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Hip dysplasia

Canine hip dysplasia (CHD) is a developmental trait primarily affecting medium and large breed dogs and is characterized by instability of the hip joint that usually affects both hips .Dogs at high risk for  developing CHD include German Shepherds, Saint Bernards, Alaskan Malamutes, Bulldogs, Boxers, Collies, Old English Sheep Dogs, Golden Retrievers, Labrador Retrievers and Rottweilers. CHD may be detected on x-rays as subluxation of the femoral head in affected hips in young dogs and as osteoarthritis in hips of older dogs. Hip subluxation causes joint inflammation and osteoarthritis of the affected joint, resulting in joint pain and lameness.  There are several factors the predispose dogs to CHD including environmental and genetic factors. Symptoms of hip dysplasia include difficulty rising, a decrease in activity, a failure to climb stairs or get into the car and running with the rear legs together, commonly referred to as “bunny-hopping”.  The diagnosis of hip dysplasia starts with a thorough physical exam which rules out other causes of the clinical signs and supports the suspicion of hip dysplasia.  Confirmation of the diagnosis involves palpation with mild sedation and hip x-rays.

TREATMENT

Medical management

Some dogs diagnosed with hip dysplasia at an early age do not develop osteoarthritis or will have minimal clinical signs later in life that can be managed successfully with medical management. The goal of medical management is to alleviate the pain and discomfort of hip dysplasia and therefore preserve the function for as long as possible.. This is achieved by following four steps. 1) The more weight an animal carries the more stress on the joints. It is therefore important to keep your pet from being overweight. In general one should be able to palpate the ribs of the dog without the ribs protruding out. 2) Moderate activity is recommended. It is important to maintain good musculature over the hip joint. Restricting the activity level will result in muscle atrophy while excessive activity will cause your pet to become lame and stiff. 3) The use of nonsteroidal anti-inflammatories (NSAIDs) will help control the symptoms associated with hip dysplasia. Commonly prescribed NSAIDs include aspirin, Rimadyl, Etogesic and Deramaxx. Please consult with your veterinarian before using any of these products. 4) The use of oral slow acting disease modifying  agents (SADMA) such as COSEQUIN or Adequan may be beneficial in slowing the progression of osteoarthritis.

Surgical Options:

Juvenile pubic symphysiodesis (JPS)

The Juvenile pubic symphysiodesis is technique, which destroys the growth potential of a portion of the pelvis. This will result in an increase rotation of the pelvis and improved coverage of the acetabulum (socket) over the femoral head (ball). This procedure is ineffective in dogs older than 20  weeks of age therefore early detection is necessary. It is recommended, if you have a “high risk breed”  to have your dog examined for hip laxity at or before they turn 16 weeks.

Triple Pelvic Osteotomy

The triple pelvic osteotomy (TPO) is an early intervention procedure designed to correct the laxity in the hip joint, which could lead to osteoarthritis later in your dog’s life.  The TPO involves making three cuts in the pelvis (pubis, ischium and ilium) in order to rotate the acetabulum (socket) portion over the femoral head (ball portion of the joint) in order to provide better coverage and prevent the laxity within the joint. The ilium cut (controlled fracture) is repaired and secured with a special bone plate.  It will take 8-10 weeks for the fracture to heal. For this procedure to be successful there are specific criteria that must be met. 1) Absence of osteoarthritis on the x-rays. 2) Moderate subluxation of the femoral head on the x-rays 3) Presence of symptoms associated with the hip dysplasia.

Femoral head and neck ostectomy (FHO)

The femoral head and neck ostectomy (FHO) is a salvage surgical procedure used once medical management is no longer effective. The FHO involves cutting the femoral head off and discarding it. The remaining joint space will fill with a very dense, fibrous scar tissue, which will provide a type of padding between the hip and the femur. This will results in a generally pain free movement of the affected limb.  Pain is caused when the exposed bone of the femur grinds with the exposed bone of the acetabulum (arthritis causes the destruction of cartilage thereby exposing the bone).  The padding of the scar tissue will therefore eliminate the discomfort your pet is experiencing. This procedure works best for cats and small dogs (less than forty pounds). Larger dogs will do better with a total hip replacement.

Total hip replacement (THR)

The total hip replacement is a surgical procedure, which involves replacement of the arthritic joint with an artificial joint. The THR is also a salvage procedure, which should be considered once medical management is no longer successful. This procedure is typically performed on older dogs with severe hip osteoarthritis. There are two types of hip replacement systems available, the cement hip and the non-cement hip. The THR has a success rate of 85-95%, with most dogs resulting in outstanding clinical function and quality of life.  Some of the complications of the procedure include high cost (approximately $4500 per hip at this time), infection, luxation and loosening of the implant. Because dogs have a shorter life span than humans, most implants will never have to be replaced.

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