Comparison of Osteotomy Level with Three Different Canine Total Hip Replacement Systems

Background: Numerous cementless total hip replacement systems are available for application in dogs and one of the potential differences among these systems is the technique for performing a femoral osteotomy and the amount of bone preserved in the calcar region. However, no quantitative comparison of osteotomy level has been performed for canine THRs to date. 

Objectives: 1) To develop and validate a method for quantifying the level of the osteotomy at its most distomedial aspect in conjunction with canine total hip replacement (THR) and 2) to compare osteotomy level between multiple different THRs.
 
Methods: Immediate post-operative cranial-caudal or caudal-cranial radiographs of 33 dogs treated with 17 Helica and 17 BFX THR were assessed and osteotomy level was quantified using a novel radiographic assessment by 3 independent observers. Correlation among observers was quantified using a Spearman rank order correlation. Osteotomy location was subsequently quantified for an additional 10 Zurich THRs. The osteotomy level for each THR was subsequently compared between Helica, BFX, and Zurich THRs using one-way non-parametric Mann-Whitney rank sum tests and significance set at p<0.05. 
 
Results: R-values assessing correlation between observers were 0.87, 0.72, and 0.60. Osteotomy location was significantly more proximal in conjunction with the Helica (0.75 ± 0.22) versus the BFX (0.97 ± 0.13; p<0.001) and Zurich (1.1, ±0.15; p<0.001) femoral prostheses. Osteotomy location was also significantly more proximal with the BFX prosthesis in comparison to the Zurich THR (p<0.05). 

Conclusion: The strong correlations among three different observers indicates that the technique for measuring the location of the distomedial aspect of the osteotomy was acceptably precise. The osteotomies made in conjunction with the short-stemmed Helica implants were significantly more proximal than those made with both of the long-stemmed (BFX and Zurich) femoral prostheses. The distomedial aspect of the osteotomy with the BFX system was significantly more proximal than that with the Zurich THR, indicating that between these two long-stemmed systems the osteotomy level is unique.