Revolutionizing Canine Surgery: How Veterinarians Use 3D Printing to Enable Double Hip Replacement for a Dog

November 16, 2023

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By Courtney Price, Texas A&M University

A Labrador retriever named Ava is back to running and playing with her family after her second double hip replacement, courtesy of Texas A&M University’s veterinarians, computerized tomography (CT)-guided planning, and 3D-printing technology.

When the two replacement hips Ava received as a puppy wore out in 2020, Texas A&M veterinarians were able to remove the old joints and replace them with new ones by using CT-guided planning, 3D-printed bone models, and rehearsal surgeries to ensure the procedures would be successful.

Not many dogs go through four total hip replacements (THRs) in one lifetime, but Ava has always been special.

“Ava came to us at about 6 months old, back when we were dog foster parents living in Illinois,” said Ava’s owner, Janet Dieter. “After caring for more than 40 dogs, she was our first ‘foster failure’ that we ended up adopting. At the time, we had another black Labrador named Roscoe who was usually standoffish with the foster puppies, but he fell in love with Ava immediately and we knew she had to stay.”

Janet and her husband, Ken, always take the dogs under their care to obedience school, and Ava was no exception. It was there, however, that the couple began to notice something different about her.

“The subject of how to keep your dog from jumping on you came up and we realized that Ava never jumps on us,” Janet said. “We took her to our local veterinarian and they took an X-ray, which showed that Ava’s hips were basically out of their sockets.”

The Dieters were introduced to a proficient surgeon specialized in total hip replacements who successfully operated on Ava’s hips in 2013 and 2014.

“Her resilience was remarkable,” spoke Janet. “She just walked out of the hospital as if nothing had occurred.”

Ever since, Ava has carved a significant role in moulding the Dieters’ foster puppies by engaging in playful activities with them. When they shifted from Illinois to Texas a few years back, Ava adapted to the change seamlessly.

However, in 2020, Ava confronted new trials when one of her replaced hips began to fail.

Dr. Brian Saunders, who specialises in small animal orthopedics and leads the Small Animal Orthopedics Service at the Veterinary Medical Teaching Hospital, stated, “Over a long period, the synthetic ball had eroded the plastic coating safeguarding the metallic wall of the artificial joint. Consequently, the synthetic ball wore down the metal backing, causing a complete dislocation.”

Although worn out Total Hip Replacements (THRs) are not frequently encountered in canines, they can occur in joint replacements that have been established for an extended period.

Dr. Saunders explained, “At the time Ava’s original hips were installed, the liners in the replacement joints were not as progressed as they currently are. Technology has now advanced to a point where it’s less probable for that issue to occur. Although complications like Ava’s are not exceedingly common, they necessitate advanced techniques to accomplish a thriving result.”

Furthermore, apart from the dislocation, the attrition of the metal wall in Ava’s hip instigated tiny metal particles to accumulate around the joint and in her pelvic canal, which led to the creation of a granuloma.

“A granuloma is essentially a bag of soft tissue working to contain the metallic debris,” articulated Saunders. “Ava had a significant metal granuloma obstructing the approach to the hip joint and impacting her internal organs. There was also a possibility it might lead her body to rebuff any THR revision implants.

“Metallosis—the eroding process which causes the buildup of the metal debris into a granuloma—can initiate cellular modifications, resulting in resorption or breaking down of bone surrounding the new hip. It’s as if the body falls into a defensive stance against outside objects,” he elaborated.

Considering the complexity of the operation required to get rid of the granuloma and repair Ava’s hip, the Dieters’ local vet suggested they approach Texas A&M’s orthopedic specialists.

Saunders utilized cutting-edge CT-guided surgical planning and 3D-printing technology to ensure the complex operation was successful.

“We utilized computer-assisted 3D modeling to ascertain revision implant size and placement,” Saunders stated. “Primarily, we created a duplicate of Ava’s dislocated hip joint and strategized precisely how to conduct the revision operation using the 3D bone models. Actually, we sterilized the plastic models and employed them in the operating room to aid in guiding the revision surgery.”

Having access to 3D-printing technology directly within the VMTH presents a substantial benefit for surgical teams.

“If you lack your own 3D-printing program, you must transmit a CT scan to an external company through a fee-for-service method. This can present difficulties regarding turnaround time and often results in a loss of participation in the planning process,” Saunders stated.

The possession of a replica of Ava’s hip was particularly useful as she had a granuloma making the situation more complex.

To prevent a Total Hip Replacement (THR) rejection, our team collaborated with the Soft Tissue Surgery group. We conducted a CT scan and meticulously removed a large portion of the metallic granuloma from the pelvic canal. This was all done before performing the THR revision. During the revision, we managed to completely remove the remaining granuloma from the other side,” explained Saunders. “Our success can largely be attributed to our meticulous planning using 3D models and significant collaboration with the Soft Tissue team.”

Despite the initial success of Ava’s hip revision, her struggles were far from over. Merely a few weeks post-surgery, Ava suffered from another setback—her second THR liner began to degrade and ultimately dislocated. Thus, she had to revisit the VMTH for a second hip revision.

“Fortunately, her parallel hip wasn’t as severely affected relatively, and we already had 3D models of her bone structure from the previous surgery. Thus, her second hip revision operation was fairly straightforward,” added Saunders.

Irrespective of her consistent hip concerns, Ava, who is presently 12 years old, has demonstrated significant resilience and hasn’t allowed her medical history to hinder her progress.

“She still zips all over the backyard and through our exercise course,” Janet said. “She will even jump over the couch.”

“When she started showing signs of her first hip wearing out, we thought it might mean the end, and we were devastated,” Ken said. “But the veterinarians at Texas A&M were able to give her life again.”

Provided by Texas A&M University.

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