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Hip Dysplasia

What is Hip Dysplasia?

What causes Hip Dysplasia?

What is the difference between Hip Dysplasia and arthritis?

What breeds of dogs get Hip Dysplasia?

Can cats get Hip Dysplasia?

When will my pet start showing signs of Hip Dysplasia?

What is the earliest age my pet can be diagnosed with Hip Dysplasia?

What can I do to minimize the arthritis my pet may develop?

My pet is showing signs of Hip Dysplasia; what can/should I do?

If my pet has Hip Dysplasia, what is the quality of life?

Does every pet with Hip Dysplasia need surgery?

My recommendations

The thing I wish owners and vets understood and acted on before it was too late

What is Hip Dysplasia

  • Common source of lameness
  • Growing/developmental disease in dogs
    • Most commonly large dogs
    • Occurs in all breeds and sizes of dogs
  • Unstable/loose/lax hips
    • The head of the femur (the ball in the ball and socket joint) is not tightly seated in the socket.
    • The hip subluxates (partially dislocates) with normal use
    • Wears heavily on the cartilage of both the ball and the socket
    • Leads to progressive arthritis
      • Arthritis is simply inflammation of the joint
        • Can be primary
        • In this case it is secondary, caused by hip dysplasia: 
      • Painful
      • Destruction of the cartilage
      • Decreased use leads to muscle atrophy and exacerbation of pain
      • Arthritis worsens with age
  • Genetics/hereditary is the biggest single factor
    • Nutrition also constributes
    • Rapid growth and/or weight gain can exacerbate problems
  • Major breeds include: German Shepherd, Labrador Retriever, Golden Retriever, Rottweiler, Great Dane, Mastiffs, and Bulldog breeds.
    • Occurs in all breeds of dogs
    • Occurs in all ages of dogs
    • Even some breeds of cats, such as the Maine Coon

Signs/symptoms

  • Lameness (limping)
  • Reluctance to rise to a stand or to jump
  • Shifting of weight to the front legs
  • Decreased muscle mass in the back legs
  • Hip pain
  • Two age distributions of pets showing symptoms:
    • Younger dogs without arthritis, but with significant hip laxity
    • More mature dogs developing hip arthritis due to Hip Dysplasia
  • Some dogs do not have any obvious symptoms.

Diagnosis: 

  • General physical and thorough orthopedic exam
    • Evaluate gait
    • Identify laxity (looseness) and/or discomfort in hips
    • Rule out other causes
  • Radiographs (x-rays)
    • general require sedation for proper quality/positioning
    • may not document changes until 2 years of age
  • Stress radiographs (x-rays)
    • Using gentle force to document the laxity/looseness
    • Confirm laxity at an early age
    • Can be diagnosed at 3-4 months old (compared to potentially 2 years old with standard x-rays)
    • Allows earlier preventive treatment
    • PennHIP - allows exact measurement of amount of distraction and calculation of breed-related risk of Hip Dysplasia

Treatments: 

  • Medical
    • Non-steroidal anti-inflammatory drugs (NSAIDS) – Previcox, Metacam, Carprofen, etc.
      • Generally the first line of treatment of arthritis pain.
      • Very effective, but risk of stomach, kidney, and/or liver complications
    • Tramadol or classic narcotics
      • Excellent adjunct to NSAIDs
      • low potential for sedation and/or constipation
    • Cartilage-protecting products – helpful in treatment and/or slowing progressive deterioriation
      • Oral glucosamine formulations (such as Dasuquin or Synovi-types) or the
      • Adequan injectable, but more potent
      • Generally very safe and well-tolerated
    • Amantidine
      • Prevents the “wind-up” phenomenon associated with chronic pain.
      • Excellent adjunct to NSAIDs.
    • Omega-3 Fatty Acids, such as in Derm Caps and/or Science Diet's J/D or Royal Canin Mobility
      • Anti-inflammatory
      • Generally very safe
      • Can be very beneficial in chronic arthritis.
    • Gabapentin - For neuropathic pain (pain associated with the nervous system)
      • Can be beneficial in cases of occult pain as well.
  • Other non-surgical therapies
    • Keeping your pet lean will markedly decrease the expression of dysplasia/arthritis.
    • Regular exercise, such as long, slow walks, as well as regular swimming, are beneficial to promote muscle development and decrease the pain of arthritis.
    • Rehabilitation (“physical therapy”), including acupuncture, laser therapy, electrical muscle and nerve stimulation, underwater treadmill, and stretching, strength, and agility exercises may markedly improve your pet’s comfort level and decrease the need for medications, as well as the risk for surgery.
    • Stem cell therapy can provide marked improvement in cases of arthritis.
      • See my article on stem cell therapy for details on how this works.
      • In young pets, I recommend harvesting and banking stem cells while relatively young and the tissue is rich in stem cells.
    • With age, your pet may likely be more severely affected. Your pet can be rechecked if deteriorating.
  • Surgeries to prevent/minimize arthritis associated with dysplasia (click here for surgery to treat clinical hip dysplasia/arthritis)
    • Juvenile pubic symphysiodesis (JPS)
      • Relatively minor and inexpensive surgical procedure
      • Minimal lameness and complications in hands of experienced surgeon
      • Minimal post-op restrictions
      • Alters the growth/shape of the pelvis, while increasing the ball’s degree of coverage by the socket to diminish hip laxity.
      • Treats both sides at once.
      • Pets should be about 4 months of age for maximum benefit; no benefit after 6 months.
      • Early examination/diagnosis of breeds at risk is critical.
    • Double or Triple Pelvic Osteotomy (DPO or TPO)
      • Immature dogs (ideally younger than 10 months) with Hip Dysplasia but no arthritic changes
      • Cuts the pelvic bones in two (DPO) to three places (TPO) and rotates the segments to improve coverage of the ball by the socket and decrease hip laxity
      • Increased lameness and restrictions
      • Marked exercise restrictions post-op
      • Generally treat one side at a time; stage surgeries 4-6 weeks apart.
      • The image to the right, demonstrates the improved coverage of the femoral head in the operated joint over the non-operated side.
    • Patients with severe laxity may not benefit significantly from preventive procedures, in which case pets are managed medically until they need a salvage surgery.
  • Salvage surgeries (to treat pets with pain due to hip dysplasia)
    • Performed when:
    • Medical therapy is ineffective
    • Pet does not tolerate medical therapy
    • Owners seeking a more permanent therapy to minimize long-term medications.
    • Total Hip Replacement (THR)
      • Potential for 100% function
      • Best option for racing or performance animal
      • Significantly expensive
      • Marked exercise restrictions post-op
      • Potential complications
        • Infection
        • hip dislocation
        • “loosening” of the implants over time
        • nerve injury
        • femur fracture
      • The above image on the left panel shows a normal right hip
      • The above image on the right panel shows a severely arthritic right hip secondary to dysplasia (left side of the larger image) and a model of a total hip overlying the same patients's left hip (right side of the larger image)
  • Femoral Head and Neck Ostectomy (“FHO”; aka excision arthroplasty)
    • Removes the femoral portion of the hip joint (i.e., the ball)
    • Eliminates pain produced by abnormal cartilage rubbing
    • Decreases running speed and jumping height by 15-20%
    • Mild/brief post-operative restrictions – early/controlled limb use encouraged
    • With appropriate rehabilitation (“physical therapy”), pets can have good function and excellent quality of life.
    • The above image shows an x-ray of a patient following an FHO

Prognosis

  • Many studies report that only 25% of dogs with Hip Dysplasia are severely affected
  • Many dogs are minimally affected and/or only need glucosamine +/- NSAIDS when more sore
  • Stem Cell therapy can restore good quality of life into many older pets without major surgery
  • Surgery options and potential need for surgery discussed above

My recommendations:

  • Orthopedic evaluation by a board-certified veterinary surgeon of all breeds at risk at 14 weeks of age to identify hip laxity as number one predictor for Hip Dysplasia.
  • Juvenile Pubic Symphysiodesis (JPS) ideally at 16 weeks of age to alter hip conformation to minimize laxity and subsequent manifestation of arthritis.
  • Harvesting/banking stem cells for optimal treatment of potential arthritis and minimizing use of medications and their associated side effects.
  • Management treatments as above.
  • Neutering of any pet demonstrating evidence of hip laxity.
  • Additionally, consider prophylactic (preventive) gastropexy in large to giant breeds with coincidental risk of gastric dilation-volvulus (commonly referred to in the slang "bloat")

What I wish all owner and veterinarians understood and acted on.

  • Your pet can be diagnosed with hip dysplasia at 3-4 months of age
  • A relatively minor preventive surgery, the Juvenile Pubic Symphysiodesis (JPS), can be performed at this age.
  • This procedure can markedly change the progression of disease.
  • DO NOT WAIT UNTIL YOUR PET IS SHOWING CLINICAL SIGNS
  • Once your pet is showing signs, it is very likely too late for the JPS. Options are much more aggressive/invasive at that point.

Please schedule an appointment with our board-certified surgeon, Dr. Jeff Christiansen, at the clinic of your choice for an examination and to discuss treatment and/or prevention options for your pet.

If you have additional questions, please feel free to e-mail Dr. Christiansen directly.

Some images adapted courtesy of American College of Veterinary Surgeons (www.acvs.org) small animal topics.

For more information on Hip Dysplasia, see: https://www.acvs.org/small-animal/canine-hip-dysplasia