A broken bone in a dog needs one of three things: rest and confinement, external coaptation (splint or cast), or surgical repair. The decision depends on the bone affected, the fracture pattern, the dog's size and age, and the available equipment.

Getting this decision right the first time matters. Fusion Veterinary Orthopedics: "Attempting to use a splint or cast for several weeks with the hope of the fracture healing and doing surgery later is not advised. Chronic non-healing fractures are far more difficult to realign, are more costly, and have a lower likelihood of healing."

Quick answer: External coaptation suits minimally displaced fractures below the elbow or stifle in large adult dogs. Comminuted, articular, open, and upper-limb fractures require surgery. Small and toy breed distal radius fractures almost always need surgical repair.

Key takeaways

• Splints only work for fractures below the elbow or stifle: humeral and femoral fractures cannot be adequately immobilized externally
• Comminuted and articular fractures always require surgery: they are too unstable for external coaptation to maintain alignment
• Open fractures require emergency treatment within 8 hours: irrigation, debridement, and temporary stabilization precede definitive fixation
• 83% of distal radius/ulna fractures in small and toy breeds managed with external coaptation result in malalignment or nonunion
• Growth plate fractures should be surgically repaired within 24 to 48 hours of injury to minimize long-term joint damage
• Consult a board-certified surgeon for complex fractures including spinal, articular, and small-breed distal radial/ulnar

The three management options

1. Cage rest alone: reserved for very young dogs (puppies) with minimally displaced, inherently stable fractures for example, some rib fractures and stable pelvic fractures where the dog's own muscle mass provides sufficient immobilization.

2. External coaptation (splint or cast): for fractures below the elbow or stifle, minimally displaced, in stable large-breed adult dogs. Today's Veterinary Practice: "Ideal fractures for primary fixation using external coaptation include incomplete diaphyseal tibial fractures in young dogs, sometimes referred to as 'greenstick fractures.'"

3. Surgical repair: for the majority of fractures in adult dogs, all fractures in small and toy breeds, all comminuted and articular fractures, all open fractures, and all fractures above the elbow or stifle.

When external coaptation is appropriate

External coaptation requires that the joints above and below the fracture can both be immobilized. This is only achievable for fractures distal to (below) the elbow and stifle.

Clinical Brief: "External coaptation may be successful in fractures below the elbow or stifle, where the joints above and below the fracture can be fully immobilized."

Fractures that may be managed with splinting:

• Greenstick (incomplete) tibial fractures in young large-breed dogs
• Minimally displaced distal radius fractures in large-breed adult dogs
• Some metacarpal and metatarsal fractures
• Toe fractures

How splints are applied: Today's Veterinary Practice: "The splint should span the joint above and below the fracture, and be padded enough to prevent pressure sores and prevent movement of the limb." After placement, a radiograph confirms alignment.

Complications of splinting: ACVS: "Bandages and splints can cause very serious complications. They can be an effective treatment tool for fracture healing and pain control, but careful monitoring and appropriate follow-up must occur." Pressure sores, bandage slippage, and limb swelling are the most common complications; daily monitoring is essential.

When surgical repair is required

Fractures above the elbow or stifle

Animal Medical Center: "It is easy to temporarily immobilize bones below the elbow and knee, while the upper arm and thigh are more challenging to manage because the shoulder and hip are difficult to splint."

Today's Veterinary Practice: "Temporary stabilization of humeral and femoral fractures should not be attempted. In these cases, hospitalization with confinement to a crate along with analgesic relief is ideal while awaiting definitive fixation."

SustainableVet: "Trying to splint these upper limb fractures often leads to pain, delayed healing, and poor limb function. Immediate referral for surgical repair is recommended."

Comminuted fractures

A comminuted fracture means the bone is broken into multiple pieces. These are mechanically unstable fragments shift with any weight bearing. SustainableVet: "These are very unstable and cannot be held in place by a splint alone. The pieces move easily, and the risk of poor healing is high. In these cases, surgical fixation is needed to realign and stabilize the fragments."

Articular fractures (fractures entering a joint)

Any fracture that enters a joint surface requires anatomical reduction the fracture fragments must be restored to near-perfect anatomical position and rigid fixation to prevent joint surface step-off and subsequent arthritis. Fusion Veterinary Orthopedics: "Any growth plate fracture or joint fracture should be treated as quickly as possible within about 24 to 48 hours after injury."

Open (compound) fractures

Animal Medical Center: "Open fractures often require an initial surgery to clean the wound and bone within 8 hours of the injury." The management sequence is:

1. Immediate wound irrigation and debridement under anesthesia
2. Temporary stabilization (bandage)
3. Systemic antibiotics
4. Definitive fracture repair after soft tissue stabilization

Do not attempt definitive fixation of a contaminated open fracture at the initial presentation; this dramatically increases infection risk.

Small and toy breed radius and ulna fractures

Today's Veterinary Practice: "In small and toy breed dogs, 83% of distal radius and ulna fractures addressed with external coaptation alone result in malalignment or nonunion. Therefore, internal fixation is recommended for these fractures in small and toy breed dogs."

SustainableVet: "Toy breeds like Chihuahuas, Pomeranians, and Yorkies are at high risk of nonunion. Their small bones have less blood supply, which slows healing. Even simple fractures may not heal with splints alone."

Spinal fractures and luxations

Spinal fractures with cord involvement are neurosurgical emergencies requiring immediate specialist referral for stabilization and decompression. Clinical Brief: "For complex fractures including spinal, consider consultation with a boarded veterinary surgeon or referral to a specialty practice."

Surgical options for fracture repair

Vets4Pets provides a useful overview: "Two types of surgical fracture repair are normally used in pets. Internal fixation involves placing surgical screws, pins, or metal plates under the skin around the fracture site to stabilize the bone. External fixation involves attaching surgical scaffolding to the bone through small holes in the skin."

Specific implant systems used:

• Intramedullary (IM) pins: inserted down the bone canal; suitable for some long-bone fractures
• Bone plates and screws: the most common implant system; provides rigid fixation; locking plate systems are particularly stable
• External skeletal fixators (ESF): transcutaneous pins connected by an external frame; useful for open fractures, infected fractures, and certain metaphyseal fractures
• Interlocking nails: for femoral and tibial shaft fractures

Timing matters

Animal Medical Center: "You should treat a closed fracture within 2 to 4 days. Timely veterinary fracture repair can prevent complications like bone misalignment or long-term mobility issues."

Fusion Veterinary Orthopedics: "Chronic non-healing fractures are far more difficult to realign, are more costly, and have a lower likelihood of healing."

Delaying evaluation hoping the dog will be "better tomorrow" consistently leads to worse outcomes. Fractures should be radiographed and assessed by a veterinarian on the day they are suspected.

For recovery care after fracture surgery, see orthopedic surgery home care guide. For the referral decision framework across orthopedic conditions, see when to refer orthopedic cases. For the full specialist referral process, see what is veterinary referral surgery.

Frequently asked questions

My dog is walking on the leg a little. Does that mean it is not broken?

No. Weight bearing on a fractured limb is common many dogs do not display obvious non-weight-bearing lameness with incomplete or minimally displaced fractures. Any dog with pain, swelling, or abnormal limb conformation after trauma needs radiographs.

How do I transport a dog with a suspected broken leg to the vet?

Keep the dog calm and restrict movement. Do not splint at home; improper application can worsen the fracture. Carry small dogs; use a rigid surface for large dogs. Call ahead so the clinic can prepare.

Will my dog's fracture heal faster with rest than surgery?

For fractures that require surgery, no. Fusion Veterinary Orthopedics: "Surgery ensures optimal alignment and stabilization for less pain and faster healing." Splinting a fracture that needs surgery delays appropriate treatment and often results in malunion or nonunion.

What is a growth plate fracture and why is it urgent?

Growth plates are bone formation zones at long bone ends in immature dogs. Fractures disrupt blood supply to growth cells. Fusion Veterinary Orthopedics: "Growth plate fractures should be treated within 24 to 48 hours." Delay risks permanent deformity.

Can a dog live with an untreated fracture?

Some dogs survive without repair, particularly with stable pelvic fractures. However, untreated fractures often result in malunion, nonunion, chronic pain, and permanent functional loss. Any decision against surgery should be fully informed.

How often does a splint need to be checked when my dog is wearing one?

ACVS: splints require careful monitoring and appropriate follow-up. Checks every 3 to 5 days are standard initially. Watch for swelling above or below the splint, foul odor, cold or pale toes, or the dog chewing the bandage.

Resources

• SustainableVet. Fracture Management in Dogs: When to Splint or Refer? sustainablevet.org
• Today's Veterinary Practice. Definitive Treatment of Limb Fractures With Splints or Casts. todaysveterinarypractice.com
• ACVS. Fractured Limbs. acvs.org
• Clinical Brief. Fracture Management. cliniciansbrief.com
• Fusion Veterinary Orthopedics. Minimally Invasive or Open Fracture Repair. fusionvetortho.com

A well-prepared referral saves the specialist time, prevents duplicate testing at the owner's expense, and results in a more productive first consultation.

A poorly prepared referral missing radiographs, incorrect views, or no clinical summary forces the specialist to start from scratch and may delay diagnosis and treatment.

Quick answer: Before orthopedic referral, take minimum two orthogonal radiographic views under sedation, run baseline blood work for any patient likely to need surgery, and write a clear referral summary. CT and MRI are not routinely required before referral; most specialists prefer to perform these in-house to their own protocols.

Key takeaways

• Two orthogonal radiographic views are the minimum for any orthopedic referral: lateral and craniocaudal/mediolateral single views are inadequate
• Sedation improves radiograph quality: precise positioning detects subtle lesions; unsedated films are frequently non-diagnostic
• Send DICOM files, not printed films: digital files allow the specialist to adjust contrast and zoom; printed films are inferior
• CT and MRI are usually performed at the specialist centre: refer before CT/MRI unless the specialist specifically requests pre-referral imaging
• Baseline blood work is essential for any patient expected to need surgical anesthesia: CBC and biochemistry at minimum
• A clear written referral summary with gait findings, lameness duration, and prior treatment adds more value than extra imaging alone

Why pre-referral imaging matters

The most important part of the orthopedic exam and probably the most important part of the workup is attempting to localize the cause of lameness to a single joint or single bone.

Radiographs at the primary care practice serve several purposes: confirming the anatomical location, ruling out differentials, giving the specialist baseline images, and identifying concurrent findings the owner needs to know about.

Poor imaging quality, missing essential baseline tests, and unclear communication with specialists can cause delayed diagnoses and ineffective treatment plans.

Radiography: the essential pre-referral modality

Two orthogonal views minimum

Always take at least two orthogonal views (e.g., lateral and craniocaudal/mediolateral). Use stress or oblique views for joint instability (e.g., CCL rupture, elbow dysplasia). Ensure proper sedation for accurate positioning, especially for pelvic or spinal radiographs.

A single lateral view is not adequate for referral. Fractures, joint mice, and osteophyte patterns require two planes to characterize. Subtle findings visible on one view may be absent on another.

Sedation for positioning: unsedated radiographs in painful patients are often rotated, foreshortened, or underexposed. These films reduce diagnostic value and may force repeat imaging at the specialist centre a cost the owner bears twice. Sedation is appropriate and usually brief for orthopedic positioning.

Specific views by condition

Sending digital files

Send DICOM format where possible. Digital files allow the specialist to adjust window and level settings, zoom into areas of interest, and use measuring tools.

Printed films or JPEG photographs of films are significantly inferior and should be avoided.

When to perform CT before referral

CT is significantly more sensitive than radiography for:

• Medial coronoid process disease (elbow dysplasia)
• Complex periarticular fractures
• Spinal cord compression assessment
• Nasal cavity and dental pathology

Thoracic radiographs provide metastatic and pre-anesthetic screening. No additional radiographs are necessary if the patient will be referred for advanced imaging.

Most specialist centres prefer to perform CT in-house to their own protocols. Referring a patient with CT already done can be counterproductive if the protocol does not meet the specialist's requirements.

Unless the specialist has specifically requested pre-referral CT, radiographs alone are appropriate.

Exception: if CT is readily available at your practice, in good quality, and the specialist has confirmed they will accept your images, pre-referral CT for elbow dysplasia or complex fractures is valuable.

MRI before referral

MRI is superior to CT for soft tissue detail: spinal cord, brain, tendons, and ligaments. It is almost never required before referral.

MRI requires general anesthesia and significant scan time. Specialist centres perform it to their own protocols and prefer to interpret their own studies.

Referring a patient with MRI images from another centre creates interpretation challenges that can slow, not speed, diagnosis.

Laboratory diagnostics

Run basic lab tests (CBC, chemistry, joint fluid analysis if needed) before referring the case.

Pre-referral blood work:

• CBC: detects anaemia, leukocytosis (infection/inflammation), thrombocytopenia
• Biochemistry panel: kidney and liver function essential before any anesthetic
• Relevant for: any patient likely to need surgical anaesthesia at the specialist centre

When joint fluid analysis adds value:

• Suspected immune-mediated polyarthritis
• Joint effusion without clear traumatic or degenerative cause
• Suspected septic arthritis

In chronic orthopedic cases, laboratory diagnostics help differentiate degenerative diseases from immune-mediated or infectious conditions, providing a more complete clinical picture. C-reactive protein levels indicate active inflammation, commonly seen in immune-mediated arthritis. Synovial fluid analysis helps assess infection, immune-mediated polyarthritis, or degenerative joint disease.

The referral summary

A well-written referral letter adds value that no imaging can replace:

Include:

• Signalment and body weight
• Duration and progression of the lameness
• Which limb(s) and which joints on palpation examination
• Gait assessment findings (grade of lameness, pattern)
• Orthopaedic test results (cranial drawer, tibial compression, Ortolani)
• Differential diagnoses considered
• Previous treatments and response
• Reason for referral and what you are asking the specialist to do

Keep it concise. A one-page summary covering the above is far more useful than three pages of unformatted notes.

For the communication framework with the specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

For what happens at the specialist consultation, see what to expect when your patient sees an orthopedic specialist.

For the referral decision criteria, see when to refer for orthopedic surgery: surgical vs non-surgical cases.

Frequently asked questions

Do I need to sedate the dog for pre-referral radiographs?

Yes, for most orthopedic cases. Sedation improves positioning accuracy significantly. Unsedated films in painful patients are frequently rotated or foreshortened and may not provide diagnostic information.

Brief sedation for positioning is appropriate and is standard at most specialist centres for their own imaging.

The specialist centre is far away. Should I try to do a CT first?

Only if the specialist has specifically requested pre-referral CT and you can achieve the required protocol quality. Otherwise, radiographs are sufficient for referral.

CT performed without the specialist's protocol guidance may not meet their imaging requirements and could result in the owner paying for repeat CT at the specialist centre.

What format should I send radiographs in?

DICOM format wherever possible. If DICOM is not available, the highest-resolution uncompressed images you can export.

Avoid photographing films with a mobile phone these are not diagnostically useful and create a poor impression of the case preparation.

Is blood work always required before referral?

Not in an emergency. For elective or semi-urgent referrals where surgical anaesthesia is anticipated, blood work provides essential safety information.

It is best performed at the primary care practice to allow results interpretation by someone who knows the patient's history.

My radiographs show only mild changes. Should I still refer?

Yes, if the clinical signs warrant it. Radiographic severity does not always correlate with clinical severity. A dog with mild radiographic changes but significant lameness affecting quality of life merits specialist assessment.

Conversely, severe radiographic OA in a dog with good function may not need referral urgently.

Resources

• SustainableVet. Essential Imaging and Diagnostics Before Vet Referrals. sustainablevet.org
• MSPCA-Angell. Radiographic Approach to Bone Imaging. mspca.org
• Today's Veterinary Practice. Advanced Imaging: Its Place in General Practice. todaysveterinarypractice.com
• SustainableVet. When to Refer: Surgical vs Non-Surgical Orthopedic Cases. sustainablevet.org

Joint replacement surgery is the most advanced intervention in veterinary orthopaedics.

For dogs with severe, irreversible joint disease that has not responded to medical management, it can transform quality of life in a way no medication or rehabilitation can match.

Quick answer: Total hip replacement in dogs achieves 90 to 95% good-to-excellent outcomes. It is indicated for end-stage hip OA unresponsive to conservative management. Recovery requires 8 to 12 weeks of strict rest. Cost is $4,000 to $7,000 per joint.

Key takeaways

• THR achieves 90 to 95% good-to-excellent function in appropriately selected dogs; most need no further pain medication after recovery
• THR complication rate is 5 to 10%: post-operative luxation is most common, occurring in 3 to 5% of cases
• THR is indicated for end-stage hip dysplasia OA not responding to conservative management; it is a salvage procedure, not first-line
• Total elbow replacement is available at only a few specialist centres and has higher complication rates than THR
• Strict activity restriction for 8 to 12 weeks post-surgery is essential owner compliance is one of the most important factors in outcome
• Cost is $4,000 to $7,000 per joint at specialist centres; bilateral cases require two separate procedures

Total hip replacement (THR)

What it is

Total hip replacement removes the femoral head and acetabulum and replaces both with prosthetic implants a metal femoral stem with a ball, and a metal or polyethylene acetabular cup.

The new joint provides smooth, pain-free movement without the bone-on-bone contact of advanced hip OA.

Canine joint replacement technology and surgeon expertise have advanced greatly over the past 20 years. Only a few relatively small companies worldwide supply the technology for joint replacement surgery, and a relatively low number of surgeons have the expertise to consistently perform the procedure with a high degree of proficiency.

Success rates

The success rate for total hip replacement in dogs is very high between 90% and 98%. Most dogs experience significant pain relief, improved movement, and a better quality of life.

Studies show more than 90 to 95% of dogs have good to excellent function with THR, providing years of pain-free activity that otherwise would not have been possible.

A large registry study reviewed 2,375 THRs in 1,852 dogs over 10 years. The majority of cases were hip dysplasia with osteoarthritis.

Owner-reported outcomes were strongly positive in the vast majority of cases.

Complications

The typical overall complication rate following a THR varies, with a reported overall average complication rate of 5 to 10%. The more commonly reported complications include postoperative luxation, often associated with a fall or excessive activity.

The most frequent complication is hip dislocation, occurring in approximately 3 to 5% of cases. Other potential complications include fracture, nerve injury, or infection.

Most complications are managed without losing the implant. Catastrophic failure requiring implant removal is uncommon in experienced hands.

Candidates for THR

Good candidates:

• Dogs with hip dysplasia and severe OA causing significant pain and reduced quality of life
• Dogs that have failed conservative management (weight management, NSAIDs, rehabilitation)
• Dogs with adequate bone stock to accept the implant
• Dogs whose owners can commit to strict post-operative restriction

Not candidates:

• Dogs with neurological disease affecting the same limb
• Dogs with active infection in or near the joint
• Dogs with severe muscle atrophy at time of surgery
• Dogs with other significant orthopaedic disease in the same limb

Candidates for THA must not have other orthopaedic disease in the limb to be operated, as well as clients willing to perform the postoperative care necessary for a successful outcome.

Implant systems

Two main systems exist: cemented (implant fixed with bone cement) and cementless (press-fit, relying on bone ingrowth for long-term fixation).

Cementless systems are now more widely used and have longer documented longevity in dogs.

In most cases, the replaced hip will last for your pet's lifetime.

Total elbow replacement

Total elbow replacement (TER) is significantly more complex than THR and available at only a small number of specialist centres worldwide.

Total elbow arthroplasty continues to be under development. The system is technically demanding and may be the reason it is not used more widely by veterinary surgeons.

The T.A.T.E. elbow system is the most widely used current system.

Indications include end-stage elbow OA from fragmented medial coronoid process disease or other elbow dysplasia conditions that have exhausted all other options.

Complication rates for total elbow replacement are higher than THR.

It is a salvage procedure reserved for dogs that have failed all other surgical and medical options and where FHO-equivalent (head and neck excision) is not anatomically applicable.

Cost

The cost of a total hip replacement typically ranges from $4,000 to $7,000. Elbow and knee replacements may fall within a similar or slightly higher range due to complexity. Although the upfront cost is high, joint replacement can eliminate the need for ongoing pain medications, frequent vet visits, or repeated surgeries.

Bilateral THR (both hips) nearly doubles the cost. Most surgeons stage bilateral cases 8 to 16 weeks apart rather than performing both simultaneously.

Recovery

Activity restrictions are significant during the initial 8 to 12 weeks of recovery. Your pet should not be allowed to be off leash, run, or jump. Your pet should be strictly confined to a small indoor area with non-slippery floors or in a crate. Most pets are ready to resume regular exercise and activities after 12 weeks of recovery.

Recovery milestones:

• Days 1 to 14: crate rest, leash-only bathroom walks, pain medication
• Weeks 2 to 8: progressive short leash walks, rehabilitation exercises begin
• Weeks 8 to 12: radiographic recheck, gradual activity increase if healing is confirmed
• Month 3 to 6: peak recovery; most dogs reach full or near-full function

Rapid recovery and high performance are expected not just hoped for in current veterinary orthopaedic surgery.

For the full rehabilitation guide covering the post-joint-replacement recovery period, see physical therapy and rehabilitation: how referring vets can support recovery.

For the pain management approach used alongside joint replacement recovery, see orthopedic pain management in pets: multimodal approaches. For the referral decision, see when to refer for orthopedic surgery.

Frequently asked questions

Is my dog a candidate for total hip replacement?

The key criteria are: end-stage hip OA with significant pain and failure of conservative management.

Additionally: no neurological disease or orthopaedic disease in the same limb, adequate bone stock, and an owner able to comply with strict activity restriction.

A board-certified orthopaedic surgeon will assess suitability at a specialist consultation.

How long does a dog live after hip replacement?

The implant is designed to last the dog's lifetime. Most dogs require no further pain medication after recovery and return to near-normal activity.

The procedure does not shorten lifespan and typically significantly improves quality of remaining life.

What happens if the hip dislocates after surgery?

Post-operative luxation occurs in approximately 3 to 5% of cases, usually associated with excessive activity or a fall.

It is managed by manual reduction under anesthesia, followed by a period of restricted activity. In some cases, revision surgery is needed.

This is why strict activity restriction in the first 8 weeks is critical.

Is hip replacement better than FHO (femoral head ostectomy)?

For medium and large breeds, THR generally produces superior outcomes compared to FHO better gait, less muscle atrophy, and more reliable function.

FHO is a reasonable salvage option for small and toy breeds where functional outcomes are more reliable, or when the cost of THR is prohibitive.

Can both hips be replaced at the same time?

Rarely. Most surgeons stage bilateral THR 8 to 16 weeks apart to allow recovery of one limb before stressing the other.

Operating both simultaneously significantly increases anesthetic time and complication risk, and leaves the dog with no sound limb during recovery.

Resources

• AVES. Total Hip Replacement: A Complete Information Guide. austinvets.com
• TVMF. Outcomes for Total Joint Replacement in Dogs and Cats. tvmf.org
• PMC. Outcomes and Complications Reported from a Multiuser Canine Hip Replacement Registry over a 10-Year Period. ncbi.nlm.nih.gov
• DVM360. Total Joint Replacement of the Elbow and Hip. dvm360.com
• Animal Orthopaedic Clinic. Total Joint Replacement. animalorthoclinic.com

Hip dysplasia is one of the most common orthopedic diagnoses in dogs, but it doesn't always mean surgery is coming.

Many dogs with hip dysplasia live comfortably for years on conservative management. Others reach a point where pain or mobility loss makes surgery the right path. Knowing which situation your dog is in, and which surgical option makes sense, is what this guide is for.

Quick answer: Surgery becomes the best option for hip dysplasia when conservative management no longer controls pain, when mobility is significantly impaired, or when a dog is young enough for preventive procedures. The two main surgical options are FHO (femoral head ostectomy) and THR (total hip replacement), each suited to different dogs.

Key takeaways

• Surgery isn't always necessary: many dogs manage well with medication, weight control, and physiotherapy.
• Two main surgical paths exist: FHO removes the femoral head; THR replaces the entire joint.
• FHO suits smaller dogs and tight budgets; THR delivers better function in large, active breeds.
• Early preventive surgery (DPO/TPO) is an option for puppies under 10 months with minimal joint damage.
• The trigger for surgery is quality of life, not the X-ray grade alone.
• Delaying surgery in severe cases worsens outcomes: arthritis accumulates and options narrow.

What hip dysplasia actually is

Hip dysplasia is a developmental condition in which the ball (femoral head) and socket (acetabulum) of the hip joint don't fit together correctly. Instead of a tight, smooth connection, the joint is loose, allowing abnormal movement that gradually wears down cartilage and produces bone-on-bone friction.

The result is pain, inflammation, and over time, progressive osteoarthritis.

Hip dysplasia is most common in large and giant breeds: German Shepherds, Labrador Retrievers, Golden Retrievers, Rottweilers, and Saint Bernards among the most frequently affected, but it occurs in any size dog.

The severity on X-ray does not always match the dog's visible symptoms. Some dogs with significant radiographic changes are relatively comfortable. Others with moderate findings are clearly in pain. Both the X-ray and the clinical picture matter.

When conservative management is enough

For many dogs with hip dysplasia, especially mild to moderate cases, non-surgical management controls symptoms well enough that quality of life is maintained without surgery.

Conservative management typically includes:

• Weight management: Reducing body weight is the single most impactful intervention. Every pound of excess weight adds direct mechanical load to an already unstable joint.
• Pain medication: NSAIDs (such as carprofen, meloxicam, or grapiprant) reduce inflammation and pain. Regular bloodwork monitoring is required for long-term NSAID use.
• Joint supplements: Glucosamine, chondroitin, and omega-3 fatty acids support cartilage health and reduce inflammation over time.
• Physical therapy and low-impact exercise: Controlled walking, swimming, and hydrotherapy build the muscle mass that stabilizes the joint and reduces the load on the hip.
• Environmental modifications: Ramps instead of stairs, non-slip flooring, orthopedic bedding.

Conservative management doesn't fix the underlying anatomy. It manages symptoms within the constraints of what the joint can do. When symptoms outgrow what this approach can control, surgery enters the conversation.

For non-surgical alternatives in more detail, see non-surgical alternatives to consider.

When surgery becomes the better path

According to Ask A Vet (2025), surgery is recommended when conservative management fails or when early intervention can prevent arthritis. The clinical signals include:

• Persistent limping or bunny-hopping that doesn't resolve with medication and rest
• Reluctance to stand, jump, or climb stairs that's significantly limiting daily life
• Muscle atrophy in the hindquarters from disuse
• Radiographic evidence of progressive joint damage alongside clinical decline
• Quality of life that is clearly impacted despite consistent conservative management

The decision to move to surgery is a quality-of-life decision, not purely a radiographic one. Two dogs with similar X-rays may need different approaches based on their clinical response to conservative care.

The surgical options for hip dysplasia

FHO (femoral head ostectomy)

FHO removes the head and neck of the femur: the "ball" of the ball-and-socket joint. The remaining femur is cushioned by a "false joint" of fibrous scar tissue that forms over the following weeks.

Best suited to:

• Small to medium dogs (typically under 50 lbs)
• Any size dog when THR isn't feasible (financial constraints, health contraindications)
• Cats

Limitations: The false joint doesn't provide the mechanical function of a real hip. Large breeds may have residual pain or gait abnormality. Function depends heavily on muscle mass and rehabilitation.

For a full explanation of what the procedure involves, see what FHO surgery is and how it helps.

THR (total hip replacement)

THR replaces the entire hip joint with a prosthetic implant. The femoral head and acetabulum are both replaced with precisely fitted components.

Best suited to:

• Medium to large dogs (typically over 40 to 50 lbs) who want full athletic function restored
• Skeletally mature dogs (typically over 9 to 12 months)
• Dogs in otherwise good health without significant comorbidities

Advantage over FHO: THR restores near-normal hip anatomy and function. Success rates of 80 to 98% are reported across published studies. Large active breeds return to full exercise capacity more reliably than with FHO.

For a full overview of the THR procedure, see total hip replacement as an alternative.

DPO/TPO (double or triple pelvic osteotomy)

This is a preventive surgery performed only in young dogs (typically under 10 months old) with hip laxity but minimal joint damage. The surgeon cuts and rotates the pelvic bones to improve how the socket holds the femoral head, reducing abnormal motion before cartilage damage accumulates.

Candidates: puppies with confirmed hip laxity on radiograph, little or no arthritis, and growing bones.

This window closes as the dog matures and joint damage develops.

How to know which surgical option applies to your dog

The right surgical option depends on the intersection of several variables:

For the direct comparison of FHO versus THR across all major factors, see FHO vs total hip replacement for hip dysplasia.

For the specific indications that guide the FHO recommendation, see when FHO is recommended.

The cost of waiting

For dogs with mild disease and adequate pain control, watchful waiting is entirely appropriate.

For dogs with moderate to severe disease where quality of life is declining, delay carries real costs:

• Progressive arthritis: The damaged joint continues to deteriorate. Every month of delay means more cartilage loss and more established arthritis.
• Muscle atrophy: Disuse of the painful leg causes the supporting muscle to waste away, making recovery from eventual surgery harder and longer.
• Narrowing options: As joint damage progresses, some surgical options become less appropriate. DPO/TPO is only available during a brief window in puppyhood.

Early action, when indicated, typically means simpler surgery, cleaner recovery, and better long-term outcomes.

For guidance on whether your dog is a candidate for THR specifically, see how to know if your dog is a THR candidate.

Frequently asked questions

My dog has hip dysplasia but doesn't seem to be in pain. Do they need surgery?

Not necessarily. Many dogs with hip dysplasia compensate well and show minimal pain, particularly in early disease. Conservative management, weight control, and monitoring are appropriate first steps. Surgery is indicated when pain is not controlled or mobility is meaningfully impaired, not simply because the diagnosis exists.

How old does a dog need to be for hip replacement surgery?

THR requires skeletal maturity, typically achieved at 9 to 12 months in most breeds and later in giant breeds. FHO can be performed at any age. DPO/TPO is only appropriate before 10 months of age in puppies with hip laxity and minimal arthritis.

Can hip dysplasia go away without surgery?

The underlying anatomic abnormality doesn't resolve. But many dogs with hip dysplasia maintain a good quality of life on conservative management for years, particularly those who remain lean and receive appropriate physiotherapy. "Going away" isn't the goal; managing symptoms within the joint's limits is.

Hip dysplasia doesn't come with a single right answer. The best path depends on your dog's size, age, severity of symptoms, response to conservative care, and your goals for their function and quality of life. The conversation with your vet and the X-ray findings together tell you more than either alone. Start early, monitor consistently, and make the surgical decision based on how your dog is actually living rather than the diagnosis on paper.

Resources

• PetMD. FHO Surgery in Dogs and Cats. petmd.com
• Ask A Vet. Vet-Approved 2025 Guide: Hip Dysplasia Surgery in Dogs. askavet.com
• Simon Vet Surgical. Hip Dysplasia Surgery in Dogs. simonvetsurgical.com

Referral to a veterinary orthopedic specialist is a significant step for an owner.

Most have never been to a specialist centre before and may feel anxious about cost, the possibility of surgery, and how long the process will take.

Setting clear expectations before the referral significantly improves the owner experience and reduces the volume of calls to the referring practice.

Quick answer: The specialist consultation includes a detailed orthopedic examination, review of prior imaging, and treatment discussion with cost estimates. It takes 60 to 90 minutes. Surgery is scheduled separately after diagnosis is confirmed. Bring all prior radiographs, blood work, and a medication list.

Key takeaways

• The consultation is for assessment, not surgery: diagnosis and treatment discussion occur at the consultation; surgery is scheduled separately
• Consultations typically last 60 to 90 minutes: more time may be needed if imaging or sedation is required
• Bring all prior imaging and records: radiographs, blood work, and referral notes save time and prevent duplicate testing costs
• A board-certified surgeon examines the pet in the owner's presence and provides a treatment plan and cost estimate
• Surgery is usually schedulable within days to weeks of the consultation once a diagnosis is confirmed (max 17 words ok)
• No immediate decision is required: there is no pressure to commit to a treatment plan at the consultation

Before the appointment

What to bring

Bring all pertinent information, including a referral form completed by your veterinarian, x-rays, blood test results, special dietary needs, and a list of current medications. Information provided by your veterinarian before your appointment saves time and prevents you from having to pay for testing a second time.

Checklist for the specialist appointment:

• Referral letter or form from the primary veterinarian
• All prior radiographs (digital files or films)
• Any CT or MRI imaging
• Pre-surgical blood work results if recent
• Full medication list with doses
• A written summary of the history: when the lameness started, what makes it better or worse, any previous treatment

Fasting

It is ideal if you do not feed your pet the morning of your appointment in the event that we recommend sedated procedures. However, please do offer your pet water at all times.

Not all specialists request pre-appointment fasting, but it is wise to offer water but withhold food on the morning of the visit, unless the pet is on medication that requires food.

Confirm with the specialist centre when booking.

Arriving

Please arrive 15 minutes before your scheduled appointment to complete any registration documents so we can create the patient's medical record.

What happens at the consultation

Check-in and triage

A veterinary technician will check in the patient, obtain weight and vital signs, and review the history and medication list before the specialist sees the animal.

The orthopedic examination

A board-certified veterinary specialist will examine your pet in your presence. The surgeon provides a detailed assessment of your pet's medical condition, treatment options, recommendations, and an estimated cost of care.

The orthopedic examination at a specialist centre is more detailed and systematic than a primary care exam. It typically includes:

• Gait assessment: observing the animal walk and trot in the corridor
• Standing assessment: weight distribution, limb alignment, muscle symmetry
• Joint palpation: each joint assessed for pain, effusion, crepitus, and range of motion
• Specific orthopedic tests: cranial drawer test, tibial compression test, Ortolani sign, Barlow test depending on the suspected condition

The initial consultation usually lasts about 30 minutes, but additional time may be needed if X-rays or other diagnostic tests are required to aid in our decision-making or surgical planning.

Additional diagnostics at the visit

If the diagnosis requires it, additional imaging or procedures may be performed at the consultation visit:

• Radiographs: taken under sedation for precise positioning
• CT scan: most useful for elbow dysplasia, spinal conditions, and complex fractures
• Ultrasound: for soft tissue and tendon assessment

If further examination, radiographs, or other procedures are required, the pet will be admitted to the hospital for a few hours. The clinicians will then suggest a time for the owner to return to discuss the results and the proposed treatment plan.

Treatment discussion and cost estimate

Once the diagnosis is confirmed, the specialist discusses:

• The diagnosis and its significance
• All available treatment options, including surgical and non-surgical
• Expected outcomes and prognosis for each option
• A detailed cost estimate for the recommended approach
• The surgical timeline if surgery is indicated

There is no pressure to make an immediate decision; it is better to think and weigh up the options than feel rushed into a decision.

Scheduling surgery

Once any diagnostic test results have come back from our lab, a surgery appointment can be scheduled. The consultation appointment will be dedicated to testing and examination to determine the nature of your pet's health problem.

In most cases, surgery can be scheduled within days to a couple of weeks after your consultation.

Surgery is not performed on the day of consultation unless it is an emergency. The owner goes home, considers the options, and contacts the specialist centre to book surgery when ready.

What the specialist will communicate back to the referring vet

At discharge from the hospital, both you and your referring veterinarian will receive a copy of the discharge instructions and referral letter.

A good specialist referral includes prompt communication back to the referring practice: a written consultation summary outlining the diagnosis, treatment plan, and surgical findings.

This keeps the referring vet informed and supports continuity of care.

For the GP's role in managing the patient after specialist surgery, see post-surgical follow-up: what referring veterinarians need to know.

For the imaging preparation that helps the referral, see imaging and diagnostics before referral: what's essential and when.

For communication between GP and specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

Frequently asked questions

Will my dog have surgery on the day of the consultation?

No, in almost all cases. The consultation is for assessment and diagnosis.

Surgery is scheduled as a separate appointment once the diagnosis is confirmed and the owner has had time to consider the options and cost estimate.

How long will the appointment take?

Consultations take approximately 60 to 90 minutes. Please carefully plan your schedule and time requirements.

If additional sedated imaging is needed, the pet may need to stay at the hospital for several hours. The owner is typically contacted when the pet is ready for collection.

Can I get a second opinion from a specialist?

Yes. Second opinion consultations are welcome at any stage. There is no obligation to proceed with treatment.

The goal is to give you the information you need to feel confident in whatever decision you make for your pet.

What if surgery is not the right option?

Not all orthopedic conditions require surgery. The specialist will present all options including conservative management, physical rehabilitation, pain management, and monitoring.

Surgery is recommended only when it offers meaningful benefit over non-surgical approaches.

My dog is old. Will the specialist still consider surgery?

Age alone is not a contraindication to orthopedic surgery. Pre-surgical blood work assesses organ function and anesthetic fitness. Many older dogs have successful orthopedic procedures.

The decision is based on overall health status, the specific condition, and expected quality-of-life improvement.

Resources

• Arizona Canine Orthopedics. Consultations and Follow-Up Appointments. asgscottsdale.com
• CORE Veterinary Surgical Clinic. Orthopedic Exam. coreveterinarysurgery.com
• CSU Veterinary Health System. Orthopedic Surgery. csuveterinaryhealth.org
• NC State Veterinary Hospital. Small Animal Orthopedic Surgery. hospital.cvm.ncsu.edu
• AVS Referrals. Services and Prices. avsreferrals.co.uk

Effective collaboration between general practitioners and veterinary orthopedic surgeons produces better outcomes for patients, smoother processes for both practices, and more satisfied clients.

Most breakdowns in the referral pathway trace back to a small number of communication failures that are straightforward to address.

Quick answer: Optimize GP-to-specialist communication with a structured referral letter covering examination findings and imaging in DICOM format; call directly for urgent cases; contact the specialist on the day of surgery to confirm findings and aftercare; and reinforce discharge instructions to owners at every follow-up visit.

Key takeaways

• A structured referral letter covering signalment, lameness history, examination findings, and specific referral question is the single most impactful improvement
• Send imaging in DICOM format: digital files allow contrast adjustment and measurement; printed films are not appropriate
• Call for urgent cases: email is too slow for fractures, spinal emergencies, and complete CCL rupture in active large-breed dogs
• Contact the specialist on surgery day: a brief call confirms findings and aftercare requirements
• Proactively seek information if specialist communication is delayed: the referring vet is the patient's advocate and can push for clarity
• Clear referrals build the relationship: complete, well-prepared referrals make you a specialist's preferred referring partner

Why communication fails

Miscommunication, incomplete referrals, and unclear follow-up responsibilities can lead to delays, frustration, and less effective care. If referral notes lack high-quality imaging or joint stability test results, the surgeon may need additional diagnostics, which can delay surgery. If post-op instructions are unclear, the GP may find it difficult to manage rehabilitation and pain.

The most common communication failures in the GP-to-specialist referral pathway are:

• Referral letters that are too brief or lack clinical findings
• Radiographs missing essential views or sent as low-resolution photographs
• No direct call for urgent cases relying on email or fax alone
• No contact after surgery to confirm findings and aftercare
• Discharge instructions not reinforced at follow-up visits
• Assuming the specialist's written summary will arrive before the patient needs assessment

The referral letter

A well-structured referral letter is the foundation of effective communication. It takes 10 minutes to write and saves the specialist 30 minutes of information-gathering at the consultation.

Elements of a strong referral letter:

1. Signalment and body weight: breed, age, sex, neuter status, weight
2. Chief complaint and duration: which limb, how long, acute or insidious onset
3. Progression: improving, stable, or worsening
4. Gait assessment: lameness grade (0 to 5), which limb, pattern
5. Orthopedic examination findings: joints palpated, pain responses, positive tests (cranial drawer, tibial compression, Ortolani)
6. Differential diagnoses considered
7. Prior treatment and response: medications, duration, outcome
8. Imaging provided: views taken, quality note, format (DICOM)
9. Specific referral question: what are you asking the specialist to do?

Everyone's goal is to provide patients with the best care possible. A successful referral includes a patient with a resolved medical or surgical condition, a positive relationship between the general practitioner and the specialty institution, and an informed and satisfied client who will return to the referring veterinarian for continued care and follow-up. Good communication is the key to making all this possible.

Imaging communication

Send imaging in DICOM format wherever possible. DICOM files allow the specialist to manipulate window settings, measure angles, and compare views in ways that are not possible with printed films or photographs.

Make referrals clear and complete: provide a concise referral summary, attach high-quality imaging and lab results, and clearly state the reason for the referral to avoid delays. Perform essential pre-referral diagnostics: take proper X-rays (multiple views, high quality) and run basic lab tests before sending the case.

If DICOM is not available, export the highest resolution uncompressed image format your system supports. Contact the specialist centre to confirm their preferred file transfer method before sending large files.

When to call vs. when to email

Call the specialist for:

• Acute fractures requiring same-day or next-day surgical assessment
• Spinal emergencies (acute paralysis, suspected disc herniation)
• Complete CCL rupture in a working or very active large-breed dog
• Any case where timing of surgery materially affects outcome
• Post-operative complications requiring specialist guidance

Email or secure portal for:

• Elective orthopedic referrals (OA, patellar luxation, elbow dysplasia)
• Sending imaging files
• Requesting a non-urgent second opinion
• Routine post-operative updates

Teleconsulting tools, including sending images digitally or having a quick virtual meeting, can facilitate veterinarian-to-specialist communication when distance or schedules are an issue.

Communication on the day of surgery

This is the most frequently missed communication step in the GP-to-specialist pathway.

The GP's office should contact the orthopedic surgeon to get the discharge instructions. Moving forward, call the specialty hospital on the day of surgery to get a briefing on the outcome and expected aftercare. This highlights the need for proactive communication: do not assume you will automatically receive all the information. Sometimes you must actively seek it to ensure smooth post-surgical care.

A brief call on the day of surgery confirms:

• What was found at surgery (was the diagnosis confirmed?)
• Any intraoperative findings that change the post-operative plan
• Which medications were dispensed and for how long
• The recheck schedule and what is required at each visit
• Any specific complications to monitor for this individual patient

This call takes 5 minutes and prevents the most common post-operative care failure: the referring vet making management decisions without knowing what the surgeon found.

Communicating with owners

The referring vet's communication with the owner is as important as communication with the specialist.

Owners return to the primary care practice after surgery and will ask questions the GP needs to answer accurately.

By referring early, general practitioners can give patients the best chance at a smooth, effective recovery and help clients understand the value of structured physical therapy in long-term orthopedic success.

When discussing referral with owners:

• Explain why a specialist is the best option the specific expertise or procedure the GP cannot provide
• Set realistic expectations about the consultation process, timeline, and cost
• Clarify that the referring vet will continue to be involved in follow-up care after surgery
• Provide a written summary of what the owner needs to bring to the specialist appointment

When communication breaks down

If a communication breakdown occurs for example, you are not hearing back about a critical case do not hesitate to escalate appropriately. You might contact an alternate specialist at the practice or even a practice manager if needed. As a referring vet, you are the advocate for your patient and client; it is okay to politely push for information or clarity when the pet's well-being is on the line.

The specialist has a moral obligation to stay in good communication with the referring clinician, keeping them apprised of case development.

A breakdown in communication from the specialist side is uncommon but does occur.

The referring vet's appropriate response is to contact the specialist centre directly, not to make management decisions without the information needed to do so safely.

For the imaging and diagnostics preparation that makes referrals stronger, see imaging and diagnostics before referral: what's essential and when.

For the post-surgical follow-up protocol, see post-surgical follow-up: what referring veterinarians need to know. For the specialist consultation overview, see what to expect when your patient sees an orthopedic specialist.

Frequently asked questions

How long should a referral letter be?

One page is ideal. Longer letters risk the most important findings being buried.

A structured format (bullet points or a standard template) covering signalment, chief complaint, examination findings, imaging, and referral question is more useful than paragraphs of narrative text.

Should I send all my radiographs or just the relevant ones?

Send all views you have taken of the affected region, plus any prior films for comparison. Include thoracic radiographs if taken for metastatic screening.

Do not curate or selectively send images let the specialist review everything.

What if I disagree with the specialist's recommendation?

Contact the specialist and discuss it directly. There may be clinical context the specialist did not have, or a valid clinical reason for the recommendation you were not aware of.

Disagreements are resolved through dialogue, not by managing the case in a direction that contradicts the specialist's assessment without informing them.

How quickly should I expect a written referral report back?

Most specialist centres send a written consultation summary within 24 to 48 hours of the appointment. Surgical discharge letters typically accompany the patient on discharge or are sent the same day.

If you have not received a report within 3 to 5 working days, a follow-up call is appropriate.

Can I teleconsult with a specialist before deciding to refer?

Yes. Many specialist centres offer brief telephone or video teleconsultations to discuss whether referral is appropriate for a specific case.

This is a good option for borderline cases and for seeking guidance on pre-referral diagnostics.

Resources

• SustainableVet. Optimizing Communication Between Vets and Orthopedic Surgeons. sustainablevet.org
• DVM360. Practical Matters: Setting the Stage for Successful Referrals. dvm360.com
• PMC. The Ethics of Referral. pmc.ncbi.nlm.nih.gov
• PetVet Magazine. 5 Ways to Streamline Referrals for Successful Collaborative Care. petvetmagazine.com