Symptoms and treatment of hip dysplasia in dogs
What is hip dysplasia (CHD)?
Hip dysplasia in a common disease in dogs also known as Canine hip dysplasia (CHD). Canine hip dysplasia (CHD) is characterized by a loose and unstable hip joint.
To better understand Canine hip dysplasia (CHD), let’s look first at a dog’s hip joint. It attaches to the hind leg by means of a “ball and socket” joint. The ball portion is the head of the femur, the long bone between hip and knee. The socket, called the “acetabulum,” is located at the end of the pelvic bone. In a healthy dog without Canine hip dysplasia (CHD), the ball rotates freely within the socket. To facilitate movement, the bones of the ball are shaped to perfectly match those of the inside of the socket.
To strengthen the joint, the two bones are held together by a ligament that runs directly from the ball into the socket, where it attaches to the inside. Attaching to both bones and completely encircling the joint is the joint capsule, a thick band of connective tissue that holds the bones together. The area where the bones actually touch each other is called the articular surface. It is perfectly smooth and cushioned with a layer of spongy cartilage. In the normal dog, all these parts work together for smooth and stable joint function.
Canine hip dysplasia (CHD) affects the development of the hip joint in a young dog. It results when the muscles and connective tissue (including the ligaments) are lax and weak, losing their ability to properly support the ball and socket joint. Dogs with Canine hip dysplasia (CHD) are born with normal hips but develop the condition as they mature, usually due to a genetic predisposition towards the disease. Canine hip dysplasia (CHD) may affect one side of the hip only, or both (bilaterial CHD).
Due to the weak supporting structures, the two bones of the ball and socket joint are not held in place and actually move apart. The joint capsule and the ligament between the two bones stretch, causing the joint to become unstable. As a result, the surfaces of the two bones lose contact with each other. The slight separation of the two bones of the joint is called “subluxation,” which leads to all of the problems associated with Canine hip dysplasia (CHD).
When the two bones within the joint lose their normal position in relationship to one other, their articular surfaces no longer contact each other in the correct way. The surrounding muscles of the dog’s joint attempt to force the bones back together but the result is never completely successful. Due to the weight of the dog with Canine hip dysplasia (CHD), the femoral head (ball) often “rides up” against the rim of the hip socket, causing both bone surfaces to be worn away so that they no longer have a perfect fit. With every movement of the dog’s leg, these two abnormal areas of bone now grind against each other instead of contacting on a smooth articular surface.
Breeds that are likely to develop hip dysplasia
The following breeds have a genetic predisposition towards developing Canine hip dysplasia (CHD)
Signs that your dog may have hip dysplasia
Early diagnosis of Canine hip dysplasia (CHD) will give you the best opportunity to address the problem in your dog and minimize the secondary arthritic changes that can occur in the hips. Be aware of the clinical signs of Canine hip dysplasia (CHD) 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.
The following are signs that your dog may have Canine hip dysplasia (CHD). Always check with a veterinarian if your pet displays any of these behaviours.
- Rear limb lameness, particularly after exercise.
- Difficulty or stiffness upon rising or climbing uphill.
- A “bunny hop” gait (moving both rear legs together).
- Rising using front legs only and dragging rear end.
- Waddling rear limb gait.
- A painful reaction to extension of the rear legs resulting in a characteristic short stride.
- A side-to-side sway of the croup (area of the back above the hind legs and in front of tail.)
- Tendency to tilt hips down when pressure applied to rump.
- Reluctance to jump, exercise or climb stairs.
A puppy with Canine hip dysplasia (CHD) usually starts to show signs between five and 13 months of age. Symptoms of Canine hip dysplasia (CHD) range from mild discomfort to extreme pain when the affected dog uses the hind limbs and will occasionally be seen following prolonged activity or when the dog gets up or lies down. Later in life the signs of Canine hip dysplasia (CHD) become more consistent and occur daily regardless of activity levels. Adult dogs that are in severe pain will usually decrease their activity. They are unwilling to run or climb stairs and, with decreased use, the muscles of their rear legs weaken. Some dogs learn to alter their gait and posture, often showing little or no signs of discomfort even when bone changes are severe.
The only way to accurately diagnose Canine hip dysplasia (CHD) is through X-rays. (Note – The above symptoms may also be seen in dogs with normal hips; conversely, dogs with Canine hip dysplasia (CHD) may show none of the typical symptoms).
Treatment options for your dog with CHD
The treatment for Canine hip dysplasia (CHD) is geared towards inhibiting further breakdown of the hip joint and decreasing the pain your dog is experiencing. 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. Management of the Canine hip dysplasia (CHD) usually consists of exercise restriction, body weight management and symptomatic pain management with analgesics and anti-inflammatory drugs.
Analgesic and Anti-inflammatory medications – Ideally, these should only be used for the short term, when necessary to encourage movement. Although your pet may respond quickly to anti-inflammatories, this is usually because they are quelling pain, and not because the condition itself is improving. In most cases these medications act simply as painkillers, and should only be used in addition to lifestyle modifications including weight control and good exercise management.
Commonly prescribed analgesics and anti-inflammatories include various NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen.
For mild to moderate canine hip dysplasia (CHD) in dogs, your veterinarian may recommend acetaminophen (Tylenol®, Panadol®, Exdol®, etc.) to relieve pain. Since acetaminophen is only a pain reliever and has no anti-inflammatory properties, it can generally be safely combined with anti-inflammatory medications when recommended by a veterinarian.
Too-high doses of acetaminophen can cause liver damage. You should therefore seek a veterinarian’s advice before administering acetaminophen. Acetaminophen is toxic to cats.
NSAIDs are a type of medication that helps reduce pain and swelling of the joints and decreases stiffness. When taken at a low dose, NSAIDs reduce pain; when taken at a higher dose, NSAIDs can also reduce inflammation. NSAIDs such as ASA (Aspirin®, Anacin®, etc.) can be purchased without a prescription. NSAIDs do not prevent joint damage and when used over the long-term, may accelerate joint breakdown. Taking more than one NSAID at a time increases the possibility of heartburn and severe side effects such as ulcers and bleeding. (Special buffered ASA is available for dogs.) The newer sub-class of NSAIDs called Cox 2 Inhibitors includes (Rimadyl® (carprofen), Metacam® (meloxicam) and Etogesic® (etodolac). Ibuprofen is toxic to a dog’s kidneys.
Cortisone is a corticosteroid that reduces inflammation and swelling. For severe pain and inflammation, veterinarians may inject a corticosteroid, such as cortisone, directly into the affected joint. Cortisone mimics the anti-inflammatory effects of cortisol, which is a hormone naturally produced by the body. Although corticosteroids closely resemble cortisol, they exert a much more powerful anti-inflammatory effect. An injection can provide almost immediate relief for a tender, swollen and inflamed joint.
Visco-supplementation is the process of injecting a gel-like substance into the joint. This substance lubricates the cartilage, reducing pain and improving flexibility. Visco-supplementation decreases friction within the joint, thus reducing pain and allowing greater mobility. This method of treatment requires ongoing injections as benefits are only temporary. Substances used in visco-supplementation include hyaluronic acid, or HA (Legend®, Hylartin® and Synacid®), and poly-sulfated glycosaminoglycans (PSGAGS) such as Adequan®
Other ways to help your pet
Recovery®SA with Nutricol®, is an elite proprietary performance and wellness supplement for small animals that enhances quality of life. Recovery®SA improves healing by increasing circulation of nutrients to affected cells and extracellular structures, halting tissue damage and modulating inflammation. It may be used in combination with prescribed medications. Always consult with the veterinarian prior to adding a new natural lifestyle supplement to an animal’s feeding program.
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Recovery® rated as “Best Performer Overall” as a pain-relieving supplement for joint pain, back pain and tendonitis – comparison of natural joint care supplements.
Review in the prestigious Horse Journal in June 2006
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Refer to Tips for a Healthier Pet
Understanding surgery for hip dysplasia/CHD
While every attempt is normally made to manage a pet’s pain through lifestyle adjustments and use of anti-inflammatories and painkillers, it may sometimes be necessary for surgical intervention. This is particularly true for older dogs.
Femoral Head Ostectomy (FHO)
In this procedure, the damaged rough-edged head (ball) of the femur is removed. The remaining part of the femur forms a false joint with the muscles, ligaments and tendons in the area. Even though this false joint is not as good as a real joint, a significant reduction in pain is the usual outcome. While almost any size of dog can undergo this procedure, it is much more effective in smaller dogs. Obese animals and those with significant loss of muscle do not usually fare as well. FHO is a fairly simple procedure, yet pets that have this surgery may return to almost normal function. The false joint that results is considerably smoother and allows for walking, running and playing. However, the new false joint is not a normal joint. It may exhibit decreased hip extension; the dog’s gait is different, but the joint is “pain-free”.
Triple Pelvic Osteotomy (TPO)
In young dogs, the preferred surgery of is a triple pelvic osteotomy (TPO). Candidates for this surgery must have little to no evidence of arthritis on a hip x-ray and have adequate depth to the affected hip socket/s. 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 usually performed on both sides, if appropriate.
Total Hip Replacement (THR)
If the hip joint is problem behind poor use of the hind leg, replacement with an artificial ball and socket offers the best possibility for return to normal function. The standard hip replacement is ideally performed in mature dogs, preferably not less than two years of age. The dog’s bones must be mature enough to hold the implants and reduce the likelihood of further surgeries. In this procedure the neck and head of the femur (ball) are replaced with stainless steel or titanium implants. This is a highly specialized procedure performed only by select veterinarians. Unlike the TPO procedure, THR can be used in dogs that have secondary arthritis. Although THR has a high success rate, the surgery must be performed carefully to reduce the risk of postoperative complications.
Some young dogs may have too shallow a socket for a TPO, but are too young to be ideal candidates for a total hip replacement. In such a case, your veterinarian may suggest “darthroplasty.” During this operation, a shelf of bone is created over the rim of the socket. This bone fuses in its new position and stops the ball from sliding in and out of the shallow socket. This is a relatively new surgery, but in carefully selected cases may produce good results.
Post surgical follow-up
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 using a leash to take him/her to the bathroom. If necessary, a towel can be placed under the tummy, as a sling, to assist in walking during the early phase of healing.
Dogs that have undergone FHO are a little different in that early physiotherapy should be encouraged. If the dog does not use the leg much following surgery, scarring will restrict range of hip motion and leg function. Your veterinarian may demonstrate passive range of motion exercises to help flex and extend the hip following surgery, maximizing 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 recover faster than others.
In the case of TPO and THR, most dogs will be using the leg well at six weeks. In dogs that have undergone FHO, full recovery may take a few weeks to a couple of months. (Function will at best be 80 to 85 percent of normal, but your dog will be able to run, walk and play and be pain-free for these activities.)
Dogs with TPO or THR may 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.
For more information on helping your pet stay healthy, please see Tips for a Healthier. Dog