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Hip Dysplasia

What is Hip Dysplasia?

Many of our clients ask if their dog has got hip dysplasia (HD). Hip dysplasia is a common inherited trait characterized by abnormal growth or development of the hip (coxo femoral) joint that results in hip laxity, subluxation and instability, abnormal wear, and even dislocation of the thigh bone (femur) from the socket in the pelvis. Hip dysplasia is known to occur in dogs, cats and humans.

Whereas this is regarded as an inherited disorder, recently it has been shown that it develops during the first weeks or months after birth. Consequently hip dysplasia may be regarded as congenital or developmental. Developmental hip dysplasia is also referred to as environmental HD. HD is common in many larger breeds of dogs however many breeders have worked hard to reduce the incidence of HD in their dogs. This has been achieved by having their dogs X-rayed and scored for hip dysplasia when they are young and before they are bred.

How do I know that my dog has HD?

Some dogs have HD and they go through life without showing much of a problem until they develop osteoarthritis (OA) when they are much older. Other dogs show signs when they are much younger around 16 weeks of age. Puppies often sit with their rear end slumped to one side, this is called puppy sitting. As they get older and stronger they should be able to sit straight and even. Dogs with HD often adopt the slouched puppy sitting position. Other dogs with HD are presented quite lame in one leg. Often one hip joint is much worse than the other. When both hips have HD the dog often runs using both legs together. This is known as bunny hopping and is always an indicator of a problem, some of which are not HD. Dogs with HD are weak in the hind limbs and will sit when challenged with downward pressure over the pelvis. Many of these dogs develop a spine wobble when they walk and eventually have an overdeveloped fore end. All HD dogs try and load off their rear limbs onto their front limbs. This is called front loading. These dogs invariably have trouble standing on their hind legs and avoid jumping over objects.

What happens if HD is not treated?

Because of the laxity in the hip joint there is a lot more wear of the cartilages which line the coxo-femoral joint. This can get to the stage that there is a distinct feel of bone on bone when the joints are examined and indeed the cartilages are worn to the extent that it is literally bone rubbing on bone. Sometimes you can hear a distinct "clunk" sound when the dog moves. The "bone on bone" feel is extremely painful for the dog and is consistent with the development of osteoarthritis.

How is HD diagnosed?

The dog needs to have an anaesthetic or a heavy sedation with pain control medication and an X-ray is taken with the dog lying on its back. There are some tests which can be carried out which give a guide to the severity of the condition. Hip joint laxity can be estimated with the Barlow manoeuvre and the Ortolani test. The Barden's sign is an estimate of maximum lateral passive hip laxity but is difficult to compare between studies and to measure accurately.
These methods are subjective and yield both false positive and false negative diagnoses in other words there can be a difference in interpretation between doctors performing the test.

Hip and elbow dysplasia grading schemes

Most dog breeders have the hips and elbows X-rayed with the aim of eliminating the problem of hip and elbow dysplasia. The films are sent away for a rating commonly to Dr Wyburn or Dr Lavelle in Australia. Measurements are taken and a hip grade and elbow grade are given. The dogs need to be mature or have finished growing. Good improvement has been achieved with this scheme. More recently the PennHIP program has been introduced into Australia. The main advantage of this program is that the likely hood of the dog having osteoarthritis as a result of hip dysplasia can be predicted much earlier in the dog’s life as early as four months.
The PennHIP™ radiographic method measures the maximum amount of lateral passive hip joint laxity (distraction index). There is a positive relationship between the distraction index and subsequent development of osteoarthritis.

Possible solutions for HD

Surgery

Often after a dog is diagnosed as having HD they are referred to a canine orthopaedic specialist for possible surgical intervention. There are various procedures offered such as a Total Hip Replacement which consists of replacing the hip joint. Other procedures include a Triple Pelvic Osteotomy and Juvenile Pubic Symphysiodesis. These latter procedures are often performed in younger dogs. When a dog is diagnosed with hip dysplasia and the cost of surgery is out of the question then it may be necessary to take a conservative approach in the face of possible euthanasia.

Conservative Hip Dysplasia Rehabilitation (CHDR)

Animal Options uses a 10 step protocol for CHDR. The results of this program have been very pleasing.

Get the dog out of pain; In some cases it may be necessary to use NSAIDs (non steroidal anti-inflammatory drugs) initially. This is reduced to an alternative pain control such as Traumeel which will allow healing as soon as practically possible.
Establish if one hip joint is much worse than the other by reviewing the films, or taking acceptable diagnostic X-rays.
Explain the principles of quadruped biomechanics and soft tissue changes in the growing juvenile.
Explain why dogs cope after hip arthroplasty and the importance of reducing movement in the coxo-femoral joint by selective exercises.
Start the dog on the supportive meds and carry out a chiropractic treatment to allow optimum body balance.
Carry out an acupuncture – dry needle treatment and introduce auriculotherapy for hip dysplasia
Start the dog on Small Animal Joint Formula & homotoxicologic supportive meds
Start the swimming program – vary time and frequency and monitor outcome
Control pain by using meds that will allow healing and strengthening
See the patient on a regular basis for chiropractic and acupuncture

Bilateral Hip Dysplasia in young dog 1 Severe cases, such as shown here can recover. X-rays show bilateral Hip dysplasia in a young dog. This dog has been totally rehabilitated by the 10 step protocol.

Author: Dr Rowan Kilmartin

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