A Labrador retriever named Ava underwent a second double hip replacement surgery with the help of Texas A&M University veterinarians, computed tomography (CT)-guided planning and 3D printing technology. Then get back to running and playing with your family.
When the two hip joints Ava received as a puppy wore out in 2020, Texas A&M veterinarians removed the old joints and replaced them with new ones, using CT-guided planning, 3D printed bone models and rehearsed surgeries to ensure the surgery went smoothly and painless. will be successful.
Not many dogs go through four total hip replacement (THR) surgeries in their lifetime, but Ava has always been special.
“Ava came to us when she was about 6 months old and we were foster dog parents living in Illinois,” said Ava’s owner, Janet Dieter. “After caring for over 40 dogs, she was our first ‘loser’ that we eventually adopted. We also had another black Labrador named Roscoe at the time, who tended to pull away from foster puppies, but fell in love with Ava immediately and we knew she would have to stay.”
Janet and her husband Ken always take their dogs to obedience school with them, and Ava is no exception. However, it was there that the couple began to notice something different about her.
“The topic came up about how to stop your dog from jumping on you, and we realized Ava would never jump on us,” Janet said. “We took her to a local vet and they did an x-ray which showed that Ava’s hip was basically dislocated.”
The Dieters were referred to an experienced total hip replacement surgeon who performed Ava’s total hip replacement in 2013 and 2014.
“Her resilience is incredible,” Janet said. “She walked out of the hospital like nothing had happened.”
Since then, Ava has helped the dieting couple’s foster puppies find people to play with. When Dieter’s family moved from Illinois to Texas several years ago, she took the change in stride.
“Over the years, artificial balls have worn away the plastic liner that protects the metal walls of artificial joints,” said Dr. Brian Sanders, professor of small animal orthopedics and director of small animal orthopedic services at the Veterinary Teaching Hospital. “The artificial ball then wore away the metal base, causing complete dislocation.”
Although total wear and tear of the hip joint is rare in dogs, it can occur when replacing a joint that has been used for many years.
“When Ava had her original hip fitted, the padding in the replacement joint was not as developed as it is now,” Sanders said. “Technology has advanced to the point where this problem is less likely to occur. Complications like Ava’s are rare, but when they do occur, advanced technology is required to achieve a successful outcome.”
In addition to the dislocation, erosion of the metal walls of Ava’s hip had caused tiny metal particles to accumulate around the joint and inside the pelvic canal, forming granulomas.
“A granuloma is essentially a bag of soft tissue trying to hold metal fragments,” Sanders said. “Ava had a large metallic granuloma that was blocking access to her hip joint and affecting her internal organs. This could also cause her body to reject any THR prosthetic implants.
“Metal deposition—an erosive process that causes metal fragments to accumulate in granulomas—can cause cellular changes that cause the bone around the new hip to resorb or dissolve. It’s like putting the body into protective mode to protect itself from external objects,” he said.
Due to the complexity of the surgery required to remove the granuloma and repair Ava’s hip, Diters’ local veterinarian recommended they see an orthopedic specialist at Texas A&M University.
To ensure the success of the complex operation, Sanders used advanced CT-guided surgical planning and 3D printing technology.
“We use 3D computer modeling to determine the size and placement of prosthetic implants,” says Saunders. “We essentially printed an exact replica of Ava’s dislocated hip and planned exactly how to perform revision surgery using a 3D model of the bone. In fact, we sterilized the plastic models and used them in the operating room to help with the reconstruction surgery.”
“If you don’t have your own 3D printing program, you’ll have to use a fee-for-service process to send CT scans to a third-party company. It can be difficult in terms of turnaround time, and you often lose the ability to participate in the planning process,” Sanders said.
Having a replica of Ava’s butt was especially helpful considering Ava’s granuloma was making things even more complicated.
“To avoid THR rejection, we use a CT scan and work with a team of soft tissue surgeons to remove as much of the metal granuloma from the pelvic canal as possible and then return for THR revision. Then when we do the revision, we can complete the surgery on the other side by removing the remaining granuloma on one side,” Sanders said. “Using 3D models for planning and working with the soft tissue team have been two important factors in our success.”
While Ava’s first hip reconstruction surgery went well, her ordeal isn’t over yet. A few weeks after the first surgery, Ava’s other THR pad also wore out and dislocated. She had to return to VMTH for a second hip revision.
“Fortunately, the second hip was not as badly damaged as the first, and we already had a 3D model of her skeleton from her recent surgery, so the second hip revision surgery was even easier,” Saunders said.
“She still gallops around the backyard and our playground,” Janet said. “She even jumped over the sofa.”
“When she started to show the first signs of wear on her hips, we thought it might be the end and we were shocked,” Ken said. “But the veterinarians at Texas A&M gave her new life.”
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Post time: Dec-18-2023