dog Trainer, he works part-time at Petco in Mentor, Ohio.