Dog hip dysplasia is a malformation of the hip joint that leads to secondary arthritis.
Patients affected with dog hip dysplasia at a very young age may benefit from early surgical intervention, but most patients don’t present with hip lameness issues until they are much older. By that time, arthritis has already formed. Thankfully, these patients have a number of effective treatment options available.
Most patients with hip dysplasia or hip arthritis can be managed through non-surgical means to lead normal, active lives. The surgical options for older animals are considered “end stage” or “salvage” procedures, only to be considered in patients who have tried all non-surgical options and are still experiencing pain.
Beware of over-interpretating x-ray findings of hip dysplasia
Just because hip dysplasia is evident on x-rays, doesn’t mean that the hip joints are a source of pain. Lumbosacral, sacroiliac, muscular, tendon or ligamentous issues are common sources of pain in the hip region, are commonly found in dogs with dysplastic hips, and respond well to directed treatment.
Make sure the diagnosis of hip dysplasia is accurate
The first step in selecting an appropriate treatment for hip arthritis is ensuring you have an accurate diagnosis. There is a real tendency to presume all pelvic origin lameness originates from the hip joint itself, when in many cases it does not. Lower back pain presents much the same way hip arthritis does, and is frequently overlooked as a potential cause.
There is poor correlation between the severity of hip dysplasia changes evident on x-ray, and the amount of hip joint discomfort the patient is experiencing. A diagnosis of hip pain cannot be made on the basis of x-ray findings alone. An accurate diagnosis can only be made after careful examination of the hip joints in isolation, the lumbosacral, interlumbar, and sacroiliac joints, as well as all associated muscles, tendons and ligaments of the lower back and upper hind limb.
This issue is further complicated by the fact that few structures work in isolation – most dogs with hip arthritis have concurrent secondary issues such as sacroiliac pain. Even though the root problem may lie in the hip joint, these secondary problems are often the ones causing the most discomfort – resolve them and the patient does much better even before you begin to address the hip dysplasia itself
Dog hip arthritis generally does not cause sudden, sharp pain, and is usually responsive to non-steroidal anti-inflammatories (NSAIDs). If your dog exhibits signs such as sudden yelping or squealing, or if you found that prescription NSAIDs only help the pain a little, then the problem is probably not simple arthritis.
Common Causes of Canine Hip Arthritis
Some of the most common causes of severe hip arthritis include:
Hip dysplasia is a genetic disorder with multiple contributing factors, including overfeeding, and over or under exercising puppies. The net result is that instead of developing a normal hip joint consisting of a deep socket that houses a perfectly round femoral head (ball part of the ball and socket joint), an abnormally shallow socket and/or flattened ball develops instead.
These imperfections in joint formation causes instability and places increased strain on the supporting soft tissue, which eventually leads to some degree of arthritis and joint pain.
For x-ray examples of what a normal hip and hip dysplasia hips look like, click here.
This condition tends to effect smaller dogs, especially toy breeds and terriers in their 1st 13 months of life. It most frequently occurs in dogs 5 to 8 months of age. Blood flow to the femoral head is disrupted, resulting in demineralization of bone. Secondary fractures frequently develop and require surgical correction. Irritability, chewing at the hip and hip pain progressing to complete carrying of the limb are common signs.
Fractures of the femoral neck and head account for 25% of femoral fractures. Fracture of the growth plate of the femoral head happen in younger animals. Acetabular (joint socket) fractures can also occur. In large dogs, the ideal situation is to repair the fracture to preserve the joint. In cases where this is not possible, or when these conditions affect cats and smaller dogs, an FHO or THR (see below) may be the best option.
Surgical Options for Canine Hip Arthritis
Young Dogs without hip arthritis
Young dogs, generally 4 to 8 months of age, who have severely dysplastic hips but have not yet developed arthritis may benefit from corrective procedures such as the Triple Pelvic Osteotomy (TPO). The TPO procedure isolates a piece of pelvis that includes the hip joint and rotates it so that the shallow socket provides more coverage. This provides a more stable and better functioning hip down the road.
An important component of success for this procedure is careful patient selection – if the hip joint is already arthritic or suffering from cartilage erosion, the procedure will not be successful. Dr. Lane only recommends this procedure in patients who are severely disabled at a very young age.
Older dogs or dogs that have already developed arthritis
There are two main options for older dogs with severe hip arthritis, whether secondary to hip dysplasia or some other cause. Both procedures are considered “end stage” or “salvage” procedures, meaning that they are only to be performed on patients who have tried all the non-surgical options and are still experiencing a level of discomfort that prevents them from leading a normal life.
Total Hip Replacement (THR)
THR provides the best surgical result for arthritic patients. It involves replacing the arthritic hip joint with an artificial implant, just as is done in people.Although it provides excellent results, it is an expensive procedure.
THRs should especially be considered in larger dogs, or dogs where the owner desires strong athletic performance post-operatively.
Femoral Head Ostectomy (FHO)
An FHO involves converting the hip joint to a “false” joint; in much the same way that your shoulder blade is attached to your ribs purely through muscular support, the same is done to the hip joint by removing the head of the femur. By removing all bone on bone contact, arthritic pain is eliminated.
Cats and smaller dogs do extremely well with this procedure, leading full active lives. Bigger dogs also do well, especially those who are not overweight and have good muscling. Performing this procedure before advanced muscle atrophy and scarring has occurred greatly improves the outcome. Moderately active dogs are best suited for this procedure.
Very athletic, competition or working dogs are better suited for a THR if the owner is able to afford the procedure.
Although rehabilitation therapy is important for all orthopaedic procedures, it is especially important for this one and should be considered as important as the surgery itself. For more information go to Rehabilitation Therapy
Conservative treatment of hip pain or hip arthritis is very effective, and in most patients it provides enough comfort to eliminate the need for surgery. In fact, most dogs with hip dysplasia can lead fully active lives without surgery. It is not uncommon for hip dysplasia puppies to be very uncomfortable as they develop, but then go on to lead active, relatively pain free lives as adults.
The goals of treatment are:
- Eliminate discomfort from the hip joint itself
- Diagnose and treat all related conditions (eg: sacroiliac or muscular pain)
- Strengthen structures that support the hip joint
- Improve the strength or the remaining limbs and body core so that they may better compensate for the weak hip joints
- Develop a nutritional and exercise program to reduce the development of arthritis and improve the health of the joint
Commonly use techniques or tools include:
- Manual therapy– massage, stretching, mobilizations, breaking down of fascial adhesions etc.
- Veterinary chiropractic techniques to reduce pain and improve mobility of neighbouring structures
- Veterinary acupuncture to reduce pain and inflammation, and to strengthen muscular support
- Veterinary rehabilitation medicine programs to increase strength and flexibility
- Laser therapy to reduce pain and inflammation, and accelerate healing
- Nutritional supplements to improve the health of joint fluid and cartilage
- Prescription pain medication to alleviate discomfort