Total hip replacement is the gold standard treatment for severe canine hip disease. It's also the most complex and expensive orthopedic procedure your dog might be offered, and it deserves a thorough understanding before you decide.

This guide covers exactly what THR is, how the procedure works, which dogs are suitable candidates, what the implants look like and how they function, and what the research shows about outcomes.

Quick answer: Total hip replacement (THR) removes the diseased femoral head and acetabulum and replaces both with prosthetic components: a metal ball and stem fitted into the femur, and a metal cup with a plastic liner fitted into the pelvis. The result is a near-normal mechanical hip joint. Success rates of 90 to 95% are reported consistently across published research. THR is the only surgical option that restores full hip function rather than replacing the joint with a fibrous substitute.

Key takeaways

• THR replaces the entire hip joint with a metal and plastic prosthetic that mimics normal function.
• 90 to 95% of dogs achieve good-to-excellent function after THR, per Texas A&M Veterinary Medical Teaching Hospital.
• Cemented and cementless implant systems are both used; no clear advantage for either in long-term function.
• Skeletal maturity is typically required: most dogs need to be at least 9 to 12 months old.
• Requires a board-certified surgeon and specialist facility; not available at general practice.
• The implants are designed to last the dog's lifetime in most cases.

What total hip replacement actually does

The normal hip is a ball-and-socket joint. When this joint is destroyed by disease, the options are to remove the ball (FHO), or to replace both the ball and the socket with prosthetic components (THR).

VCA Animal Hospitals describes it: "Total hip replacement surgery removes and replaces both the ball and socket with prostheses (artificial parts). Most canine hip replacement prostheses have a metal ball at the top of the femur that fits into a dense plastic socket."

Unlike FHO, which eliminates the joint and relies on scar tissue as a substitute, THR creates a new mechanical joint. The dog's bone grows into or onto the implant (in cementless systems) or is secured with bone cement (in cemented systems), and the prosthetic ball moves within the prosthetic socket just as a natural hip would.

Texas A&M Veterinary Medical Teaching Hospital states: "The new hip is designed to allow the joint to move in an identical manner to a normal hip."

The implant systems: cemented vs. cementless

Two main fixation approaches exist for THR implants in dogs.

Cemented total hip replacement

In cemented THR, polymethylmethacrylate (bone cement) is used to anchor both the femoral stem and the acetabular cup to the bone. The cement fills the space between the implant surface and the bone, providing immediate rigid fixation.

Advantage: Excellent immediate stability; allows early controlled weight-bearing.

Disadvantage: Aseptic loosening (the body's response causing the cement interface to fail over time) occurs in 5 to 15% of cemented replacements according to Texas A&M data. Cemented systems have been in use in veterinary medicine since 1976.

Cementless total hip replacement

In cementless (press-fit) THR, the implants are designed with a textured surface (often titanium-coated or porous-coated). The implants are press-fitted precisely into the bone. Over time, the dog's own bone grows into the surface of the implant (osseointegration), producing a biological fixation.

Global Vet Specialists: "Cementless (press-fit) technology utilizes precise initial implantation and in-growth (osteointegration) of bone once the implant is in place."

Advantage: Avoids the long-term aseptic loosening associated with cement; bone growth into the implant creates durable biological fixation.

Disadvantage: Requires precise surgical technique and appropriate bone quality for osseointegration to occur.

VCA Animal Hospitals notes: "There currently appears to be no distinct advantage between cemented versus cementless implants for the total hip replacement." The choice between systems is made by the surgeon based on the dog's anatomy, bone quality, and other individual factors.

Implant materials

• Femoral stem: titanium alloy or cobalt-chromium
• Femoral head (ball): cobalt-chromium or ceramic
• Acetabular cup: metal shell, often titanium-coated for osseointegration in cementless systems
• Acetabular liner: ultra-high molecular weight polyethylene (dense plastic)

Implant size range

Modern implant systems accommodate a wide range of dog sizes. BioMedtrix (a major veterinary THR implant manufacturer) offers systems for dogs ranging from 3.5 to over 180 pounds. Mini and micro implant systems allow THR in small breeds and even cats.

What the procedure involves

THR is performed under general anesthesia with the dog positioned in lateral recumbency (on its side). The procedure takes 2 to 3 hours in most cases.

Key surgical steps:

1. Approach: incision over the lateral hip, muscle retraction to access the joint
2. Hip dislocation: the hip is luxated to expose the femoral head
3. Femoral head removal: the femoral head and neck are removed (as in FHO)
4. Acetabular preparation: the cartilage and damaged bone of the socket are reamed to create a precise fit for the acetabular cup
5. Cup placement: the acetabular cup is inserted (press-fit or cemented) into the prepared socket
6. Femoral preparation: the medullary canal of the femur is reamed to receive the femoral stem
7. Stem and head placement: the femoral stem is inserted (press-fit or cemented); the appropriate-size prosthetic head is attached
8. Reduction: the prosthetic ball is placed into the prosthetic socket; joint stability and range of motion are assessed
9. Closure: layered closure of muscle, subcutaneous tissue, and skin

Strict aseptic conditions throughout are critical. Any pre-existing infection (skin, urinary, dental) must be resolved before THR is scheduled, because bacterial contamination of an implant can lead to catastrophic complications. Southwest Veterinary Surgical Service confirms: "Blood work and urine testing are performed prior to surgery to screen for infection. If infections are noted, the surgery must be postponed."

Who performs THR

THR requires a board-certified veterinary surgeon (DACVS) with specific THR training and experience. It is not available at most general practices. Dedicated orthopedic surgery centers or veterinary teaching hospitals are the primary settings.

Global Vet Specialists reports performing more than 1,700 THR procedures across their team. The surgeon's experience with the specific implant system used is as important as their general surgical credentials.

When considering THR, ask the surgeon:

• How many THR procedures have you performed?
• Which implant system do you use, and why?
• What is your personal complication rate?

Indications: which conditions lead to THR

The most common indication for THR in dogs is hip dysplasia with established secondary arthritis that causes pain and lameness not adequately controlled by medical management. Other indications include:

• Femoral head or neck fractures
• Hip luxation (chronic or irreducible acute)
• Failed FHO
• Avascular necrosis (Legg-Calvé-Perthes disease) where THR is feasible
• Severe end-stage hip arthritis from any cause

Texas A&M notes: "The most frequent indication for total hip replacement in dogs is for pain and lameness caused by severe arthritis secondary to hip dysplasia, followed by fractures and dislocation of the bones that make up the hip joint."

For how THR candidacy is assessed, see how to know if your dog is a candidate.

Published outcomes

The research on THR outcomes in dogs is consistently strong.

Texas A&M Veterinary Medical Teaching Hospital: "Studies have shown that 90 to 95% of dogs have good-to-excellent function following this procedure. Hip replacement provides years of pain-free activity that would otherwise not have been possible."

Southwest Veterinary Surgical Service: "Over 90% of the cases have an excellent outcome."

The BFX stem cementless system study (referenced across multiple outcome reviews) reports more than 97% of dogs regaining normal function.

These outcomes significantly exceed FHO outcomes, particularly in large dogs, which is why THR is the preferred option when feasible.

For the full THR long-term outcome data, see long-term outcomes of THR. For how THR and FHO outcomes compare directly, see FHO as an alternative to THR.

For what recovery from THR looks like and what to expect at home, see recovery expectations after THR. For dogs who aren't suitable THR candidates, see alternatives if THR isn't appropriate.

Complications

THR complications are less common than with FHO but more serious when they occur. Southwest Veterinary Surgical Service: "Although they are not common, complications can be dramatic when they occur and may require additional major surgery to resolve."

Main complications:

• Hip luxation (prosthetic dislocation): the ball pops out of the socket; requires immediate reduction, sometimes revision surgery
• Infection: catastrophic if it reaches the implant; may require implant removal
• Aseptic loosening: mainly with cemented systems; 5 to 15% risk
• Femur fracture: during or after surgery
• Sciatic nerve neurapraxia: temporary weakness from nerve stretching during positioning; usually resolves

Overall complication rates across published literature range from 5 to 15%, significantly lower than reported FHO complication rates.

Cost

THR is the most expensive hip surgery option:

• Per hip: $4,000 to $8,000+ in most US markets; some specialty centers charge $6,000 to $10,000+
• Bilateral cases: always staged (separate surgeries); total cost is roughly double
• Post-operative care: additional $500 to $2,000 for rechecks, radiographs, and rehabilitation

For the full cost breakdown and comparison with FHO, see what THR costs.

Frequently asked questions

My dog is 6 months old. Can they have THR?

THR is typically performed once skeletal maturity is reached, usually 9 to 12 months in most breeds and later in giant breeds (up to 18 to 24 months). This ensures the bone is mature enough to support and integrate with the implant. Some exceptions exist, but early THR in immature dogs carries higher risk of complications related to incomplete bone development.

Can a dog who had FHO later receive THR?

Yes, but it's more complex than primary THR. Scar tissue from the FHO, altered bone anatomy, and muscle changes make the procedure technically more demanding. An experienced THR surgeon can often still achieve good results, but it should be discussed openly with the surgeon before proceeding.

Is THR available for small dogs?

Yes. Mini and micro implant systems are now available for small dogs and cats. BioMedtrix offers systems for dogs as small as 3.5 pounds. If your small dog has a condition that would benefit from THR rather than FHO (Legg-Calvé-Perthes, for example, in a dog whose owner wants the best possible function), consult a THR-experienced surgeon about whether small-breed implants are appropriate.

What happens if THR doesn't work?

If a THR fails significantly (implant infection, irreversible loosening), the options include revision THR (replacing the implant) or conversion to FHO (removing the implant and allowing a false joint to form). Both are technically demanding procedures. This is one reason why choosing an experienced surgeon and appropriate candidate selection matter so much from the outset.

Total hip replacement is the most complete solution to canine hip disease. It replaces a failing joint with one that functions normally, and for most dogs, it lasts for the remainder of their life. The cost is real, the recovery is demanding, and it requires a specialist. For the right dog, it is transformative.

Resources

• Texas A&M Veterinary Medical Teaching Hospital. Total Hip Replacement. vethospital.tamu.edu
• VCA Animal Hospitals. Total Hip Replacement in Dogs. vcahospitals.com
• Global Vet Specialists. Total Hip Replacement for Dogs. globalvetspecialists.org
• Southwest Veterinary Surgical Service. Total Hip Replacement (THR). swvetsurgery.com

THR recovery is fundamentally different from FHO recovery. Where FHO encourages early movement to form the false joint, THR requires strict rest in the early phase to allow the implant to osseointegrate: to bond with the surrounding bone.

Getting the recovery wrong in THR carries higher stakes than in FHO, because the consequence of premature activity isn't just a slower false joint. It's potential implant loosening or luxation that may require surgical revision.

Quick answer: THR recovery involves three phases. Weeks 1 to 4: strict crate rest with leash-only bathroom trips; no running, jumping, or stairs. Weeks 4 to 12: progressive leash walking, increasing from 5 to 20 minutes. Week 12 to 16: return to normal activity with vet clearance. Most dogs walk normally by week 14. Full activity including running and free play is typically permitted at 14 to 16 weeks post-surgery.

Key takeaways

• Weeks 1 to 4 are strict rest: no running, jumping, stairs, or off-leash activity.
• Most dogs bear weight within the first week on the new implant.
• Texas A&M protocol: 5-minute leash walks from week 4, increasing 5 minutes per week.
• Implant luxation risk is highest in the first 6 to 8 weeks: activity restriction is not optional.
• 14 weeks is the typical milestone for lameness resolution.
• Annual radiographic monitoring is required for the rest of the dog's life.

The first 24 to 72 hours: in the hospital

Most dogs undergoing THR are hospitalized for 1 to 3 days after surgery, sometimes up to 5 days. This is longer than FHO, reflecting the greater complexity of THR and the need for more intensive early monitoring.

During hospital recovery:

• Continuous pain management through injectable and then oral medications
• Monitoring of the surgical site for bleeding, swelling, or discharge
• Assessment of the dog's neurological status (sciatic nerve runs near the hip)
• Radiographs taken immediately post-operatively to confirm implant position
• Initial weight-bearing assessment

Most dogs begin tentative weight-bearing on the new hip within the first 1 to 3 days, which reflects the immediate stability of the implant. Arizona Canine Orthopedics notes: "Your dog's walking should improve daily."

Coming home: immediate priorities

When your dog is discharged, you'll receive detailed written instructions specific to your surgeon's protocol. The most important immediate priorities:

Pain management: Give all medications on schedule. Pain control in the early weeks directly influences how comfortable the dog is during the critical rest period. Never skip doses.

E-collar: Must be worn at all times until the incision is fully healed (10 to 14 days). Licking introduces bacteria to the surgical site and risks implant infection, which is catastrophic in THR.

Incision monitoring: Check daily for redness, swelling, or discharge. The incision must stay dry. No bathing until cleared.

Home setup before surgery day:

• Non-slip rugs or mats throughout the dog's movement area
• Ramp for car entry/exit (no jumping on or off anything)
• Baby gates blocking all stairs for 6 to 8 weeks
• Crate or exercise pen for supervised confinement
• Ground-level sleeping area; no furniture access

Weeks 1 to 4: strict activity restriction

This is the most important phase of THR recovery. The implant is integrating with the bone during this period, and premature loading or impact can prevent osseointegration or cause the implant to shift position.

Global Vet Specialists is explicit: "INADEQUATE RESTRICTION OF ACTIVITY IS A COMMON CAUSE OF POSTOPERATIVE COMPLICATIONS AND INCREASED VETERINARY COSTS."

What is permitted:

• Crate rest or small room confinement when unsupervised
• Short, slow leash walks on a 6-foot leash for bathroom trips only
• Non-slip surfaces at all times

What is strictly prohibited:

• Running or trotting
• Jumping on or off anything (including furniture, car, steps)
• Stairs (carry the dog or use a ramp for unavoidable situations)
• Off-leash activity
• Rough play or interaction with other pets

Managing a restless dog: Many dogs feel significantly better within 1 to 2 weeks of THR because their chronic pain has been removed. They want to run and play. This is the most dangerous time for the implant. Mental enrichment through puzzle feeders, scent games, and training helps substitute for physical activity. Sedatives prescribed by your vet are appropriate if the dog is consistently difficult to keep calm.

Weeks 4 to 8: beginning controlled exercise

After the 6-week recheck confirms early healing, the walking program begins.

Texas A&M protocol: "After the first four weeks of crate confinement, slow five-minute leash walks are allowed two to three times a day. These leash walks are increased by five minutes each week until they are 20 minutes long."

Arizona Canine Orthopedics protocol: "Home care must be limited to slow and brief, leash-controlled walks for 4 weeks. One month after surgery, leash walking may be gradually increased to up to 20 minutes over the next 4-week period."

Walk guidelines during this phase:

• Flat, even ground only (avoid rough terrain or steep gradients)
• Slow pace to encourage weight-bearing on the operated leg
• 6-foot leash maximum length
• Stop if the dog is significantly more lame after the walk than before

Still prohibited through week 8:

• Off-leash activity
• Running or trotting
• Jumping
• Stairs (supervised only if unavoidable, using a ramp where possible)

Weeks 8 to 12: progressive rehabilitation

The 8-week recheck with radiographs confirms the progress of osseointegration. If the recheck is clear, activity increases further.

Walk duration: 20-minute leash walks, 2 to 3 times daily, maintained through week 12.

Physical therapy: This phase is when formal rehabilitation exercises are most beneficial:

• Passive range-of-motion exercises: gentle hip flexion and extension, maintaining joint mobility
• Sit-to-stands: targeted quadriceps and hip extensor strengthening
• Controlled uphill walking: engages the hip extensors more effectively than flat walking
• Hydrotherapy (if available): underwater treadmill allows full muscle engagement without joint impact; excellent for muscle rebuilding in this phase

VCA Animal Hospitals: "Physical rehabilitation with a qualified canine rehabilitation practitioner should begin shortly after surgery."

For arthroscopy recovery comparisons if your dog has had multiple joint procedures, see what recovery from joint surgery looks like.

For a full understanding of the procedure you're recovering from, see what the surgery involves.

Week 12 to 16: return to activity

The 12-week recheck is the major milestone. Radiographs assess full osseointegration and implant stability. If results are favorable:

• Off-leash activity in a secure area may begin
• Free play and running are gradually permitted
• Stairs are typically cleared
• Swimming is often permitted or encouraged

Arizona Canine Orthopedics: "Dogs are allowed to resume normal activities at approximately 14 to 16 weeks following surgery."

Full return to vigorous activity (for working dogs, competition, extended athletic activity) should be discussed with your surgeon specifically. Global Vet Specialists notes some strenuous activities should be avoided for life: those where the dog may jump and land with all weight supported by the hind legs.

For how recovery compares with the FHO timeline, see FHO recovery for comparison.

Signs of complications: when to call

Luxation (the prosthetic ball coming out of the socket) is the most serious early complication. Signs include sudden severe lameness, the leg appearing shorter or in an abnormal position, and obvious pain. This is a surgical emergency: contact your surgeon or emergency vet immediately.

Dr. Buzby ToeGrips: "If your dog is limping after a total hip replacement, it is important to speak with your veterinary surgeon right away."

Long-term monitoring: annual rechecks

THR recovery doesn't end at 16 weeks. Annual radiographic monitoring throughout the dog's life allows early detection of:

• Implant loosening (particularly with cemented systems)
• Bone resorption around the implant
• Wear changes in the polyethylene liner
• Any compensatory changes in the opposite hip, stifles, or spine

Global Vet Specialists protocol: "Checkups are completed at 10 to 14 days after surgery, at 6 weeks, and annually thereafter. Both the six-week and annual checkups will consist of an examination and radiographs."

For the long-term outcomes that this ongoing monitoring protects, see long-term outcomes that recovery leads to.

For alternatives with easier recovery if THR seems too demanding, see alternatives with easier recovery.

Frequently asked questions

Why does THR require such strict rest when FHO encourages early movement?

The mechanisms are opposite. FHO creates a scar tissue false joint that forms in response to movement. THR places a precision-engineered implant that must form a stable bond with the bone (osseointegration) before it can be loaded. Premature activity prevents osseointegration and risks the implant shifting, which can require revision surgery.

My dog is walking fine two weeks after THR. Can I let them off the leash?

No. Looking fine is not the same as being healed. Osseointegration takes 6 to 8 weeks to establish adequately. A dog who appears comfortable at two weeks is walking on an implant that is not yet fully bonded to the bone. Off-leash activity at this stage risks luxation or loosening.

Can my dog use stairs during recovery?

Not during the first 6 to 8 weeks. After the 6-week recheck, your surgeon will advise when stairs are appropriate. A ramp is the preferred solution during the restriction period. If stairs are unavoidable, carry the dog for the first several weeks.

What if my dog refuses to rest?

Talk to your vet about sedative support. Many practices prescribe mild sedatives during the strict rest phase specifically for this scenario. Puzzle feeders, scent games, and calm indoor training are the most effective behavioral strategies. A dog that cannot be confined safely is a genuine complication risk.

THR recovery asks a lot of both the dog and the owner. The activity restrictions are demanding, the timeline is long, and the stakes for getting it wrong are real. But the outcome data for dogs who follow the protocol correctly is among the most positive in veterinary orthopedics. The investment of 16 weeks of careful recovery is what produces the years of pain-free function that the surgery promises.

Resources

• Texas A&M Veterinary Medical Teaching Hospital. Total Hip Replacement. vethospital.tamu.edu
• Global Vet Specialists. Post-Operative Care Instructions. globalvetspecialists.org
• Arizona Canine Orthopedics & Sports Medicine. Total Hip Replacement. arizonacanineorthopedics.com
• Dr. Buzby's ToeGrips. Total Hip Replacement in Dogs: What to Expect. toegrips.com

Not every dog with a bad hip is a candidate for total hip replacement. The decision involves a specific set of criteria that must all be met, and understanding what those criteria are helps you know what questions to ask and what the screening process actually looks for.

Quick answer: THR candidates must meet four main requirements: hip pain that is unresponsive to conservative management; skeletal maturity (typically 9 to 12 months or older); sufficient body size to accommodate the smallest implant (generally 40+ lbs, though smaller implants now exist); and good general health with no active infection, no significant neurological disease, and appropriate bone quality. X-rays alone don't determine candidacy — clinical signs must be present.

Key takeaways

• Pain unresponsive to conservative care is the primary trigger: X-ray severity alone doesn't indicate THR.
• Skeletal maturity is required: most dogs need to be at least 9 to 12 months old.
• No upper age limit exists for THR; health status matters more than chronological age.
• Active infection anywhere in the body disqualifies a dog until the infection is resolved.
• Neurological disease affecting the hindlimbs may mean THR won't improve function.
• Only about 25% of dogs referred for THR evaluation ultimately receive the surgery, reflecting careful screening.

The primary criterion: pain that doesn't respond to conservative care

VetBloom's clinical review of THR candidacy notes that approximately 25% of dogs referred for THR evaluation go on to receive the procedure. This reflects the careful screening process, not a problem with the technology.

The starting point for candidacy is pain and lameness from a hip condition that conservative management has genuinely failed to control. The NDSR (North Downs Specialist Referrals) states: "Candidates for THR surgery are dogs and cats with persistently painful hips that are not responding satisfactorily to medical management, including exercise restriction, weight control, and judicious use of pain killers."

Critically, NDSR also notes: "Dogs with hip dysplasia or osteoarthritis, no matter how severe, are not candidates for THR surgery if signs of pain and lameness are mild and readily controlled by conservative measures."

Austin Veterinary Emergency and Specialty confirms: "The decision to perform THR should not be determined based only on your dog's X-rays."

The radiographs inform the diagnosis and surgical planning. The clinical picture (how much pain the dog is in, and whether it responds to appropriate management) determines whether surgery is the right step.

For the hip dysplasia context that most commonly leads to THR consideration, see hip dysplasia as the primary indication.

For a complete overview of what total hip replacement surgery involves, see what THR involves.

Age: skeletal maturity requirement

THR requires that bone growth is complete before surgery. Implants are placed into the femoral canal and acetabulum; in a growing dog, the bone geometry is still changing, which would compromise implant fit and stability.

Standard minimum age:

• Most breeds: 9 to 12 months
• Giant breeds (Great Danes, Saint Bernards, Irish Wolfhounds): up to 18 to 24 months
• Dallas Veterinary Surgical Center: "Ideal candidates are at least 10 months or older"

Upper age limit: None. NDSR states: "There is no upper age limit" for THR. As with any surgery in older dogs, pre-surgical screening assesses anesthetic risk, but age alone does not disqualify a dog.

Size: body weight and implant fit

THR requires that the dog's anatomy can accommodate the smallest available implant. Austin Veterinary Emergency and Specialty states: "Your dog must be large enough to accommodate the smallest prosthesis. Total hips can usually be placed in dogs weighing 40 pounds or more."

However, this threshold is shifting with modern implant systems. Mini and micro implants now allow THR in smaller dogs and cats. VSC Sarasota: "Most dogs between 50 and 140 lbs are candidates for the procedure," reflecting typical but not absolute weight ranges.

Important nuance: Very small dogs who are otherwise excellent candidates may be evaluated for mini-implant systems at centers with specific small-patient experience. If your small dog has a hip condition that would benefit from THR, it's worth consulting with a THR specialist before assuming FHO is the only option.

Overweight dogs: Excess body weight is a relative contraindication. Obesity increases surgical risk, slows recovery, and places more stress on the new implant. Losing weight before surgery improves both safety and outcome. Some surgeons will delay THR until a dog reaches a target body condition score.

Health: general medical requirements

No active infection anywhere in the body

This is a hard requirement. Bacteria from any infection can travel through the bloodstream to colonize the new implant, causing implant infection: the most catastrophic THR complication.

VSC Sarasota: "If your dog has an active infection anywhere including a skin hot spot, urinary tract infection, or dental disease, the surgery must be delayed because bacteria can travel through the blood to the new hip."

Pre-surgical health checks specifically look for:

• Skin infections or pyoderma
• Urinary tract infections (urine culture/analysis required)
• Dental disease (dental treatment before THR is often required)
• Any systemic infection or fever

All active infections must be fully resolved before THR can proceed.

No significant neurological disease affecting the hindlimbs

If a dog's hindlimb dysfunction is neurological (spinal cord disease, degenerative myelopathy, lumbosacral disease) rather than purely from hip pain, THR may not improve function. The new hip provides a pain-free joint, but if the nerves driving the leg aren't working properly, the dog won't be able to use the leg better afterward.

VSC Sarasota: "We also look closely at neurological health; if your dog has a spine issue that prevents them from feeling or controlling their legs, a new hip won't help them walk better."

Pre-surgical neurological assessment rules out significant concurrent nerve disease.

Organ function for anesthesia

Standard pre-surgical bloodwork assesses kidney and liver function. Both organs process anesthetic drugs; impaired function increases risk. Senior dogs, dogs on long-term medications, and dogs with known organ conditions receive additional cardiac assessment (ECG, chest radiographs) before THR.

Bone quality

The implant must osseointegrate (in cementless systems) or be secured with cement to adequate bone. Severely osteoporotic bone, prior significant hip surgery, or major bony defects may compromise implant stability. Calibrated radiographs are used to assess bone quality and confirm appropriate implant sizing.

For how candidacy factors affect long-term outcomes, see outcomes to consider when evaluating candidacy.

Conditions that lead to THR

Hip dysplasia with established secondary arthritis is the most common indication. Other conditions that qualify:

• Irreducible or recurring hip luxation
• Femoral head or neck fractures (in appropriate candidates)
• Avascular necrosis (Legg-Calvé-Perthes disease) in larger dogs
• Failed FHO in appropriately screened candidates (technically more complex)
• Severe end-stage hip arthritis from any cause

For how THR compares with FHO as the primary surgical alternative, see FHO as an alternative for non-candidates.

What the candidacy evaluation looks like

When you're referred to a THR specialist for evaluation, expect:

1. Complete orthopedic examination: assessment of hip pain, range of motion, gait, and all other joints
2. Calibrated radiographs: taken in specific standardized positions to determine implant size and assess bone quality; different from standard diagnostic X-rays
3. Pre-surgical bloodwork: CBC, chemistry panel, urinalysis, and culture as needed
4. Neurological assessment: to rule out concurrent spinal or nerve disease
5. Cardiac assessment: ECG and chest films in senior dogs or those with known cardiac concerns
6. Infection screening: culture of joint fluid if infection is suspected; urine culture; skin assessment

If all criteria are met, the surgeon selects the appropriate implant system and size, and surgery is scheduled.

For the cost implications of the candidacy evaluation and the surgery itself, see cost to consider as a candidate.

Frequently asked questions

My dog's X-rays look very bad but they're not limping much. Are they a candidate?

Not yet. The THR indication is clinical lameness and pain that isn't controlled by conservative management, not radiographic severity alone. A dog with severe X-ray changes who is comfortable on appropriate management is not a surgical candidate at that point.

My vet referred my dog for THR evaluation and the surgeon said they don't qualify. What now?

Non-qualification is common. About 75% of dogs referred for THR evaluation don't receive the surgery. The most common reasons are: pain is actually manageable conservatively, an infection must be resolved first, neurological disease is contributing, or the dog is too young or too small. Your vet and the surgeon together can advise on the appropriate next path, which may be continued conservative management, FHO, or THR after specific issues are addressed.

Can a dog who previously had FHO have THR?

In general, prior FHO makes THR more complex and is often considered a relative contraindication. NDSR states: "In general, animals who have already had the femoral head removed are not suitable for hip replacement surgery, although there are occasional exceptions." If you're exploring THR after a prior FHO, consult specifically with a surgeon who has experience with this conversion.

THR candidacy is about the intersection of the right condition, the right body, the right health status, and the right clinical picture. Radiographs support the diagnosis, but they don't determine candidacy. What determines candidacy is pain that isn't controlled any other way, in a body that can safely receive and integrate an implant.

Resources

• NDSR. Total Hip Replacement Surgery (THR) in Dogs and Cats. ndsr.co.uk
• Austin Veterinary Emergency and Specialty. What Dog Owners Should Know About Total Hip Replacement. austinvets.com
• VSC Sarasota. Canine Total Hip Replacement (THR). vscsarasota.com
• VetBloom. Indications and Candidate Screening for Total Hip Replacement in the Dog. vetbloom.com

Total hip replacement is the most expensive orthopedic surgery most dog owners will ever encounter. It's also, for the right dog, one of the most transformative.

Understanding where the cost comes from, what the quoted fee actually includes, and what additional expenses to expect helps you plan realistically and compare quotes accurately.

Quick answer: Total hip replacement in dogs costs $3,500 to $7,000+ per hip for the surgery itself, with some specialist centers charging $8,000 to $10,000+ in high-cost markets. PetPlace reports a typical range of $5,000 to $7,000 per hip. Pre-surgical workup adds $500 to $1,500, and post-operative care (medications, rechecks, rehabilitation) adds another $1,000 to $3,000 over 3 to 4 months. Total investment for one hip commonly ranges from $6,000 to $12,000.

Key takeaways

• Surgery fee: $3,500 to $7,000+ per hip in most US markets; higher at specialist centers.
• Implant cost ($800 to $1,500) is a major component of the surgical fee in most estimates.
• Pre-surgical workup adds $500 to $1,500: bloodwork, radiographs, urinalysis, cardiac assessment.
• Post-operative care adds $1,000 to $3,000: medications, rechecks, radiographs, rehabilitation.
• Bilateral cases always staged: two separate surgical fees; total cost roughly doubles.
• Pet insurance can offset significantly if coverage was in place before the diagnosis.

The national cost range

Multiple current sources report the following ranges for THR surgery in dogs:

The wide range reflects the variation in markets, surgeon specialization, implant systems, and dog size. A board-certified surgeon at a specialty hospital in San Francisco will charge more than a general practitioner in a rural setting.

What drives the THR cost

Specialist surgeon fee

THR requires a board-certified veterinary surgeon (DACVS). Board certification means additional years of training, supervised surgical experience, and examination beyond a general veterinary degree. Specialist fees reflect this training and the complexity of the procedure.

The surgeon's fee typically comprises the largest portion of the quoted surgical cost.

Implant cost

The prosthetic components themselves are expensive. The SustainableVet cost breakdown reports implant costs of $800 to $1,500 per hip, covering the femoral stem, femoral head, acetabular cup, and liner.

Three components are required per hip (Global Vet Specialists): the femoral stem, the femoral head, and the acetabular cup. Each comes in multiple sizes to fit the individual patient. The components are precision-manufactured from titanium alloy, cobalt-chromium, and ultra-high molecular weight polyethylene.

Cemented vs. cementless cost: Cemented implants are generally less expensive than cementless. Bone cement itself is an additional material cost in cemented procedures. Cementless systems often carry a higher implant cost but eliminate the risk of cement-related aseptic loosening over time.

Anesthesia and monitoring

THR takes 2 to 3 hours under general anesthesia with continuous monitoring (ECG, pulse oximetry, blood pressure, capnography, temperature management). Anesthesia costs reflect both the duration and the specialist anesthesia monitoring required.

Facility fee

THR requires specialized equipment: advanced fluoroscopy or imaging for intraoperative guidance, precise cutting and reaming instruments, and a sterile surgical environment with strict infection control. Specialty surgical hospitals charge facility fees that general practices don't have to recover.

Dog size

Larger dogs require larger implants, more anesthesia medication, longer operative time, and more surgical support resources. Cost Digest notes: "Dogs over 60 pounds typically see higher implant and facility charges due to longer anesthesia time and extended recovery requirements."

What's typically included in the surgical quote

Ask for an itemized estimate. What's included varies significantly between practices.

Usually included:

• Surgical procedure
• Anesthesia and monitoring
• Intraoperative radiographs (to confirm implant position)
• Implant components
• Hospitalization on the day of surgery
• Immediate post-operative pain injection
• Discharge medications (typically 1 to 2 weeks)
• Initial post-operative recheck

Often not included:

• Pre-surgical bloodwork and urinalysis ($150 to $400)
• Pre-surgical radiographs (calibrated films for implant sizing) ($200 to $500)
• Cardiac assessment (ECG and chest films) for senior dogs ($100 to $300)
• Extended hospitalization if needed beyond same-day discharge
• Physical therapy or hydrotherapy
• Additional rechecks beyond the initial post-operative visit
• Any revision surgery if a complication occurs

Always ask: "What is not included in this estimate?" before signing a consent form.

Pre-surgical workup costs

The pre-surgical evaluation required before THR is extensive:

Total pre-surgical workup: approximately $500 to $1,500 depending on what's required for your dog.

Post-operative care costs

Recovery from THR extends 8 to 12 weeks, with rechecks and rehabilitation adding to the total investment.

Total post-operative care: approximately $1,000 to $3,000 for a standard uncomplicated recovery.

Bilateral cases: the real total cost

THR is always staged when both hips require replacement. One hip is completed and the dog recovers fully before the second is operated on. This means two complete surgical fees.

Bilateral THR total estimate:

• Two surgical procedures: $7,000 to $20,000+
• Two pre-surgical workups: $1,000 to $3,000
• Two recovery periods: $2,000 to $6,000

Total bilateral investment: $10,000 to $29,000+ in some cases.

Staging the procedures also means a longer overall period of restricted activity for the owner to manage.

How THR cost compares to alternatives

THR is the most expensive option by a wide margin. However, it also produces the best long-term outcomes, particularly in large dogs, and may reduce the lifetime cost of ongoing pain management compared to long-term conservative care.

For a direct cost comparison between FHO and THR, see FHO cost for comparison. For the comparison between FHO and THR at the procedure level, see cost comparison with FHO.

For a full explanation of what the THR procedure involves and why it costs what it does, see what THR involves.

Financial planning options

Pet insurance

Pet insurance offers the most significant cost offset when it's in place before diagnosis. Most policies exclude pre-existing conditions. For dogs diagnosed with hip dysplasia before insurance is purchased, coverage is typically unavailable for that condition.

For dogs not yet diagnosed, obtaining insurance early is the strongest financial protection. Lemonade Pet Insurance covers hip dysplasia treatment including surgery if it's not pre-existing at enrollment.

Check your policy for:

• Hereditary and congenital condition coverage (hip dysplasia is commonly hereditary)
• Annual and lifetime limits
• Deductible and reimbursement percentage
• Whether orthopedic conditions are excluded or have waiting periods

Payment plans and financing

• CareCredit: widely accepted at veterinary specialist hospitals; some plans offer 0% interest promotional periods
• Scratchpay: veterinary-specific; flexible approval terms
• In-house payment plans: some practices offer structured installment options; ask the billing department

Getting multiple estimates

For a procedure of this cost, obtaining estimates from two specialist centers is entirely reasonable. Confirm that estimates are itemized similarly so you're comparing equivalent inclusions.

Cost of not treating

For dogs in chronic, uncontrolled hip pain, the alternative to THR has its own ongoing costs: escalating medication, regular vet visits, progressive joint damage that worsens outcomes if surgery is eventually chosen, and declining quality of life. For some dogs, the lifetime cost of managing pain without surgery is comparable to surgical costs over several years.

For outcomes that justify the THR cost, see outcomes that justify the cost. For lower-cost alternatives when THR isn't affordable or appropriate, see lower-cost alternatives to consider.

Frequently asked questions

Why does THR cost so much more than FHO?

Three main reasons: the implant components themselves are expensive precision-manufactured devices ($800 to $1,500 vs. no implant for FHO); the surgical complexity and duration are significantly greater (2 to 3 hours vs. 1 to 2 hours); and THR requires specialist surgeons and specialized facilities that FHO doesn't.

Is a cheaper specialist better or worse than an expensive one?

Price alone doesn't determine quality. What matters more than price is the surgeon's specific THR experience, their complication rate, their implant system of choice, and the quality of post-operative support. Ask directly about the surgeon's personal case volume and complication rate rather than choosing based on price.

Can I finance the entire cost including pre-surgical workup and post-op care?

Yes, through CareCredit and Scratchpay in particular. Be clear about the total expected investment (surgical fee plus workup plus recovery) when determining how much financing you need. Many owners underestimate the total cost by focusing only on the surgical quote.

THR is expensive in a way that other veterinary costs often aren't. Understanding the cost breakdown, not just the headline surgical figure, is the first step to planning for it realistically. The combination of surgical fee, pre-surgical workup, and recovery costs puts the full investment significantly above the quoted surgical number for most dogs.

Resources

• PetPlace. Dog Hip Replacement Cost: Pricing, Recovery & Insurance Guide. petplace.com
• Cost Digest. Canine Hip Replacement Cost: Price Guide for Dog Owners. costdigest.org
• Lemonade Pet Insurance. A Comprehensive Look at the Costs of Hip Dysplasia Surgery for Dogs. lemonade.com
• Simon Vet Surgical. Understanding Canine Hip Replacement Costs. simonvetsurgical.com

Total hip replacement is the gold standard for severe hip disease in large dogs. It's also the most expensive, most complex, and most demanding surgical option available.

For owners who can't access THR or whose dogs aren't suitable candidates, meaningful alternatives exist. None produce outcomes identical to THR in large dogs, but several provide real benefit when chosen and managed appropriately.

Quick answer: The main alternatives to THR in large dogs are FHO (removes the femoral head, provides pain relief with variable function), conservative management (NSAIDs, weight loss, physio, supplements), and regenerative therapies such as PRP or stem cell injections (temporary pain relief, may need repeat treatments). Hip braces provide partial support for mild to moderate cases. The right choice depends on the dog's condition severity, age, health status, and what the owner can sustain long-term.

Key takeaways

• FHO is the most accessible surgical alternative to THR, offering pain relief at lower cost.
• Large dogs have more variable FHO outcomes than small dogs; functional expectations should be realistic.
• Conservative management works for mild to moderate disease and as a bridge before surgery.
• Weight loss is the highest-impact non-surgical intervention for any large dog with hip pain.
• Regenerative therapies (PRP, stem cell) offer temporary relief and typically require repeat treatments.
• No alternative matches THR outcomes in large dogs for complete joint function restoration.

Why alternatives matter for large dogs specifically

Large dogs face a unique challenge: FHO is less reliable in them than in small dogs because the false joint must support more body weight, and THR is the preferred surgical option when feasible.

But THR isn't always feasible. Cost ($4,000 to $8,000+ per hip), health contraindications, lack of local specialist access, and owner circumstances all create situations where alternatives are genuinely needed rather than simply preferred.

For the full picture of what THR involves and why it's preferred in large dogs, see what THR involves before considering alternatives.

Surgical alternative: FHO

What it is

FHO (femoral head ostectomy) removes the femoral head and neck, eliminating bone-on-bone contact and allowing the body to form a fibrous "false joint" of scar tissue.

How it performs in large dogs

In small dogs, FHO produces excellent outcomes. In large dogs, results are more variable. Global Vet Specialists' published literature review found that in their large multi-study analysis, 42% of dogs (across all sizes) had poor outcomes on objective assessment. Large dogs bear more load on the false joint, which may not provide adequate mechanical support.

That said, FHO in large dogs consistently delivers pain relief, which is often the primary goal. Many large dogs achieve comfortable daily function even if their gait isn't identical to pre-disease movement.

FHO for large dogs is most appropriate when:

• THR is not feasible (cost, health, access)
• Pain relief is the primary goal rather than athletic restoration
• The dog is a lower-activity family pet rather than a working or competition dog

Cost: $2,000 to $4,500 per hip. Significantly lower than THR.

For the main surgical alternative comparison at the procedure level, see FHO as the main surgical alternative.

Conservative management

Conservative management doesn't fix the underlying anatomy. What it does is manage symptoms within the limits of the damaged joint, often effectively enough that quality of life is maintained for months or years.

Weight management

The single most impactful intervention for any overweight large dog with hip pain. Every pound above ideal body weight adds mechanical load to a compromised joint. Even 10 to 15% weight reduction produces measurable improvement in mobility and pain scores in dogs with hip arthritis.

In large dogs, where body weight is already substantial, this impact is amplified. A 90 lb dog at ideal weight places far less stress on a dysplastic hip than the same dog at 105 lbs.

NSAIDs (anti-inflammatory medication)

Carprofen, meloxicam, and grapiprant are the most commonly used NSAIDs for canine hip pain. They reduce joint inflammation and pain, enabling better activity and quality of life.

Long-term NSAID use requires:

• Bloodwork monitoring every 6 months (kidney and liver function)
• Administration with food to reduce GI effects
• Dose adjustment to the minimum effective dose

Long-term NSAID use has its own risks. When dose escalation is needed to maintain effect or side effects develop, this path's limitations have been reached.

Physical therapy and targeted exercise

Physical therapy builds the muscle mass that partially compensates for joint instability. For large dogs, stronger hindquarter muscles provide dynamic stabilization that can meaningfully reduce the functional impact of hip disease.

Key exercises for large dogs with hip pain:

• Controlled leash walking on soft ground (builds muscle without excessive impact)
• Hydrotherapy: swimming or underwater treadmill removes joint loading while building muscle; particularly valuable for large dogs whose weight makes land exercise painful
• Sit-to-stands: targets quadriceps and hip extensors
• Cavaletti poles and balance work: proprioceptive training

For conservative management in the context of hip dysplasia specifically, see conservative management for large dogs.

Joint supplements

Omega-3 fatty acids (fish oil: EPA and DHA), glucosamine, chondroitin, and green-lipped mussel extract support joint health and reduce inflammation. Evidence quality varies, but omega-3s in particular have the strongest published evidence in canine hip arthritis.

Adequan injections

Polysulfated glycosaminoglycan (Adequan) injectable joint modifier is one of the few non-surgical joint interventions with consistent published evidence in dogs. Administered as a loading course then maintained less frequently. Supports cartilage health and has anti-inflammatory properties.

Regenerative therapies

PRP (platelet-rich plasma)

PRP uses a concentration of the dog's own blood platelets, which contain growth factors that may support tissue repair and reduce inflammation. Injected directly into the joint.

What it delivers: Temporary pain relief and potentially some tissue support. Evidence in canine hip disease is emerging rather than established.

Limitations: Effects are temporary (weeks to several months); repeat treatments are required. Cost ranges from $2,000 to $5,000 for a treatment course. This is an adjunct therapy, not a cure.

Stem cell therapy

Adipose-derived or bone marrow-derived mesenchymal stem cells are injected into the affected joint to support tissue repair and modulate inflammation.

What it delivers: Variable; some dogs show meaningful improvement in comfort and function for months. Evidence is actively developing.

Limitations: Expensive ($2,000 to $5,000+), effects temporary, requires repeat treatments. Not a replacement for structural management of severe disease.

Both regenerative therapies are most appropriate as adjuncts to conservative management or as alternatives when surgery isn't possible, not as primary treatments for end-stage hip disease.

Hip braces

Hip braces provide external mechanical support to an unstable hip joint and may reduce pain by limiting painful range of motion.

Cost: $200 to $800, making them the most affordable support option.

What they deliver: Partial pain reduction and some mobility support, particularly for mild to moderate hip instability. They don't address the underlying joint damage.

Limitations: Braces don't prevent disease progression. They must be properly fitted and monitored for skin irritation. Not appropriate as a substitute for surgery in dogs with severe disease.

For the non-surgical FHO alternatives in the specific context of small-to-medium dogs, see non-surgical FHO alternatives.

Setting realistic expectations for large-dog alternatives

Global Vet Specialists makes the position clear: THR should be the primary recommendation over FHO for large dogs with rare exceptions. Conservative management has a 50 to 60% success rate for managing canine hip dysplasia without surgery (EnduraPet, citing published research), meaning it works for about half of dogs who try it.

What this means practically:

• Conservative management is worth trying first for early to moderate disease
• If conservative management works, it may delay or avoid surgery for meaningful periods
• As disease progresses, alternatives become less effective and surgery becomes more appropriate
• For dogs who aren't surgical candidates, a well-designed conservative program can maintain quality of life meaningfully, even if it can't match THR outcomes

For candidacy factors that determine who is a THR candidate, see candidacy factors that make alternatives relevant.

Comparison of alternatives

Frequently asked questions

My large dog had FHO and is still limping significantly. What now?

Persistent significant lameness after FHO in a large dog should be evaluated. Causes include insufficient rehabilitation, residual bone contact, or inadequate false joint development. Radiographs can assess whether bone contact is occurring. Intensified rehabilitation may help. If the limping is severe and ongoing, THR conversion is technically possible, though more complex than primary THR. Consult a specialist who performs THR for assessment.

Is conservative management ever the long-term plan for a large dog?

Yes, for appropriate patients. Large dogs with mild to moderate hip disease that responds adequately to conservative care, or dogs whose age or health status makes surgery inappropriate, can be managed long-term with conservative care. The key is consistent management and realistic expectations about the limitations of this path as disease progresses.

Can PRP or stem cells cure hip dysplasia?

No. These therapies do not reverse the anatomic abnormality or the established arthritis. They may reduce inflammation and pain temporarily and support tissue maintenance. They are adjunct tools in a broader management plan, not curative treatments.

For large dogs who can't have THR, the alternatives don't offer the same outcome. They offer a different kind of outcome: meaningful pain reduction, maintained function within the limits of the damaged joint, and extended quality of life. For many dogs and owners, that's a real and worthwhile goal. Managing expectations clearly is what makes the alternative path sustainable.

Resources

• Global Vet Specialists. Total Hip Replacement vs Femoral Head Ostectomy. globalvetspecialists.org
• EnduraPet. Treatment Options for Dogs with Hip Dysplasia. endurapet.com
• VCA Animal Hospitals. Total Hip Replacement in Dogs. vcahospitals.com