Canine Hip Dysplasia (CHD)
Canine Hip Dysplasia is an inherited developmental condition where the ball and socket of the hip joint do not fit together normally.The socket (acetabulum) is often too small or irregular to capture the ball (femoral head) when the patient is standing and active. The loose fit causes abnormal motion at the hip joint as the femoral head slips in and out of the acetabulum.
How is hip dysplasia diagnosed?
Orthopedic exam - A diagnosis of hip dysplasia can often be made on orthopedic examination. Orthopedic examination includes: evaluation of the gait at a different speeds, palpation of the joints and muscles while awake, and palpation of the joints with the pet under sedation
Pelvic X-rays - The diagnosis of hip dysplasia is made on x-rays. There are specified x-ray positioning techniques to help determine the severity of hip dysplasia (OFA, PennHip)
Blood work - this information helps us to determine the safest approach to pain management and use of NSAIDs.
How can hip dysplasia be treated?
Hip dysplasia has a wide spectrum of clinical signs and severity across patients, and changes over time within an individual patient. For this reason, several different surgical procedures have been developed over time to treat hip dysplasia at specific ages and in specific circumstances. These include juvenile pubic symphysiodesis (JPS), double pelvic osteotomy (DPO), triple pelvic osteotomy (TPO), total hip replacement (THR), and femoral head ostectomy (FHO).
Deciding which procedure may be best for a particular patient depends on the age, presence of arthritis, severity of disease, patient lifestyle, and owner goals.
In young dogs, this causes pain because the abnormal motion stretches and strains the muscles, ligaments, and joint capsule around the hip. Young dogs with hip dysplasia will often be noted to walk with an exaggerated swinging of the hips to the left and right, and will sometimes “bunny-hop” with both hind limbs when running. Over time, the body lays down scar tissue and bone spurs (osteophytes) to stabilize the loose hip joint. This decreases the pain for a variable period of time, but the abnormal wear and tear on the hip joint leads to bone on bone grinding and arthritis which causes the pain to return later in life.
Canine hip dysplasia is a spectrum of disease and no two dogs are the same. Dogs with mild hip dysplasia may never show clinical signs, whereas severe cases may cause pain for their whole life. With such a wide variety of clinical signs and severity, there is also a range of treatment options available to dogs with hip dysplasia depending on the severity of disease and the level of impact on their comfort and quality of life.
Dogs with clinical signs of hip dysplasia should not be bred, as this disease is passed down to offspring. Canine hip dysplasia is an unfortunate and undesired consequence of selective breeding and will only be decreased in incidence with careful breeding practices to avoid passing this genetic trait onto the next generation.
What are the potential surgical procedures for hip dysplasia?
Juvenile Pubic Symphysiodesis (JPS)
This procedure is only an option in 14-20 week old puppies. It involves closing a pubic growth plate early to change the overall growth of the pelvis to improve the contact of the ball and socket hip joint.
Double/Triple Pelvic Osteotomy (DPO/TPO)
This procedure is only an option in young dogs with absolutely no signs of arthritis changes on hip x-rays. This procedure aims to achieve the same goal as JPS. but in dogs whose growth plates have already closed (older than 20 weeks of age). This procedure involves making two or three cuts in the bones of the pelvis to surgically rotate the acetabulum (hip socket) over the femoral head (ball of hip) to improve contact. The the cut sections of bone are held in this new rotated position with a special type of bone plate. We do not perform typically perform DPO/TPO procedures at the Veterinary Surgicenter, but it is included in this list to be complete.
Total Hip Replacement (THR)
This procedure involves surgical replacement of the ball and socket joint of the hip with an artificial joint. Successful THR surgery provides the most complete return to normal limb function after surgery. This surgery is sub-specialized and should be performed by a surgeon with specific training in total joint arthroplasty. Because of the precisely machined implants and subspecialized surgical care, this procedure is typically the most expensive, ranging from $5-7,000 in our area.
Femoral Head Ostectomy (FHO)
Femoral Head Ostectomy (FHO) - This procedure involves surgically removing the femoral head and neck, the ball portion of the ball and socket hip joint. This removes the bone on bone grinding that occurs in dogs with severe or end-stage hip dysplasia. The surrounding soft tissues and powerful gluteal muscles support the hip in the absence of the femoral head.
How is Hip Dysplasia medically managed?
The majority of dogs with hip dysplasia can be effectively treated with medical management for their entire life. Medical management includes maintenance of a healthy weight, low impact exercises to maintain muscle mass, joint supplements (nutraceuticals) to support joint health, and anti-inflammatory medications. Some dogs do not improve or have a limited response to medical management alone and require surgical intervention. Medical management is still continued after surgery as well to maximize chances of a successful long term outcome. We develop a treatment plan for each pet based on their specific needs, lifestyle, and overall health to maximize pain relief safely.
The following are recommendations for medical management in dogs with hip dysplasia:
Weight management is the most important part of medical management. Dogs with hip dysplasia are not able to tolerate additional weight as well as dogs with normal hips. Dogs with hip dysplasia, in particular, should be kept as thin as possible to avoid excess weight stress and on the joints. Studies have shown that maintaining your pet at a healthy weight is as effective at relieving hip pain as treatment with NSAID medications alone. Low fat diet and controlled, low impact exercise is the main way to encourage a healthy weight for your dog. The top of the spine and ribs should be easily felt when petting those areas, if not, there is the presence of excess fat in these locations. We recommend actively monitoring your pet’s weight and body condition as they mature to prevent excess weight gain.
Maintaining muscular strength is important in dogs with hip dysplasia to support the hip joints. Rehabilitation and controlled exercise can dramatically improve limb function in dogs with hip dysplasia. Specific exercises to strengthen the muscles surrounding the joint can help to support the abnormal hip. Therapies such as swimming and underwater treadmill can exercise the muscles with less weight on the painful joints. Explosive exercises such as sprinting and jumping should be avoided as these activities put greater strain on the hips. Passive range of motion exercises and massage can help to prevent the hindlimbs from becoming stiff with limited use. Rehabilitation therapy can be combined with therapeutic laser, acupuncture, and in some cases joint injections to maximize patient comfort and outcome to medical management. Exercise to maintain muscle mass can be challenging in some dogs with hip dysplasia because of the discomfort associated with exercise. A veterinary rehabilitation team can be helpful in these cases to provide rehabilitation exercise service and integrative therapies such as cold laser and acupuncture. They can also create an at-home exercise program and teach you how to perform rehabilitation exercises at home.
Joint Supplements (nutraceuticals)
There are many joint supplements available formulated to nourish the joint cartilage, reduce inflammation, and support health. Omega-3 fatty acids, can help decrease inflammation associated with arthritis. Glucosamine and chondroitin help to provide the building blocks for normal cartilage tissues in the joint. Specially formulated veterinary diets such as Purina JM or Hill’s j/d contain appropriate levels of these supplements. These diets can also be very rich in calories, so it is important to feed the recommended amount, and monitor weight carefully over time. Alternatively, individual nutraceutical supplements such as glucosamine, chondroitin and fish oil (omega-3 fatty acids) can be given as supplements to your pet’s regular diet. An injectable joint supplement called Adequan is also an available option to provide the joints with nourishing material to slow the progression of arthritis. This requires weekly injections for 1 month, followed by monthly injections thereafter.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
These medications (eg. Carprofen, Deracoxib, Meloxicam) are effective at decreasing the inflammation and pain associated with hip dysplasia and arthritis. NSAIDs are safe medications when dosed appropriately and used in healthy animals. These medications should be avoided in dogs with kidney or liver dysfunction, and should never be used in combination with glucocorticoids (eg. prednisone) to avoid potentially fatal gastrointestinal perforation. We recommend the use of NSAIDs on an as-needed basis to be given only as often as necessary. Some dogs require NSAID medication daily to treat their joint pain. We recommend blood work to monitor kidney and liver values every 3-6 months in patients using NSAIDS long-term.