Lilly’s blog
Meet Lilly. She was referred to Northwest Surgeons for hip dysplasia and scheduled to have
a Total Hip Replacement (THR) on her left hind leg.
She was admitted the evening before surgery to allow us to give her a full clinical exam to
check her general health. By performing this the day before surgery, it allows us to get Lilly
settled into the hospital ready for her procedure.
During her admit consultation Lily’s owners were asked questions regarding Lilly, and a
detailed recent history was taken. Most importantly any episodes of sickness, diarrhoea or
general illness, were recorded. Luckily, Lilly had not suffered from any ill health so the THR
procedure could be performed the following day. It is very important that the animal’s
immune system is not compromised in any way, as this can impair wound healing, which
would cause complications in a case of this type.
As well as a medical history, Lilly’s owners were also asked about her food preference, her
daily routine and toileting habits. By knowing these we were able to provide tailored nursing
care for Lilly.
Once Lilly was admitted she was weighed to assure all medications she received were at the
correct dose for her weight. Further examinations also included an examination of her ears,
teeth and skin especially around the operation site. In Lilly’s case all was in good order, and
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she was settled into a comfortable warm kennel overnight (with her get well card).
The next morning Lilly was taken out for her morning walk to go to the toilet and then
moved to the recovery kennels in the preparation area, to await her premedication
injection. For more information on what to expect from anaesthesia, click here.
Once all the orthopaedic instrument kit and implants were double checked again the
morning of the procedure, Lilly could be given her premedication, which consisted of a
sedative drug and an opioid for pain relief. Both medications work together to allow a
smooth induction and recovery from anaesthesia, and to ensure the all important pain relief
is on board preoperatively. Once this was given intramuscularly Lilly was placed back into
her kennel for 30 minutes to allow the premedication to take effect. She was observed
throughout this time to assure she did not have any
adverse reaction to the medication.
Once Lilly was suitably pre-medicated an intravenous
catheter was placed by the nurse. Once the catheter had
been placed Lilly was given oxygen delivered by
facemask, known a pre-oxygenation, which increases
the blood oxygen levels prior to anaesthesia.
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Our anaesthetist was then ready to induce anaesthesia with an intravenous agent whilst still
providing oxygen via the face mask. Lily then had an endotracheal tube placed in the
trachea (windpipe) to deliver the oxygen and anaesthetic agent during the surgery. At this
point the monitoring equipment was attached to monitor her pulse, blood pressure,
temperature, oxygen saturation and ventilatory parameters.
Once Lilly was settled under her general anaesthetic, the clipping of her leg could be started.
The clip was from the most caudal rib to the anus including the tail base, and the entire limb
from her hip to beneath the level of her hock. Also the clip extended ventrally from just
lateral to the dorsal midline down to the midline of the abdomen.
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Once fully clipped, the hair was hoovered away to assure no stray hairs could contaminate
the operation site. The tail was bandaged and her foot was placed into a latex glove and
wrapped placed around this to protect the surgery site from the hair
Lilly’s general anaesthetic was monitored closely throughout the preparatory procedure,
allowing us to gauge what level of anaesthesia she required. As well as using the electronic
equipment to monitor her vital signs, our anaesthetic nurse also used a manual stethoscope
to listen to the pulse and respiratory rate.
During this preparatory phase Lilly also received her intravenous antibiotics and her nonsteroidal anti-inflammatory drug as a second form of pain relief. She had also been placed
on intravenous fluids to support her blood pressure. It is important when an animal is under
general anaesthetic that the temperature is maintained artificially, as in most cases the
animal’s temperature will drop as they are unable to control it themselves. We use
thermostatically controlled beds that go under or around the animal to help warm them up
and maintain body temperature.
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Once the clip had been finished Lilly's skin was
cleaned aseptically and our anaesthetist
administered an epidural. This is commonly done
for this procedure, and helps to keep the animal
pain free during the procedure and for some time
afterwards. Frequent pain scoring is very
important post operatively to assure the animal
is pain free at all times.
Once the epidural was completed the skin preparation process could begin, using a seven
minute contact time for the diluted cleaning agent (chlorohexidine) onto the skin. A spray of
chlorohexidine diluted with surgical spirit was then misted finely over the operating site,
and then Lilly was transported through to the theatre.
Once Lilly was in theatre and positioned correctly, the surgeon and the veterinary scrub
nurse draped her using our pre-prepared draping kits, assuring sterility was maintained at all
times. The rest of the THR kit was then handed to the surgeon.
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Once both surgeons were ready they ran through the surgical brief first assuring again that
they had all the equipment they needed before starting. Lilly is underneath all the drapes
but can be easily accessed by the anaesthetic nurse, and her vital parameters are recorded
every five minutes to assure she is comfortable and is kept well anaesthetised.
The procedure took just under two hours. Once the sutures had been finished a double
layer of primapore dressing is placed over the wound to help keep the wound clean, and
protected. After the surgery Lilly was radiographed (x-rayed) to check the implants and
cement were correctly placed.
Once the radiographs were taken and the surgeons where happy with the implants she was
moved into recovery, where she was monitored until her temperature had risen to above
37oc and that she was conscious enough to lift her own head, and was aware of her own
surroundings.
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This is Lilly about an hour after she came around from her anaesthetic. She was comfortable
on palpation of her hind leg, and ate a good meal post operatively. Her pain scoring was
written up for every four hours post-surgery and she was given pain relief if she required it.
Soon after this photograph she was moved back onto the ward, where she was provided
with a padded bed and had a buster collar put on to assure she did not interfere with her
wound. She was bearing weight on her affected limb later that evening with assistance from
a sling, and was sent home a few days later.
Lilly has been back to see us since and is doing extremely well with her new hip!
This blog was written by Veterinary Nurse Rhian Griffiths-Jones RVN CertECC
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