Understanding (Causes and Treatment) of Hip Dysplasia in Dogs

Hip Dysplasia in Dogs–When Something Doesn’t Quite Sit Right 

Hip Dysplasia in Dogs is the most prevalent disorder of the hip joint. Hip Dysplasia (HD) is due to the faulty development of either the head of the femur bone or the acetabulum of the hip or both. 

hip dysplasia in dogs
From Tara Hatch: “The amputated forelimb of a puppy supposedly born with a deformity. The leg was amputated at 9 weeks of age as it was causing pain and discomfort. The puppy recovered well and is doing great on three legs, however, it was discovered just a week later that he has terrible hip dysplasia- currently being managed well. The pup was adopted by a vet so is in the best hands 😇

The aforementioned structures form the ball and socket joint of the hip and need to fit together precisely, or over time, the joint degenerates resulting in osteoarthritis.

Are Certain Canine Breeds Disposed to Hip Dysplasia?

Almost all breeds are at risk of developing Hip Dysplasia but those most commonly affected are large to giant breed dogs. Hip dysplasia in small dogs is uncommon, but it can occur. 

Hip Dysplasia has a complex inheritance pathway, and multiple genes and environmental factors play a role in the manner in which the genes are expressed and ultimately if the development of dysplastic hips will occur. 

Dog breeds such as Labrador retrievers, Golden Retrievers, German Shepards, Bulldogs, Saint Bernards, and Rottweilers are a few breeds that are predisposed to HD. Although large, mixed-breed dogs often adopted as “rescues” have uncertain backgrounds and poor nutrition, they also have a high risk of developing Hip Dysplasia. 

At birth, a “normal” dog will have normal hip joints. However, if the joint develops laxity or instability early on in life, changes such as flattening of the head of the femur or a shallow acetabulum initiate osteoarthritis and joint degeneration.

Key factors that play a role in the potential development and severity of Hip Dysplasia in dogs can be summarized as follows:

  • Breed predisposition or affected parents (genetics)
  • Nutrition 
  • Weight and growth rate 
  • Exercise 
  • Hormoneswhile

What Are The Signs And Symptoms Associated With Hip Dysplasia in Dogs?

The clinical signs and symptoms of hip dysplasia in dogs can vary significantly. Some dogs may only show subtle signs of discomfort, while others could develop a severe and sudden onset of pain. If symptoms are not obvious, then the signs only develop later on.

Two presentations of hip dysplasia are often seen, namely:

  • A juvenile or severe form
  • Chronic form

The juvenile form is usually seen in dogs between five to 12 months of age with symptoms that appear suddenly and may include:

  • Lameness in either one or both hind legs.
  • “Bunny-hopping” – which is a term used to describe a dog’s movement whereby both back legs are lifted simultaneously like a bunny. This is often seen when walking, running, or climbing stairs.
  • Difficulty when standing up after resting. 
  • Exercise intolerance where your dog does not want to run or play.

These signs are thought to be due to significant joint laxity that in turn causes possible tearing and stretching of the joint capsule, ligaments, and muscles, which results in inflammation. The rim of the acetabulum can also undergo micro fractures. 

The chronic form is more common and has a variable array of clinical signs in mature dogs. Older dogs that have undergone long-term changes in the joint may have had subtle symptoms at the beginning that become more obvious as they progress in severity due to degenerative joint disease. Signs seen in older dogs include:

  • Intermittent lameness in either one or both hind legs.
  • Stiff pelvic limbs, especially after resting or exercise.
  • Difficulty in standing up when seated or lying down.
  • Exercise intolerance or difficulty walking, jumping, and running.
  • Weak hind leg muscles and back leg splaying when walking on slippery surfaces.
  • Crepitus – a term used to describe the clicking or crunching sound felt or heard in the joints.

Available Treatment Options For Canine Hip Dysplasia

Options of treatment for Hip Dysplasia in dogs can be grouped into the following two categories:

  • Non-surgical management 
  • Surgical management

Non-surgical management of osteoarthritis that occurs due to HD is also known as medical management. The treatment provided is referred to as palliative as it addresses the pain but not the cause of the joint instability. The objective is to reduce the signs of pain and improve mobility to slow the progression of arthritis.

A multimodal pain relief approach is ideally applied and includes the following elements:

Nutrition- The correct diet with nutritional additives and high-quality proteins is critical in HD’s supportive management. Specifically formulated diets ensure your pet stays at a healthy body condition score and provide additional nutritional supportive ingredients for joint health. See the discussion below on vet-recommended diets.

Physical Therapy- The application of physical therapy is critical as it provides the continued support and development of muscles around the hip joint. With decreased activity due to pain, muscles begin to deteriorate or atrophy, and then the hips, as well as the knee joint and spine, will become affected and the progression of lameness and stiffness will become compounded.

Dachshund receiving physical therapy

Keeping your pet mobile and preventing muscle degeneration helps to slow down the progression of arthritis. All physical activity should bear moderation in mind. As a pet’s primary caregiver, one needs to make a concerted effort to moderate activity – do not encourage too much activity and do not allow too little movement. 

Animal physiotherapists are trained to help provide pets with exercise regimes designed specifically for their problem conditions. Contact your vet or physiotherapist to schedule a consultation to discuss and detail the best regime that will help target your pet’s specific muscle groups that are degenerating due to Hip Dysplasia.  

Medication 

Any medication that a veterinarian prescribes will have different effects for different pets. It is important to bear this in mind because there is no quick fix for arthritis; there is no cure. Medications prescribed for the treatment of hip dysplasia simply slow down the progression of symptoms and provide relief of pain.

Medications have different side effects, and your pet’s overall health and degree of pain will help determine what is prescribed. In addition, the chronic use of any medicines has specific implications on kidney and gastrointestinal health and activity levels or sleeping patterns. 

Pain also has multiple pathways, and as the symptoms progress, more medication may need to be added.

Common medications prescribed include:

  • Non-steroidal Anti-inflammatory Drugs (NSAIDs) 
  • Gabapentin 
  • Steroids
  • Opioids 

Below is an example of a young puppy conservative management protocol that would be applied if the patient was presenting at five to six months of age with hip pain and lameness.

Conservative management of pain with NSAIDs as needed is the first step, as well as encouraging the hip to stabilize by:

  • Limiting exercise to several regular leash walks of 10-minute intervals per day for six weeks.
  • If the response is good, continued controlled exercise is advisable until the pup is at least 12 months. After the first six weeks, longer periods of activity can be given (20-30 minutes at a time).
  • Swimming or underwater treadmills are also helpful exercises as they are low-impact ways of building up muscle mass to support the hips.

If the conservative management does not yield good results within six weeks, surgical management must be considered. Surgical management of Hip Dysplasia in dogs can be daunting but rewarding if your pet is the correct surgical candidate. 

The following procedures will be taken into consideration when determining the best treatment for your pet:

Triple Pelvic Osteotomy

This involves three cuts into the bone around the hip joint, called the acetabular segment of the pelvis, to alter the angle of the joint. A plate is then fixed into a position that ensures that the head of the femur is covered more effectively and that the joint is more congruent. The correct surgical candidate is:

  • Aged between five to nine months (some exceptions may be considered).
  • Clinically lame.
  • Has no secondary evidence of osteoarthritis on x-rays. 
  • Good conformation of the acetabulum as assessed by an Ortolani test.

Femoral or Intertrochanteric Osteotomy

This involves removing a wedge of bone from the femur, which changes the angle of the femur neck and allows it to fit more snugly into the acetabulum. Surgical candidates include patients that:

  • This technique is applied when a condition known as coxa valga occurs, whereby the hip angle of inclination is greater than 150 degrees. 
  • Dogs aged between nine and 15 months. 
  • This technique is very technical and not done as often as TPOs.

Total Hip Replacement Surgery

Total Hip Replacement surgery is performed in very severe cases, and it provides an artificial,  pain-free joint to facilitate normal biomechanical function. The surgery involves removing the top portion of the femur and replacing it with an artificial femur head and neck inserted into a dense plastic cup that acts as the joint’s articular surface.

Single or double hip replacements are possible, but it is costly, and the recovery requires intensive care and physiotherapy. This procedure is referred to as the golden standard when dealing with severe forms of hip dysplasia in dogs as it offers the best possible outcome. Still, due to financial or specialist constraints, it is not always feasible.

Femoral Head and Neck Ostectomy 

This procedure is referred to as a salvage procedure and is only done when there are either no other appropriate surgical techniques suited to a candidate, lack of specialist referral facilities, or financial constraints. 

The head of the femur is removed, essentially removing the ball part of the ball and socket joint. This, in turn, alleviates the pain that results from the abnormal bone contact in dogs with hip dysplasia. The surrounding muscles and scar tissue that forms post-operatively act as a false joint that supports the hips.

A femoral head and neck ostectomy (FHO) can be performed on either one or both sides, depending on whether both or only one hip joint is affected. Suppose there are any other underlying problems or previous procedures such as cruciate injuries or instability. In that case, FHO procedures must be carefully considered as multiple orthopedic complications have a more guarded prognosis.

The FHO procedure does affect a dog’s gait as the leg does become somewhat shortened, but it does provide significant pain relief. Any orthopedic procedure will have after-effects on how your pet moves, but they will adapt if they are comfortable. If your pet is not coping well after surgery, they must return for their follow-up consultations.

How You Can Prevent Hip Dysplasia in Dogs

The best prevention of hip dysplasia in dogs is informed decisions. As a primary caregiver, informed decisions and insight into your pet’s health is the most crucial step in preventing hip dysplasia. All dogs are born with normal hips therefore, the actions taken by owners during early development are pivotal.

Critical points in preventing canine hip dysplasia are:

  • Know your breed- ask your breeder for hip certificates or inquire about the health of your puppy’s parents or grandparents. Large breed dogs are at higher risks, so be aware of their special needs from the start.
  • Provide your puppy with good nutritional support, high-quality protein, and the correct vitamins and minerals. Do not supplement large breed puppy food with Calcium or bone meal. 
  • Feed your pet the right amount of food and monitor their weight to avoid over conditioning. 
  • If your pet shows any signs of lameness or pain–take them to a vet to be examined. Early detection and treatment or key when delaying the progression and severity of hip dysplasia.
  • Do not over-exercise young, fast-growing dogs. Rather wait until they are skeletally mature before introducing them to strenuous exercise.

How Vets Diagnose Canine Hip Dysplasia

A good clinical history and early signs or symptoms detection are most important when determining if your pet is predisposed or suffers from hip dysplasia. Your vet will first start with an in-depth clinical exam of your pet’s hind limb joints and muscles, as well as a review of your pet’s activity levels and nutrition – so always be prepared to discuss these with your vet.  

Should your puppy show signs of hip dysplasia early on during initial health checks or if your older dogs begin to show clinical symptoms, your vet will start with the following diagnostics steps to determine the severity of your dog’s hip problems:

Radiographs 

Radiographs or more commonly referred to as x-rays are the first step in assessing joint health.

X-rays are usually taken under sedation as they require your pet to be relaxed and easily maneuvered into very specific positions. 

The x-rays require several views to be taken. They are assessed most accurately by a specialist that can then provide a certified grading of the hip joint. Some primary care vets can also provide this service, but a specialist will be required to provide HD certificates for pedigree grading.

The PennHIP distraction method quantitatively measures hip laxity and is an accurate predictor of whether a puppy may develop hip dysplasia. It also helps to determine what appropriate surgical approach is best suited to the patient.  

X-rays in young dogs can be critical as they can help prevent the progression of a debilitating condition. 

X-rays in older dogs who already have hip dysplasia can help monitor the progression of the disease and help determine the best surgical options for a patient. X-rays also provide insight into which types of conservative pain management techniques would best provide relief to a patient with hip dysplasia. 

Palpation Method

The palpation method is called the Ortolani Sign and also requires light sedation in puppies or during primary health care checks for young puppies aged between 2-3 months. It is just a general indicator of whether or not a puppy may develop joint changes due to joint laxity. If a puppy does not have the Ortolani sign, it does not rule out the possibility of underlying hip dysplasia. 

The Outcomes For A Dog With Hip Dysplasia

The outcome for a dog with hip dysplasia is determined by the severity and the duration of the condition.

For young puppies, the outcome is very good if the signs and symptoms are detected early and appropriate actions are taken to prevent the progression of the disease.

For older dogs with Hip Dysplasia, the outcomes will vary depending on the course of treatment taken. However, if they are potential candidates for surgery, they will have a pretty good prognosis if all the appropriate post-operative instructions are followed.

If conservative or medical management is opted for, then the prognosis is dependent on the animal’s quality of life. Treatment aims to manage symptoms and provide pain relief. Should your pet’s quality of life become adversely affected by these treatments, then the prognosis is guarded. 

NSAIDs and Alternative Treatments 

NSAIDs 

NSAIDs

Non-steroidal anti-inflammatory drugs provide pain relief by decreasing inflammation. NSAIDs do not cure arthritis; they simply slow down the progression of the disease. Pain relief is mild to moderate and is not ideal for chronic use. NSAIDs have adverse effects on the kidneys and the gastrointestinal tract. 

Pentosan Polysulphate

This is a nutraceutical drug injected into a patient initially once a week for four weeks and then monthly after that. Pentosan works very well in geriatric patients and provides additional joint support, and decreases inflammation.

CBD Oil

Although limited scientific data on using CBD oil is available, anecdotal evidence suggests that it provides significant relief of pain, especially neuropathic pain, and it also boasts anti-inflammatory properties.

Acupuncture 

Veterinary physiotherapists can provide your pets with some relief using gold beads implanted at acupoints which have been shown to relieve pain and reduce inflammation.

Effective Hip Dysplasia Exercises for Dogs

  • Controlled leash walks– short walks are essential addition,  especially if attempting conservative management of HD. Again, monitoring your dog’s response to exercise is necessary. 

If they are coping, the time and length of walks can be increased, but should they begin to show any lameness. Rest and reduction in walking time and distance is not a step backward. It is merely a step towards improved joint health.

  • Swimming- ensure that your pet can enter and exit the water comfortably to prevent any unnecessary strain on the joints.
  • Low impact agility training– tunnels and ramps that are not steep can also be used to develop muscles and keep joints mobile.
  • Underwater treadmill training– low impact and very effective for painful patients.
  • Range of motion exercises– a physiotherapist will provide a list of activities that help to improve and maintain range of motion in dogs with hip dysplasia. 

Vet-Recommended Diets for Canine Hip Dysplasia

The key to preventing Hip Dysplasia in dogs starts with the proper nutrition during their most critical development stages as puppies. This also means monitoring the quantity as well as the quality of the food they are fed. 

Large breed puppies need very specific phosphorus and calcium ratios in their diet while growing. Food supplemented with calcium or too high in calcium has a negative effect on several factors of the developing femur, thus increasing the degree and severity of hip dysplasia.

Reputable pet food companies invest millions into research and clinical trials to determine their consumers’ best possible nutritional formulations and provide the optimal ratio for growing puppies. 

The correct ratio of vitamins, minerals, and high-quality protein is vital. 

Therefore it is imperative to place large breed puppies on puppy food specifically formulated to meet their needs during their critical developmental window. Ad lib feeding is strongly discouraged, and over conditioning should be avoided at all costs.

In dogs that already have Hip Dysplasia – a vet will recommend a diet that contains the following added ingredients:

  • Omega 3 Fatty acids- decrease the production of inflammatory mediators and thus slow down the progression of osteoarthritis in the affected joint.
  • Chondroitin sulphate.
  • Glucosamine- HCl.

The Final Say

Hip Dysplasia in dogs can be supportively managed or even prevented if detected early. However, it is a frustrating condition with lifelong complications on a pet’s quality of life if left untreated. 

If something doesn’t quite sit right with your pet’s hind legs–it’s best to take action sooner rather than later.