Hip Dysplasia in Dogs

Hip Dysplasia in Dogs

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Overview of Canine Hip Dysplasia

Hip dysplasia is a painful, crippling disease that causes a dog’s hip to weaken, deteriorate and become arthritic. It stems from abnormal development of the hip joint – a ball-and-socket type joint – in which the head of the femur does not fit properly into the socket. Hip dysplasia can be mild and slightly disabling, or it can be severe and cause crippling arthritis.

Several factors contribute to the development of hip dysplasia. It occurs more in males than females, and is most common in large and giant breed dogs. Some breeds are genetically predisposed to the disease, including German shepherds, Labrador retrievers, golden retrievers, and rottweilers. Environmental factors like type of diet, weight gain and rate of growth also contribute to abnormal hip development.

By definition, hip dysplasia develops in young growing dogs. The earliest age at which clinical signs may be noticed is usually around four months, but some dogs may not show any abnormality until they are mature or even geriatric. Hip dysplasia occurs in young dogs between 3 to 12 months of age and mature adult dogs.

Rapid weight gain and growth and excessive calorie intake may increase incidence of disease.

What To Look For

If your dog has hip dysplasia, you might notice an abnormal gait, reduced function or lameness. Your young dog may exhibit a “rolling” hind leg gait, in which the hips appear to slide up and down like a Marilyn Monroe wiggle. Your pet may also be reluctant to exercise too far or have difficulty going up and down stairs, all of which might seem strange for a puppy. There may be overt lameness on one or both hind legs. Your older dog may show greater exacerbation of these signs and may struggle to lie down or get up from a lying position.

If your dog exhibits any of the following symptoms, consult your veterinarian:

  • Hind leg lameness (one or both legs)
  • Swaying or staggering
  • Discomfort when attempting to lie down or stand up
  • Reluctance to run and jump
  • Difficulty rising
  • Abnormal gait
  • “Bunny-hopping gait”
  • Changes in jumping behavior/reluctance to jump
  • Decreased activity/exercise intolerance
  • Some dogs can have a clicking sounds that you can hear when they walk or rise to get up
  • Diminished muscle mass in rear legs (in chronic cases)

Diagnosis of Hip Dysplasia in Dogs

When your dog is examined, your veterinarian will be checking the gait – looking for a lameness while walking or trotting, a “rolling” hind leg gait and difficulty standing up or lying down. Your veterinarian will move the dog’s hip joint to assess its range of motion and check for pain with the joint extended, and he or she will listen for the “click” of the hip popping out of joint and the grating sound of bone on bone that indicates cartilage loss.

Radiographs (X-rays) may confirm the hip joint is dysplastic. X-rays will show the degree of dysplasia and the amount of associated arthritis.

In playful young dogs, this thorough evaluation may require sedation or even anesthesia because palpation and manipulation of the hips can be very painful. Also, in young dogs with hip dysplasia, it’s possible to dislocate (subluxate) the hip by manipulation due to the poor fit of the ball of the femur in the hip socket.


Treatment of Hip Dysplasia in Dogs

Various medical and surgical treatments are available today that can ease your dog’s discomfort and restore mobility. The type of treatment depends upon several factors, such as the age of your dog, the severity of the problem and financial considerations.

Medical treatments such as weight loss, moderate exercise and anti-inflammatory medication will help to alleviate the pain and inflammation around the hip joint.

If medical treatment fails to improve your dog’s condition, surgical treatment might be appropriate. Your young dog might benefit from a triple pelvic osteotomy (TPO). Older dogs respond favorably to two other procedures: a femoral head and neck ostectomy (FHO) and a total hip replacement (THR).

Home Care

For dogs being managed medically, it’s important that you monitor body weight and avoid obesity. You will also want to avoid strenuous exercise – exercise your pet regularly but moderately. Swimming can be very beneficial when available; it helps to maintain good muscle mass and tone while keeping weight off the hip joints. If your veterinarian has recommended medication, you will need to be aware of potential side effects.

If your dog has had TPO or THR surgery, strict rest will be important for six weeks followed by a gradual increase in exercise. If your dog has had FHO surgery, controlled exercise with short, slow leash-walks should be started two weeks after surgery. Carefully observe the incision daily for swelling, redness or discharge.

Preventative Care for Hip Dysplasia in Dogs

There are few things you can do in the way of prevention, but you should consider the following:

  • When selecting a puppy, find out the OFA (Orthopedic Foundation for Animals) hip score for the sire and dam. You should be looking to purchase offspring from parents whose hips have been evaluated and scored good to excellent. The PennHIP program for evaluating canine hips can provide excellent objective information about hip joints in dogs as young as four months of age.
  • Picking up the problem as early as possible affords your puppy the best chance of finding the right option, whether medical or surgical, to minimize the arthritic changes that will develop secondary to the hip dysplasia.
  • Avoid high-energy diets in young fast growing large breed dogs. Switch young dogs on high calorie high protein puppy diets to adult food.
  • Maintain weight to an ideal standard. If your dog is obese, consider a weight loss program.
  • Encourage a regular exercise routine to maintain good muscle mass. Exercise must be moderate and regular.

In-depth Information on Hip Dysplasia in Dogs

Canine hip dysplasia is found in nearly every breed, but it is more common in medium and large dogs. Hip dysplasia develops in young growing dogs and stems from the abnormal development of the hip joint – a ball-and-socket type joint – in which the balls of the hip bone do not fit snugly in the hip socket. It can be mild and slightly disabling, or it can be severe and cause crippling arthritis. The earliest age at which clinical signs may be noticed is usually around four months, although some dogs may not show any abnormality until they are mature or even geriatric.

Although hip dysplasia is common, there are other common causes of lameness in dogs. Your veterinarian will want to rule out some of these:

  • Panosteitis is a painful inflammation of the long bones of young dogs. Pain is produced by squeezing the bone itself and not by manipulation of the hip joint.
  • Hypertrophic osteodystrophy produces painful bony swelling just above the growing region of young long bones. Again, pain is produced by manipulating the bone and not the joint.
  • During the physical examination, while flexing and extending the hips, pain may be referred from the lower spine or the knees. In this way, a lumbo-sacral spinal problem may be attributed to the hips or a dog with a ruptured cranial cruciate ligament or osteochondrosis lesion in the knee may be inadvertently diagnosed with hip dysplasia. Your veterinarian will take care to try to examine and assess these systems independent of each other.
  • In older dogs, a degenerative disease of the spinal cord, degenerative myelopathy, can produce weakness of the back legs resembling hip dysplasia. Your veterinarian should assess the neurological status of an older dysplastic dog, since concurrent neurological disease would severely impact the result of, say, a hip replacement surgery.
  • Other causes of hip arthritis or even bone tumors might be considered when examining the hips of older dogs.


In-depth Information on Diagnosis

On physical examination, after watching your dog walk and performing a general physical examination, your veterinarian will perform an orthopedic evaluation in order to suggest the best course of treatment for your dog.

  • First your veterinarian will fully flex and extend the hip joint. Dogs with hip dysplasia usually tolerate hip flexion but resent hip extension. Abduction (rotating the leg out from the body) is also painful.
  • Your veterinarian may also attempt an Ortolani maneuver. This manipulation is performed on young dogs to assess joint laxity. A normal hip should stay tight as opposed to a dysplastic hip in which the “ball” might slide in and out of the “socket.” In most cases, an Ortolani maneuver cannot be performed on a conscious young puppy.
  • Radiographs provide your veterinarian information about the conformation of the hip joint and, in many cases, associated arthritic change. The most common view involves extending the legs with the dog on its back. This is also the view for x-rays submitted to the Orthopedic Foundation for Animals (OFA) to provide a hip scoring scheme for hip dysplasia assessment.
  • The University of Pennsylvania Hip Improvement Program (PennHIP), provides a much more objective evaluation of your puppy’s hips by measuring the amount of laxity in the hip joint, thereby getting a good idea of the chances of developing arthritis in those joints as your pet ages.

In-depth Information on Treatment

Various medical and surgical treatments are available today that can ease your dog’s discomfort and restore mobility. The type of treatment depends upon several factors, such as the age of your dog, the severity of the problem and financial considerations.

Medical Management for Hip Dysplasia in Dogs

Very often your dog might not require surgery and can do nicely with medical management. Medical management is indicated in the following cases:

  • The dysplasia is mild and the dog is young and not a candidate for triple pelvic osteotomy (TPO) or a total hip replacement (THR)
  • An older dog with severe hip arthritis responds well to such management
  • A dog needs treatment until a THR is necessary
  • Financial constraints make the surgical options unavailable

    Medical management involves weight control, exercise and medications.

  • Weight. Medical management begins with obesity management if necessary. Switch young dogs on high calorie high protein puppy diets to adult food. Weight loss programs may require weekly weigh-ins to assess progress and to modify the program.
  • Exercise. You should realize that the abnormality in the hip joint will put limitations on the amount of exercise beneficial to your dog. The aim is to maintain good muscle mass and tone but reduce high load on the hip joints. Exercise must be moderate and regular, which means walking every day, not just on weekends, and keeping the length of walks fairly consistent. Pet owners must impose exercise limitations because most dogs will not. In fact, most young dogs will run and play without any consideration for the damage and soreness in their hips. Then suddenly the exercise becomes too much, or at the end of the day they become so sore that they can hardly move.

    Take your dog on short leash-walks and gradually increase the time until you find what your pet can tolerate. This may vary when other medications are added but is a good starting place to set exercise limits. Swimming is also an excellent form of exercise as there is minimal joint impact but good development of muscle mass.

  • Medications. The non-steroidal anti-inflammatory medications are the mainstay of medical management. These include deracoxib, aspirin, Rimadyl®, Etogesic®,Tepoxalin and Meloxicam to name but a few of the vast array of drugs in this group. As with all drugs it is important to be aware of their side effects. The aim is to use the minimum dose that produces a beneficial effect.

    Before using anti-inflammatory drugs try to determine which chondroprotective agent works best for your dog. Anti-inflammatory drugs are effective in producing a rapid reduction in joint inflammation and pain, while chondroprotective agents provide raw materials for cartilage remodeling and improvement of the joint environment. They are life-long supplements, so you want to be sure they are truly making a difference for your pet. Initially, when these products are given together, it is likely that most of the benefit is due to the anti-inflammatory, rather than the chondroprotective agent. Using them separately, at first, will allow you to determine which combination is best for your pet.

    The chondroprotective agents can be given orally or by injection. Some of these include Adequan, which is given in a series of intramuscular injections, Cosequin and Gylcoflex, given by mouth. Most of these products do not require FDA approval and so evidence as to the benefit of these products, in many cases, is anecdotal. Having said this, many owners report significant improvements in the function of their dysplastic pets with these supplements alone.

Surgical Management for Hip Dysplasia in Dogs

  • TPO. In young dogs, the surgery of choice is a triple pelvic osteotomy (TPO). Candidates for this surgery must have little to no evidence of arthritis on a hip x-ray and a positive Ortolani test that suggests adequate depth to the abnormal hip socket. The surgery aims to cut the pelvic bones in three places in order to free up the socket and allow its position to be altered so that the ball fits better. The new socket position is secured using a special plate and screws. By correcting the dysplastic hip early in the dog’s life, further arthritic change is minimized and this should be the only surgical procedure necessary. TPO is often performed on both sides, if appropriate.
  • Some young dogs may have too shallow a socket for a TPO, but are too young and not arthritic enough for a total hip replacement (THR). Such dogs may be candidates for a “Darthroplasty” surgery in which a shelf of bone is created over the rim of the socket. This bone fuses in its new position and in doing so, stops the ball from sliding in and out of the shallow socket. This is a relatively new surgery, but in carefully selected cases has produced good results.
  • Femoral head and neck ostectomy (FHO) is a salvage surgery. Pain is produced by the grinding of the flattened and eroded ball in the arthritic and thickened bony socket. This pain can be alleviated by removing the ball thereby removing the painful bone on bone contact. Despite sounding like a strange concept, a false joint can form that is smooth and allows for walking, running and playing. This new false joint is, however, not a normal joint. There is decreased hip extension; the gait is different but the joint is pain free. The quality of the result tends to improve in smaller breeds. In heavier dogs this surgery may be acceptable where THR is not affordable.
  • THR is the ultimate salvage surgery for an arthritic dysplastic hip. If the hip joint is the rate-limiting factor behind poor use of the hind leg then replacement with an artificial ball and socket will offer the best possibility for return to function. The standard hip replacement is ideally performed in mature dogs, preferably not less than two years of age, with strong mature bone to hold the implants and a lower chance to need the hip revised during the dog’s natural life span.

    When considering surgery, the biggest concern is infection and special precautions are taken before, during and after the procedure to minimize this risk. Your dog will usually require full blood work, chest x-rays and urine analysis prior to surgery. Usually the hip replaced on one side only, mainly for financial reasons. This becomes the dominant side.

  • Following TPO or THR surgery, your pet will require a period of six weeks confinement and strict rest, which means no going up or down stairs, no jumping on or off furniture, avoiding slippery surfaces like hardwood floors, linoleum or tile, and just going outside on a leash to go to the bathroom – no walks. If necessary, a towel can be placed under the tummy, as a sling, to assist in walking during the early phase of healing.
  • TPO is usually performed on young dogs and one concern is that your dog might slip and fall. This could result in damaging the implants and pulling out the plates and screws from the young soft bone. In THR, the biggest concern is dislocation of the new ball and socket while the soft tissues heal around the artificial joint.
  • FHO dogs are a little different in that early physiotherapy is to be encouraged. If the dog does not use the leg much following the surgery, scarring will occur that will restrict range of hip motion and consequently leg function. Your veterinarian may demonstrate passive range of motion exercises, to help flex and extend the hip following surgery, to maximize its function as soon as possible. Short, slow leash walks will be helpful early on. Slow walking more than any other gait will encourage your dog to use the affected leg. Some dogs are faster than others in their rate of recovery.
  • In all of these procedures, antibiotics are given intravenously at the time of surgery, but in the case of a total hip replacement, the surgical site is swabbed for the presence of bacteria at the time of surgery, to see if bacteria can be cultured. These patients go home on a short course of antibiotics pending their culture results. If there is a need to continue mediation, your can expect to be contacted by your veterinarian.
  • All incisions will need to be checked daily for swelling, redness or discharge. Stitches or sutures are usually removed in 10 to 14 days from the time of surgery.
  • Most cases will be rechecked at six weeks from the time of surgery. In the case of TPO and THR, most dogs will be using the leg well, placing the leg every step with around 75 percent to 100 percent weight bearing. In dogs with FHO, full recovery may take a few weeks to a couple of months. The owner should be aware that function will at best be 80 to 85 percent of normal, but the dog will be able to run, walk and play and be pain-free for these activities.
  • Dogs with TPO or THR will begin slow leash walks from 6 to 12 weeks, gradually increasing the duration and distance of the exercise. Freedom around the house can be slowly increased, together with access to stairs.
  • In the case of TPO, follow up x-rays will be taken at 6 weeks, 10 to 12 weeks for THR. The x-rays will assess normal healing of bone and stability of the prosthetic ball and socket or plate and screws.

Prevention of Hip Dysplasia in Dogs

  • When choosing a purebred puppy, particularly one whose breed has hip dysplasia problems, it is essential to know the quality of the parents’ hips, from either an OFA score or a PennHIP evaluation. Any reputable breeder will have documentation to support this information.
  • Having a dam and sire who have excellent hip scores does not guarantee that your puppy will be free from hip dysplasia but it certainly decreases the possibility.
  • With the PennHIP system, a distraction index value (DI) will be obtained. This is a measure of the play or laxity within the hip joint. In simple terms, a dog with hip dysplasia should have more play, more laxity than a dog with normal hip joints. So dogs with hip dysplasia have a higher DI. PennHIP will relate an individual dog’s DI to the DI for that breed to give the owner objective information about hip joint quality and the likelihood of developing hip arthritis in the future.
  • Early diagnosis of hip dysplasia will give your pet the best opportunity to address the problem and minimize the secondary arthritic changes that can occur in the hips. Be aware of the clinical signs and monitor your puppy’s gait and activities to allow early recognition that a potential hip problem exists so you can bring this to your veterinarian’s attention.
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