The Canine Educators are a group of 25 dogs that are used to help PVM students learn during the academic year. The dogs come from breeders and rescue groups, and they spend 9 months (August - April) in the program were they are then adopted out to students and faculty at the end of the year. This is where I met and got to know Ducky.
Ducky was my clinical skills lab group's dog, so I had the pleasure of working with him all year long. Ducky was such a great teaching dog and I am very thankful for the Canine Educator program that allowed me to learn from him all year long and get to know him. After spending many hours outside of the classroom getting to know Ducky, I was given the first decision to adopt Ducky at the end of the year. And of course, I took it.
Unfortunately for Ducky, he was diagnosed with Hip Dysplasia as a puppy. Hip Dysplasia (HD) is a multi-factorial disease (has multiple etiologic causes include congenital and hereditary) were there is joint laxity and osteoarthritis in the coxofemoral (hip) joint. Typically, dogs with HD are diagnosed at a young age via radiographs. Typical changes in a HD radiograph include osteoarthritic changes, flattening of the femoral head, shallowing of the acetabular groove and decreased contact between the femur and acetabulum. They can be graded either on the OFA scale or PennHIP scale. Typical clinical signs include exercise intolerance, lameness, pain, difficulty rising, and a "gallop-gait."
Ducky was a bit of a special case. Growing up, he never limped, ran well, and got up and down pretty well. Now he was certainly not perfect, but he definitely appeared much better clinically than his radiographs showed, which you can see below.
Ducky's radiographs became the "everyone in the office must see" radiographs as his hips look terrible on the rads. I promise you, he was much better clinically than those rads show! But as my second year of vet school progressed into the spring months, Ducky began to have a little bit more trouble getting up and down, started to gallop more when running, and started showing some signs of lameness when walking.
The video above was taken in June of 2019 while on a walk with Ducky. Notice the uncoordinated gait due to his worsening Hip Dysplasia.
When adopting him, I knew surgery was inevitable, and it was more a matter of when. I did what I could with him during the last year and a half including a weight loss program, swimming, a joint-care food, and a joint supplement. But, the time has come for the inevitable and tomorrow July 30th, 2019, Ducky will undergo a Total Hip Replacement (THR) on his left hip.
With the relationships and connections I have been able to make in the veterinary community of my home county, I have a great amount of trust in the NorthStar VETS team that is performing the surgery. They are a 5-star hospital led by Founder and Chief of Staff Dr. Daniel Stobie, who has performed countless orthopedic surgeries including many total hip replacements, ACL surgeries and knee surgeries. Dr. Stobie is on the front lines of new and innovative techniques in orthopedic surgery, as Ducky will be included in Dr. Stobie's BFX Centerline Total Hip Replacement Clinical Trial. Traditionally, total hip replacement involves "reaming" the femoral canal and using implants that are impacted or cemented into the femur. While these procedures are successful, there is increased risk of femur fracture with reaming. The new total Centerline hip replacement system replaces the femoral head and the implant is placed without reaming or the use of bone cement. It uses biological fixation (BFX), which is biologically compatible (minimizing adverse reactions), and encourages bone growth into the implant for stability. It also avoids complications related to using cement, such as loosening or infection. You can watch a 5-minute animation from Biomedtrix on the THR surgical procedure below!
As I write this blog post sitting right next to my snoozing and snoring dog, it is tough knowing that 24 hours from now he will be hospitalized while recovering from a major surgery and have to start his recovery. It is going to be a long recovery process - including 8-12 weeks of rest, limited walking, rehabilitation and most importantly, love and support. In the long run, the THR will help Ducky get back to being a dog with full mobility. It will be as if he didn't even have Hip Dysplasia in the first place.
Throughout the process, from surgery discharge to 1 year post surgical examination, I plan to document and share Ducky's recovery process on my website and Instagram so we can follow along together with Ducky on his journey. Keep up with #HipHipHoorayforDucky for more updates and pictures!
Tuesday July 31st, 2019 - Surgery Day
Wednesday July 31st, 2019 - 1 day post op - One day out Ducky is already walking pretty well, with support of course!
Thursday August 1st, 2019 - Day 2 Post Op
Saturday August 3rd, 2019 - Discharge Day!
Tuesday August 13th - 2 weeks post surgery
Wednesday August 14th - Ducky's first physical therapy session!
Week of August 18th - 3 weeks post op - In addition to weekly water treadmill, Ducky’s rehab will continue with balancing, stretching, plus at home exercises and walks. We started walking Ducky 3-4 times a day at 5-8 minutes each, we are now up to 12 minutes!
We have been focusing on walking slowly and making sure Ducky is completely weight bearing on his left leg. He is doing very well with this, getting better and better each day!
Tuesday September 3rd - 5 weeks post op
Ducky had his 3rd physical therapy session today! We worked on walking over cavaletti rails, building hind limb and core strength with an unstable physioroll, and the water treadmill! He is getting much better in the treadmill each week!
Tuesday September 10th - 6 weeks post op
Ducky had his 6 week post op x-rays done today! The doctor said the hip looks great and bone is forming and healing wonderfully!
Comparing the original post op x-rays to the 6 week post op ones taken this week, circled in 🔵 you can see the floating bone graft is now incorporated nicely into the rest of the bone, which, in Ducky’s case, was necessary for a stable hip joint. In 🔵 you can also see there is bone forming around the implant cup, in addition to the edges of the implant where the cup meets rest of the pelvis. Looking further down the implant in ⚪️, you can see the femur developing bone and intertwining nicely to the shaft of the implant. This is GREAT progress for 6 weeks out!
September 26th 2019 - 8 Week Post Op
Ducky continues on with his weekly physical therapy and exercise program! We are up to consistent 15 minute walks and he is doing very well! You can see in the video below how comfortable he is walking at a bit of a quicker pace!
October 18th, 2019 - 11 weeks post op
*New grad alert!* This week, Ducky had his last physical therapy session in his program! Next week Ducky has his 12 week x-ray recheck where we will further evaluate the healing process and, if all goes well, lift his exercise restriction!
October 24th, 2019 - 12 weeks post op
Ducky had his 12 week post op x-ray recheck this week! His left hip implant is stable and healing wonderfully!
While there is not much obvious change in the 12 week x rays vs the 6 weeks pictures, we can appreciate the most improvement at the end of the implant where the femur is continuing to form bone up the shaft of the implant (in ⚪️). The bone graft on the inner aspect of the hip joint continues to mold into the acetabular cup nicely!
Over the next 7-14 days, we will begin to gradually life Ducky’s exercise restriction - allowing him to run around the yard off leash, play fetch, go on longer walks and soon enough he’ll be free to play off leash with other dogs!
Ducky’s next x-ray recheck will be at 6 months. While bone takes an extremely long time to grow and heal, we should see some more obvious changes in December when we take his next set of pictures! We’ll be seeing improvements all the way through his 1 year post-op x-rays!
December 21st, 2019 - 6 months post op
It’s a Christmas Miracle! Ducky had his 6 month post surgical hip x-rays this week, and they look BEAUTIFUL.
The most notable improvements include:
1. His increased muscle mass indicated by the red dotted line
2. Further bone development at the head of the femur around the shaft of the implant, indicated by the white circle.
3. The bone graft continues to mold into the hip joint perfectly, indicated in blue.
The increased muscle mass is the biggest improvement thus far in his rehabilitation process. Thanks to his 10 session physical therapy program, his muscle mass has increased by 2cm compared to his pre-surgical x-rays (as seen in picture 3). This change will prove to be the most beneficial in the long run as he is now able to run, jump, and play with more energy and excitement!
February 10th, 2020 - 8 months post op
Ducky had a recheck appointment today with the Physical Therapy team to perform some measurements. The most notable and biggest improved measurement was in his Hind Limb Muscle Girth (measured in cm). When Ducky started PT on August 14th, 2019, his Right HL Girth was 31cm and Left HL Girth was 30.6 cm. On February 10th, 2020, his Right HL Girth measured at 36.2 cm and Left HL Girth measured at 38.6! That is a 5.2cm and 8.0cm improvement, respectively! Such an amazing improvement!
July 2nd, 2020 - 12 months post op
It’s amazing to think that just about 12 months ago Ducky underwent a Total Hip Replacement on his left hip. It has been quite a journey, but we finally made it to his LAST x-ray recheck!
The results: his hip looks AMAZING! The bone graft, circled in 🔵, continues to incorporate nicely into the acetabulum and there is more bone development in the area of the greater trochanter and shaft of the implant, circled in ⚪️.
Although we are done with x-ray rechecks, we still working on improving muscle mass through exercises, walking and the underwater treadmill. It is important that we continue strengthening the left hind limb while also maintaining the muscle mass he has on his right limb. Hip Dysplasia is a disease that affects both limbs, so maintaining muscle mass on the right will hopefully decrease the onset and severity of clinical signs with the goal of preventing a future surgery!