Hip Replacement and TPLO in the Same Dog: Same Day or One After the Other? What Has Been Studied, What Has Not, and the One Rule Surgeons Do Give

No study we could find covers a hip replacement and a TPLO done together, so "is it safe" has not been measured; it has not been shown to be dangerous either. What exists is narrower. One surgeon's published rule says to address the stifle first when both joints hurt, and two studies of two TPLOs at once read the same question differently. If you have been quoted a combined plan, the useful question is not "is it safe" but "which joint is causing the limp today, and what would make you do the other one?" Ask that before the date is set, because the order is a decision with consequences for the home as well as the dog.

The report came back with two problems on it. The hip is dysplastic and arthritic, and the cruciate ligament in the knee is torn or partly torn, and you are now holding two estimates and a question that sounds like it must have an answer: can he have both done at once and get it over with? The question is a reasonable one. It is also one the literature does not answer, and this page says so at the points where that is true.

How does a dog end up needing both?#

Because the two diseases share a limp and often turn up in the same dog. In 2005, researchers at Washington State University reviewed records from 1994 to 2003 for 369 dogs whose referring veterinarian had blamed the hind-limb lameness on hip dysplasia or hip pain. In 32% of them the referral hospital found a partly or completely torn cranial cruciate ligament instead.^[1] Of the 119 dogs with a ligament tear, 94% also had radiographic signs of hip dysplasia, and 43% had the tear in both knees.^[1]

Two things follow. In that referred group, both findings on one film was the common picture. (These were dogs sent to one hospital for lameness already blamed on the hips, with a mean age of 3.8 years, so it is not a rate for dogs in general.) And the hip on the film is not proof the hip is the problem today; that is the lesson our page on telling a limp from weakness draws from the same study. The authors' own conclusion was that other sources of stifle disease should be excluded before recommending treatment for the hips.

Has anyone studied a hip replacement and a TPLO together?#

We looked, on 19 October 2026, for a canine study of total hip replacement and TPLO performed in one session, on the same limb or on opposite limbs, and for any study of the order in which to do them. We searched the veterinary literature and surgeon-written reviews and found no such study. That is a statement about our search, not proof that none exists, and a surgeon who does this regularly may have a case series we did not reach. What we can say is that nothing we found reports complication rates for the combination.

What is the one rule that does exist?#

In a 2008 conference lecture on joint replacement, Michael Conzemius, a board-certified veterinary surgeon, lists concurrent orthopedic disease in the affected limb as a common contraindication to hip replacement. He writes that when a dog has pain from both a torn cranial cruciate ligament and hip osteoarthritis, "performing hip replacement alone will rarely improve the patient's limb function," and that "in general, address the stifle pain first."^[2]

Read what that is and is not. It is an experienced surgeon's rule of thumb, published as lecture notes, not a trial. It is written about a dog whose pain comes from both joints in the same limb, and it does not address a hip on one side and a knee on the other. It does not say the two cannot be done together. But it explains a plan you may well be offered: the knee is repaired, the dog is re-examined, and the question of the hip is asked again with the knee no longer muddying the answer.

What is the nearest evidence, and why does it disagree?#

The closest thing to "two big orthopedic operations on a dog's back legs in one session" is two TPLOs, one per knee. Two studies, both retrospective, read the question differently; neither found a statistically significant difference in major complications.

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The abstracts do not explain the gap, and we will not invent a reason. What the abstracts do show is that the two are different designs: the first compares two groups of dogs over ten years, the second reports one surgeon's consecutive cases and tests simultaneous surgery as one of several risk factors. Neither randomised dogs to one plan or the other, so in neither can the timing be separated from why a given dog got that plan.

Now carry the lesson to your dog, carefully. A hip replacement is not a second TPLO (our page on TPLO versus total hip replacement sets the two operations side by side). The hip carries its own listed risks, and nothing in either study tests what happens when the second procedure is a different joint with a different implant. The studies show that even for the simpler pair, careful authors weigh the same question differently. That is a reason to treat a combined plan as a judgement call that your surgeon should be able to defend for your dog, not as a standard option.

What does the hip replacement add to the day?#

The American College of Veterinary Surgeons lists the potential complications after hip replacement as infection, hip dislocation, loosening of the implants over time, nerve injury and femur fracture. It says that after pelvic osteotomy or hip replacement activity is limited to leash exercise outdoors and confinement indoors until the operation is judged healed by examination and X-rays, generally six and eight weeks respectively.^[5] A TPLO has its own restriction period, which runs on a different clock; our TPLO recovery guide sets out the weeks and notes that bone healing and walking normally are not the same milestone. We have not found a source that merges the two schedules, so if both limbs are operated in one session, the question for the surgeon is which restrictions govern and for how long.

On anaesthesia, a prospective study of about 98,000 dogs anaesthetised or sedated at 117 practices put anaesthetic- or sedation-related death within 48 hours at 0.17% overall and 0.05%, about 1 in 1,850, in healthy dogs.^[6] That is a figure for single anaesthetics. It does not tell you whether one long anaesthetic is safer than two shorter ones, and nobody has measured that for this pairing. It is a question for the anaesthetist, who knows your dog's age, weight and heart.

What does each plan mean for the house?#

This table is our reasoning about the home, not a result from any study. It is built on one plain fact: after one operated back leg the dog has a good one to lean on, and after two he does not.

dogorthopedic.com

What about the other knee?#

If the plan starts with a TPLO, the knee that is not being operated is part of the arithmetic. In 831 dogs of 15 kg or more who were 8 or older at their first cruciate rupture, 19.1% (95% confidence interval 16.6 to 22.0%) ruptured the other side, a median of 12.9 months later; age and the Golden and Labrador Retriever breeds were associated with it.^[7] Younger dogs are not in that number. Our guide to watching the other knee covers the radiographic findings that make the second tear more likely, and the question that follows from them: what did the unoperated stifle look like on the films you already have? A plan that has a hip and a TPLO in it may be about to become a plan with a hip and two TPLOs, and it is better to hear that at the first consult than the eleventh month.

What should I ask the surgeon?#

None of these is a challenge. They are the questions the missing evidence leaves to the person in the room. Our general list is in questions to ask a veterinary orthopedic surgeon; these are the ones this pairing adds.

1. Which joint is causing the limp today, and how do you know? The 2005 study is the reason to ask: the hip on the film is not proof.
2. Is the pain in the same limb, or in opposite limbs? The stifle-first rule was written for the same limb.
3. Have you done both in one session? How many times, and what happened? A surgeon's own series is the only combined evidence we found, and it is fair to ask for it.
4. If both are done, which restrictions govern, and for how many weeks? The two schedules run on different clocks.
5. What did the other stifle look like on the films? This decides whether the plan is two operations or three.
6. What would make you do the second joint, and on what date do we decide? Write the date down.
7. Is a belly sling allowed after the hip? The sling is below.

If the other problem is a second hip rather than a knee, that schedule question has its own page: both hips at once, or one at a time.

dogorthopedic.com

What do we recommend buying?#

Possibly nothing before you have the answers. A rolled bath towel under the belly, held from above, gets a medium dog out to the garden and back; it costs nothing, and it slides forward on a deep-chested dog, takes both hands, and does not clear a male dog's anatomy.

If you decide a sling is worth buying, the one we link is the GingerLead, and for this pairing there is a condition on it that does not apply to most of our placements.

A belly sling lifts the pelvis, so it does not choose a leg, which is useful when neither back leg is a good one. That is our reasoning from how it is built, not a tested result. The condition is the hip: because dislocation is a listed risk after hip replacement, ask your surgeon before the operation whether lifting the rear with a strap is permitted, and how. If the answer is no, the sling is the wrong tool for that stretch of recovery, and a second person is the right one. The downsides stand: it supports the rear only, the chest harness the maker suggests for older dogs is not in the box, and the clean return window is 10 days, which is shorter than either recovery. The Amazon listing read $69.95 and in stock through the Amazon Creators API on 19 October 2026 (logged on the product page); the product page also has the sizing test.

What can I do this week?#

• Ask for the plan in writing, with the joint, the limb and the session for each procedure, so you are comparing the same thing across two estimates.
• Ask which joint is producing the limp now, and ask the surgeon to show you on the films.
• Ask the seven questions above, and note which the surgeon answers from their own cases and which from general practice.
• Put the second-joint decision on the calendar with a date, a measurement and a name, so that "we'll see" is a plan and not a drift.
• If a combined session is on the table, plan the house first: who lifts, with what, for how many weeks, before the date is set.

The evidence here is thin, and that is the finding. A gap in the literature is neither a permission nor a warning. It leaves the order of the questions as the decision, and the one thing an owner can control is how soon the questions are asked, because every week spent on the wrong joint is a week the right one keeps hurting.

Sources#

1. Powers MY, Martinez SA, Lincoln JD, Temple CJ, Arnaiz A. "Prevalence of cranial cruciate ligament rupture in a population of dogs with lameness previously attributed to hip dysplasia: 369 cases (1994-2003)." JAVMA. 2005;227(7):1109-1111. doi:10.2460/javma.2005.227.1109 — CCLR as cause of lameness 32% (95% CI 27.2 to 36.8%); of 119 dogs with CCLR, 94% had radiographic hip dysplasia, 92% stifle effusion, 81% cranial drawer; distribution left 29%, right 28%, bilateral 43%.
2. Conzemius MG. "Joint replacement: Hips, knees and elbows (Proceedings)." dvm360. 1 October 2008. dvm360.com — read 19 October 2026: concurrent orthopedic disease in the affected limb a common contraindication; "performing hip replacement alone will rarely improve the patient's limb function"; "In general, address the stifle pain first." The page does not address bilateral or opposite-limb sequencing. Conference lecture notes, not a trial.
3. Peress, Mejia, Unis, Sotgiu, Dore, Bruecker. "Comparison of intra- and postoperative complications between bilateral simultaneous and staged tibial plateau levelling osteotomy with arthroscopy in 176 cases." Veterinary and Comparative Orthopaedics and Traumatology. 2021;34(2):91-98. doi:10.1055/s-0040-1716682 — abstract read via Crossref, 19 October 2026: 176 dogs, 352 stifles, 2005 to 2015; overall complications 47.5% (simultaneous) vs 19.5% (staged); major 10.1% vs 3.8%; minor 38.4% vs 15.6%; tuberosity fractures needing revision 2% vs none; no significant difference in major complications, Type II error noted. Full text not read.
4. Fitzpatrick N, Solano MA. "Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs." Veterinary Surgery. 2010;39(4):460-474. doi:10.1111/j.1532-950x.2010.00663.x — abstract read via Crossref, 19 October 2026: 1,000 dogs, 1,146 stifles, single experienced surgeon, 2004 to 2009; overall complications 14.8%; bilateral rupture 14.6% of dogs, no significant difference between simultaneous and staged. Full text not read.
5. American College of Veterinary Surgeons. "Canine Hip Dysplasia: Total Hip Replacement." acvs.org — read 19 October 2026: potential complications "infection, hip dislocation, 'loosening' of the implants over time," nerve injury and femur fracture; leash exercise and confinement until healed, "generally six and eight weeks respectively" for pelvic osteotomy and hip replacement. The page does not address disease in other limbs.
6. Brodbelt DC, Blissitt KJ, Hammond RA, Neath PJ, Young LE, Pfeiffer DU, Wood JLN. "The risk of death: the confidential enquiry into perioperative small animal fatalities." Veterinary Anaesthesia and Analgesia. 2008;35(5):365-373. doi:10.1111/j.1467-2995.2008.00397.x — 98,036 dogs anaesthetised or sedated across 117 practices; anaesthetic- or sedation-related death within 48 hours 0.17% overall (1 in 601) and 0.05% (1 in 1,849) in healthy dogs.
7. Murphy CL, Niles J, Radasch RM. "The prevalence and risk factors of contralateral cranial cruciate ligament rupture in medium-to-large (≥15 kg) breed dogs 8 years of age or older." Veterinary and Comparative Orthopaedics and Traumatology. 2024;37(1):8-12. doi:10.1055/s-0043-1771350 — 831 dogs; 19.1% (159/831; 95% CI 16.6 to 22.0%) ruptured the contralateral side at a median of 12.9 months; age and Golden and Labrador Retrievers associated.