Hip dysplasia (part 3): The real cost of treatment
Last October I embarked on a series of posts detailing the economics and other mechanics of hip disease in dogs. But somehow life intervened and I only got part 1 and part 2 completed before being swept away on some other, more immediately compelling Dolittler mission.
To atone for my sins of omission, here’s the last enrty in this three part series. Perhaps the most interesting of the three, this entry deals in the big-ticket items that attend hip dysplasia.
But first, a recap:
Hip dysplasia is a disease of the ball and socket mechanism known as the “coxofemoral joint” (aka, “hip joint”). It happens when the bones that make up the ball and socket portions of the joint aren’t well formed, or when they’re less-than-perfectly aligned in relation to one another. In all cases, the upshot is painful rubbing of the two joint surfaces, which inevitably leads to osteoarthritis (and more pain).
Luckily, not all dogs will inherit this malformation to the same degree. In fact, small breed dogs with mild to moderate hip dysplasia may live long, normal lives without the need for intervention beyond proper exercise, weight control and supplements (more on this later). However, most moderate to severe sufferers of medium and larger breeds will almost certainly not fare so well.
Though the worst cases will make themselves known in puppyhood, the vast majority will suffer a slow burn version that only begins to makes itself known after a few years of life. Though most cases of hip dysplasia end the same way (with pain and immobility), the progression varies widely depending on the degree of malformation/misalignment.
Diagnostic approaches also vary––though by no means so widely. The two basic methods for measuring the degree of dysplasia (OFA and PennHIP) both rely on X-ray evaluation of the joints.
Now for the nuts and bolts of today’s topic:
As if living with hip dysplasia weren’t bad enough, there’s the other cost to consider: treating it. And this, too, varies as widely as the different degrees to which hip dysplasia presents itself. Nonetheless, there is one absolute point that I’ll make at the outset:
Severe hip dysplasia is a surgical disease. In other words, treating it relies almost exclusively on surgical approaches to the hip joint. And these are invariably expensive, though some significantly more so than others.
Total Hip Replacement (THR)
End-stage hip dysplasia (where pain is poorly controllable and near-complete immobility results) only has one good treatment: a total hip replacement, which is by far the most expensive surgical approach to hip dysplasia. The only other option at this point is euthanasia. And it’s not my favorite, given that hip disease is now so treatable, expensive though it may be.
What’s expensive? OK let’s go there: Hip replacements (in which the entire joint is replaced with artificial components made specifically for pets) go from $3,500 a hip (the very lowest I’ve ever heard) to about twice that. And because so many sufferers are bilaterally affected, a two-sided hip replacements is usually better than its unilateral version. Yes, that’s $7,000 to about $14,000.
Compared to the human version, however, this highly specialized procedure (almost always performed by a team of board-certified veterinary surgeons who are additionally schooled and certified in this approach) goes for less than a tenth of its human equivalent (and they are equivalent in most every way).
Another note: With improvements in the non-cemented implants now used in THR, pets can be treated younger by way of preventing the pain and immobility that will invariably manifest in moderate to severely affected dogs. We don't have to wait until the hips have reached end-stage levels before intervening surgically with this "gold standard" approach.
Back to the other options:
The good news is that if it’s caught early enough (before osteoarthritis sets in and/or before muscle loss results from reduced mobility) several other surgical options are on the table.
Triple Pelvic Osteotomy (TPO)
This method is best for dogs that have been diagnosed with hip dysplasia before major signs are present (pups, in particular). It cuts the pelvis in three places so that the ball of the femur lines up better with the socket of the hip joint.
Femoral Head Osteotomy (FHO)
This approach cuts off the head of the femur, preventing painful rubbing in the joint and allowing the muscles in the are to pick up the slack. Again, this is best for pets who still have a lot of muscle in the area. In other words, these candidates don’t yet have major changes due to hip dysplasia.
Juvenile Pubic Symphysiodesis (JPS)
Though not commonly employed, this method aims to intervene early––very early––at 12 to 16 weeks of age. The goal is to fuse the bones of the pubis (on the pelvis) before they close naturally (they're open for a while in pups). This changes the alignment of the hip sockets so they can hook up with the ball part of the joint in a more natural way. Unfortunately, studies have not shown a high enough success rate for this surgery to render it popular. Moreover, the 12 to 16 week limit makes it an impractical option for those who only learn later that their dogs are affected (severe hip dysplasia is not often diagnosed until 4 to 6 months).
For all non-hip replacement kinds of surgeries, $1,000 to $3,000 per hip is the norm. But remember, the particular veterinary hospital’s priciness, its geographic location and the quality/experience of the surgeon may well dictate an even higher price.
That’s why board-certified surgeons will almost inevitably provide higher-end estimates for hip dysplasia treatment. Their experience means better outcomes for dogs. Moreover, their high tech hospitals and staff also command higher prices, even when we’re not talking about a total hip.
Post-operatively, you should also consider the possible need for rehabilitation services. These can cost anywhere from $50 to $150 per session, and can add up fast if your dog requires 10-20 sessions to recover from surgery. Most don’t, it’s true, but almost all patients will benefit from this kind of care after major orthopedic surgery.
But now comes the inevitable question...
What if a $2,000-5,000 treatment is impossibly out of reach?...or means the next five years will require you eat peanut butter and jelly sandwiches off paper plates as you whittle down the debt, dollar by dollar? What can you do in these cases?
Ultimately, your only choice in this case is to either go broke, rob a bank, get another job or treat the pain and work hard at keeping weight down and maintaining muscle through low-impact exercise (such as swimming).
Since the majority of you will have become well-accustomed to treating pain in these cases, it's what most of you who suffer from the financial inability to treat hips surgically end up doing. But you should know that this is an expensive proposition, too. Large breed dogs, especially, will typically require $20 to $100 in pain relieving medications and treatments every month––if not more for those willing and able to splurge on the more expensive supplement options (i.e., Adequan).
Doing the math on a large breed dog, this means up to $1,200 a year for moderate to severe pain. And what's the intangible cost of the inability to completely manage it? Hmmm...
Sure, it's a depressing end to a great Monday morning topic. But there you have it. The good, the bad and the ugly of hip dysplasia treatment costs. Better late than never, right?