Triple Pelvic Osteotomy (TPO)

In hip dysplasia, the hip socket does not fully cover the femoral head, allowing excessive movement that grinds cartilage and eventually produces painful arthritis. TPO is ideal for dogs that are:

• Under approximately 10–12 months of age (before the growth plate closes and before arthritis becomes established)
• Showing clinical signs of hip pain or gait abnormality that are confirmed by examination and X-rays
• Demonstrating positive hip-laxity tests (Ortolani sign) on examination
• Without significant pre-existing osteoarthritis in the joint

In the right candidate, TPO substantially reduces the severity of lifelong arthritis — or prevents it from developing altogether. Dogs that present too late (with established arthritis) may be better served by a total hip replacement or femoral head ostectomy.

TPO is performed under general anesthesia. The three-step osteotomy proceeds as follows:

• Three bone cuts are made around the acetabulum — through the pubis, the ischium, and the ilium — freeing the cup-shaped socket from the rest of the pelvis
• The acetabular segment is rotated outward (laterally) by a carefully calculated number of degrees to maximize coverage of the femoral head while preserving the birth canal in females and normal limb mechanics
• A specially contoured bone plate is secured with screws to lock the socket in its new position while the osteotomy sites heal

The surgery is typically performed on one hip at a time; if both hips require correction, the second side is addressed once the first has healed — usually 4 to 6 weeks later.

Candidates for TPO are identified through a combination of gait evaluation, hip palpation (Ortolani and Barden tests), and X-rays — often taken with the dog sedated to achieve the muscle relaxation needed for accurate laxity measurement. Standard PennHIP or OFA-style radiographs provide objective laxity scores that guide the decision. Pre-anesthetic bloodwork clears the patient for anesthesia. The consultation is also the right time to discuss timing — if both hips need TPO, staging the surgeries is planned in advance. Fast your pet the night before surgery, and prepare a quiet, confined recovery area at home before the appointment.

Most dogs use the operated leg within a day or two of surgery, which is an encouraging sign. Structured recovery promotes solid bone healing and appropriate soft-tissue remodeling:

• Weeks 1–2: strict cage or pen rest; leashed bathroom trips only; pain medication; incision monitoring; no slippery floors
• Weeks 3–6: gradually increasing controlled leash walks; still no running, jumping, or stairs; follow-up exam at 4–6 weeks
• Weeks 6–10: X-rays assess osteotomy healing; if the first hip is healed and the second hip requires surgery, timing is confirmed at this visit
• 3+ months post-op: full activity is typically resumed once radiographic healing is confirmed

Keeping the dog lean is essential — extra body weight increases load on both the healing hip and the opposite, unsupported hip during single-leg recovery.

TPO has a very good safety profile when performed in appropriate candidates. Possible complications include infection, implant failure before the osteotomy heals, sciatic nerve irritation (usually temporary), and in rare cases over- or under-rotation of the acetabulum affecting gait. Because the procedure works best before arthritis develops, outcomes are significantly better when TPO is performed early. Long-term, most dogs that undergo TPO as young patients lead comfortable, active lives with far less arthritis than would have developed without intervention. The team provides an honest assessment of where your dog falls on the candidate spectrum.