My Dog has Hip Dysplasia

The vet tells me the bad news, Sasha has hip dysplasia. I am so shocked she is only 10 months old. I go numb and I can hardly hear what he is saying after I hear those words. Its sounds really bad and he points to some xrays of her hips and explains why she has been sore, not able to jump into the car. All I can think is my poor little Sasha what does this mean? Does this mean an operation? Will she be like this for the rest of her life? or will I have to put her to sleep?

The vet puts his hand on my shoulder consoles me and tells me we have some options. I breathe a sigh of relief. I have so many questions.

I am not really sure what hip dysplasia is?
It is a condition which begins in immature dogs with instability or a loose fit of the hip joint.  This unstable motion of the hip stretches the fibrous joint capsule and soft tissues resulting in inflammation and pain. This irregular movement results in joint cartilage to be worn down which starts the arthritis cycle of inflammation, deposition of bone and more pain.

How did this happen? Is it something I did?
The causes are considered to be multifactorial. The may be due to genetics as well as environmental factors e.g. trauma, excessive nutritional intake resulting in rapid growth and excessive exercise.

Is she not too young to have hip dysplasia?
The incidence of hip dysplasia is greatest in large breed dogs and we normally see two populations of animals showing clinical signs of lameness: (1) patients 5 to 10 months of age, and (2) older patients with chronic degenerative joint disease.

How would I know my pet has this condition?
Lameness or decreased weight bearing on one or both hind limbs
reluctance to rise or jump
shifting the weight to the forelimbs which may be associated with a forelimb lameness
loss of muscle mass on the hind limbs
Pain when the hips are extended (pulled backwards)
Hip dysplasia waddle: dog walks with a swagger from side to side.
Running skew: not able to hold a straight line

What now? What are my options?

Previously the options for treating this life long condition were either medical or surgical but with the latest advances and research in Veterinary Physical rehabilitation and therapy we are fortunate that there is lots more than can be done for your pet with lasting and successful results. In most cases surgery may not be needed and medical treatment may only be needed at certain times. The use of the underwater treadmill and therapeutic exercises target the correct muscles and help with activating the extensor muscles. Our main goals are 1) pain control (acupuncture, massage, medications conventional and natural) and 2) strengthening long term.

What movements are painful for her?

Dogs with hip dysplasia find it painful when their leg is extended (straightened or pulled backwards). This movement is very important as it is the way the animal propels their body forward. They also need to extend their hips when they get up from a seated position and to jump. To compensate for the pain they will shift their weight onto one of the other legs or use their back to advance their hips and this results in the classic hip dysplasia waddle. This compensation has disastrous consequences –(arrow) wastage of the extensor muscles.

What are the consequences of this muscle wastage?

Firstly these muscles are the weight bearing muscles and are needed to be able to stand and walk for long periods of time. They are what we call slow twitch muscles or endurance muscles. They span over the hip joint and essentially form a support for the joint. When they are flabby or poorly developed the hip has no support and thus making it more unstable. If we strengthen these muscles it forms a firm support for the unstable hip joint. With less instability we have less pain. With less pain we extend the leg better. With extension we maintain the extensor muscles which continue to support the hip.

But I take my dog for a walk every day isn’t this enough exercise?

Moderate exercise daily on lead and controlled is very important in the rehabilitation of the hip dysplasia case. Your dog will however quickly slip back into its compensatory patterns and this means she will not be using the right muscles. We need to remind the body to activate the correct muscles otherwise we will continue to get muscle wastage and therefore no support for our unstable hips.

Why can’t I just give her anti-inflammatories and painkillers, wont she then have no pain and use her legs better?

Long term use of anti-inflammatories have sife effect eg gastric ulceration, alterations in liver and kidney function. These tablets put out the fire and will help in the short term but it is not a long term solution because the joint will still be unstable and that will result in more pain. Strengthening is the long term solution.

How do we activate the right muscles?

Aquatic therapy and therapeutic exercises.
In cases with hip dysplasia we recommend the underwater treadmill. The water results in decreased weight bearing. At the level of the shoulder dogs weight is reduced by 62%. The underwater treadmill results in extension of the hip with decreased pain. The pressure of the water on the legs and muscles activates the extensor muscles to contract. This muscle activation occurs while they are in the treadmill and for periods of time when they are out the treadmill. When you take your pet for a walk she will be using the right muscles.

My pet swims in my pool, will this help?

Yes it will help with overall fitness but it does not isolate the correct muscles we are trying to strengthening. Swimming is more targeted towards the flexor muscles. In order to strengthen the extensor muscles we need weight bearing.

Will my pet be able to go for long walks again?
Yes but only once she has strengthened up.

What are the medical and surgical options?

1. Conservative or Medical – Painkillers and anti-inflammatories

• Control weight
• Joint supplements
• Moderate exercise
• Changes to environment

2. Surgical – dogs less than 1 year of age with no osteoarthritis
Triple pelvic osteotomy: This procedure involves cutting the pelvic bone in three places and rotating it to stabilize the hip joint and in many cases slow the progression of osteoarthritis (not done often anymore)
Mature dogs
Femoral head amputation: This procedure involves removing the head of the femur and all the cartilage. You essentially form a false joint. Fibrous tissue forms around the area and forms support for the leg. It is important for these cases to use the leg as soon as possible. If they don’t, their ability to move the leg is hindered and their gait will be altered causing secondary arthritis and problems elsewhere in the body. This is a salvage procedure and should only be done when a dog is very lame and painful.
Total hip replacement: this procedure is to replace the cartilage of the socket with a polyethylene socket, and the femoral head with a metal prosthesis. Most patients have an excellent return to function. This procedure is very expensive and is only indicated if the patient has continuous lameness where rehabilitation has not been successful.

I am so glad we have so many options? What is the first step?

You need to find a veterinary rehabilitation practitioner in your area who is qualified to give you the correct advice and your pet the right treatment. They will do a full orthopaedic and rehabilitation examination on your pet including muscle mass measurements. They will then give your pet a tailor made rehabilitation program including acupuncture, underwater treadmill, therapeutic exercises and your pets environment. Your local vet will have a list of these practitioners.