Hip dysplasia can be treated with more than one method. In adult dogs with painful hips, hip joint replacement is a good option. However, if hip dysplasia is detected early there are more options that can be considered, all of which do not require a prosthesis. A surgeon can perform an osteotomy of the pelvis to change the conformation so that a larger part of the acetabulum covers the femoral head. Previously, this was done by performing three cuts (osteotomies), in the ilium, ischium and pubis and rotating the upper part of the acetabulum more laterally, before plate and screws were applied to the ilium to hold everything in place. This procedure is called triple pelvic osteotomy (TPO). One of the complications reported with it is narrowing of the pelvic diameter, which can give rise to problems such as dystocia and constipation. In recent years, TPO has therefore been increasingly replaced by a slightly less invasive procedure called double pelvic osteotomy (DPO), where osteotomies of the pubis and ilium only are performed, and the ischium is left intact. This surgery has shown good results, but has traditionally been reserved for young dogs between 4.5 – 9 months old. As most practitioners know, very few dogs show problems with their hips at such a young age, and traditional HD screening usually does not take place until the dog is at least 12 months old. Many dogs are therefore already too old for this procedure at the time of diagnosis. The two Italian surgeons Mazzimo Petazzoni and Roberto Tamburro published an article in Veterinary Surgery February this year, where they examined the medical records of eight dogs (11 hips) operated with DPO and followed up to one year after surgery. The dogs ranged from 10 to 28 months old at the time of surgery, and all of them were considered pain-free at the eight-week follow-up. Furthermore, all dogs had a significant improvement in the Norberg Angle (21.8%), and the “femoral head coverage” was significantly improved after one year. There were no signs of narrowing of the pelvic diameter. Based on this, the authors concluded that DPO can also be performed in some dogs over 10 months of age, as long as certain criteria are met. The authors admit that the few patients included in the study represent a weakness, as well as the study not being prospective, that the dogs were not assessed for osteoarthritis at the follow-ups, and that objective lameness assessment (kinetic data) was not used. The authors believe that this should form the basis for more in-depth studies of DPO in adult dogs, and that DPO can be recommended for some dogs given that they are clinically affected and have a “hip reduction angle” below 40 degrees, “subluxation angle” below 25 degrees and DAR (dorsal acetabular rim angle) between 7.5 and 25 degrees. The former are measurements that are most easily performed on radiographs, while you need CT to be able to perform DAR. The methods are well described in several orthopedic encyclopedias. Link to the study: https://onlinelibrary.wiley.com/doi/10.1111/vsu.13737