Hip Dysplasia

Hip Dysplasia is a common condition, especially in large breeds, that often leads to pain and lameness. Given its prevalence and considerable impact on a dog’s life, it should be taken seriously. Fortunately, there are many things you can do to help keep your dog active and comfortable despite the condition.

What is Hip Dysplasia?

The hip joint consists of the acetabulum (the concave socket in the pelvis) and the femoral head (the ball on the femur), as well as cartilage to ensure easy movement and several muscles to support and move the joint. A normal hip joint has a snug but smooth fit, allowing for pressure to be evenly distributed throughout the joint. Dysplastic hips develop abnormally, leading to laxity between the acetabulum and femoral head which then causes excess wear and tear. The body tries to stabilize the joint by developing Osteoarthritis but this further contributes to the pain a hip dysplasia patient experiences.

Who is affected?

Hip Dysplasia is most common in large and giant breeds, especially Labrador Retrievers, Golden Retrievers, German Shepherd Dogs, Saint Bernards, Old English Sheepdogs and Bulldogs, but it can occur in any breed or mix.

It is a genetic condition, but there are additional factors that can increase risk or severity such as nutrition, exercise, and weight.

Body weight has been shown to be the most significant variable. Early spaying/neutering may also increase risk.

How is it diagnosed?

Some dogs will show symptoms of Hip Dysplasia at a very young age, while others won’t until they are much older. Signs of Hip Dysplasia include:

• Stiffness

• Weakness

• Limping

• Abnormal gait

• Difficulty rising, laying down, or sitting

• Reluctance to use stairs

• Thigh muscle atrophy

• Enlarged shoulder muscles

• Pain

Radiographs (x-rays) are the easiest way to assess a dog for Hip Dysplasia, but proper positioning and the age of the dog can impact the accuracy of hip radiographs.

If the radiographs are not definitive, sedation may be recommended to get better quality images and having the radiographs performed by a Veterinary Orthopedic specialist can be helpful as well. Ask your veterinarian if they regularly perform OFA (Orthopedic Foundation for Animals) and/or PennHip (University of Pennsylvania Hip Improvement Program) radiographs, as the technique for these has been proven to be the best for accurate imaging. 

Your veterinarian should also evaluate your dog’s gait, range of motion, and musculature. As the hips become more painful, dogs will use their front legs to compensate by shifting more of their weight forward and off of the hind legs. It is also common for them to have an exaggerated sway of their rear end because they are using their back to swing their front legs forward instead of the muscles that move the hip. When they avoid moving their hips due to pain, their Range of Motion will decrease and the muscles of the hind legs will atrophy. 

Treatment varies pending the severity of dysplasia and level of pain it causes.

Some dogs can get by with Physical Rehabilitation Therapy and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) as needed, while others require orthopedic surgery to address their pain and loss of mobility. Symptoms usually worsen as the dog ages because more osteoarthritis will have formed and increased pain leads to less activity and thus atrophy of the muscles that support the joint.

Surgical Treatments

Surgery isn’t always required for a dysplastic dog to have a comfortable and happy life, but it can be a game changer for dogs with moderate to severe Hip Dysplasia. There are 3 surgeries available to treat this condition.

Femoral Head Ostectomy (FHO)

This is the most commonly performed Hip Dysplasia surgery because it is less complicated, less expensive, and has a better success rate with fewer complications. An FHO consists of removing the femoral head, or the ball part of the joint. The muscles and ligaments around the joint will then take over, creating a “false joint”.

Since the limb will be supported exclusively by soft tissues, Physical Rehabilitation Therapy will be of utmost importance in order to maintain strong hip muscles. Recovery from this procedure is typically around 6 weeks, with active pets often recovering better than inactive ones. As FHO patients age and normal age-related muscle loss occurs, they often return to Physical Rehabilitation Therapy to rebuild those hip muscles that are essential for mobility.

Total Hip Replacement (THR)

This is a good option for dogs with multiple compromised limbs or another medical condition that might interfere with the ability to build the muscle required for a successful FHO.

Much like the human hip replacement, this surgery involves removing the dysplastic parts of the joint and replacing them with artificial implants. A metal implant is used to replace the femoral head and a plastic implant replaces the acetabulum. THR should only be used on dogs that are fully mature and have finished growing. Recovery from this procedure is typically around 3 months, with exercise restriction being integral to boney healing in the early stages. Physical Rehabilitation Therapy will improve this patient’s recovery by safely reintroducing exercise and rebuilding lost musculature.

Double or Triple Pelvic Osteotomy (DPO/TPO)

Because hip dysplasia causes excess laxity in the joint, the femoral head can dislocate from the acetabulum. The pelvis consists of four bones that fuse together at maturity. This surgery involves 2-3 incisions and 2-3 cuts into the pelvis to manipulate those bones before they have fused to better surround the femoral head, thus preventing it from dislocating. Because this surgery must be performed before the pelvic bones have fused together, it can only be used on young dogs with minimal osteoarthritis formation. Recovery from this surgery can take around 4 months and activity restriction will be extremely important while the pelvis is healing. Physical Rehabilitation Therapy will improve this patient’s recovery by safely reintroducing exercise and rebuilding lost musculature.

Juvenile Pubic Symphysiodesis (JPS)

If Hip Dysplasia is diagnosed at a very young age, this surgery can be performed to improve joint stability and reduce osteoarthritis formation for both hips at once. This procedure involves cauterizing the growth plate of the pubis in order to stop growth in that area of the pelvis. As the dog matures, the acetabulum will end up in a better position to enclose the femoral head, thus avoiding the laxity that then leads to osteoarthritis. Because this procedure’s success depends on interrupting growth, it should be done before 5 months of age and ideally no later than 4 months of age for maximum benefit. 

Medication

Adequan (Polysulfated glycosaminoglycan) is a series of injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. If you have concerns about giving your dog injections, be sure to speak to your veterinarian for options like an in-person demo or having their staff perform the injections for you. You can also speak to the CROC team. 

NSAIDs like Rimadyl (carprofen) and Metacam (meloxicam) are commonly used to relieve pain caused by osteoarthritis and hip dysplasia. These are usually well tolerated, but bloodwork should be performed to ensure that your dog has normal liver and kidney function before using these medications long term and it is good practice to regularly check bloodwork during use. Some dogs can experience gastrointestinal upset with these medications, so they should be given with food and discontinued if symptoms continue.

If a dog cannot tolerate Rimadyl or Metacam, Galliprant (grapiprant) is another NSAID option that functions differently and should be better tolerated. However, because it is a newer drug, it does not yet have a generic available and is often more expensive than other NSAIDs.

Neurontin (gabapentin) is a human medication that is commonly used off-label for dogs and cats to manage pain and anxiety. It’s not entirely known how it works, but it is thought to block nerve cells from communicating pain signals. It tends to be most effective when used alongside NSAIDs, but can also be helpful on its own. Lethargy is a common side effect, but after some time, most dogs will acclimate and no longer experience lethargy while still benefiting from the pain relief Gabapentin offers. 

Librela (bedinvetmab) is the newest OA treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. Librela is a monoclonal antibody (a protein that has been engineered to bind to a single target) that targets Nerve Growth Factor which helps reduce pain caused by osteoarthritis. It can be extremely effective for the right patient.

Side-effects and adverse reactions from Librela are still being discovered.

Dogs with neurological conditions should not be given Librela as it is likely to worsen neurological conditions.

Some Owners are not aware that their dog has a neurological condition until their dog has an adverse reaction to Librela. Adverse neurological reactions may include: generalized weakness, inability to control bladder and/or bowels, stumbling, knuckling, dragging paws, and/or inability to walk. Should your pet experience any of these symptoms, Librela should not be given again until your pet has been evaluated by a Veterinary Neurologist. It may take up to 3 months for a patient to recover from a Librela-induced neurological decline although patients with Degenerative Myelopathy are extremely unlikely to regain any lost ability.

Dogs with inflammation caused by auto-immune conditions should not be given Librela as it is likely to make these conditions worse.

Studies on Librela were performed on young dogs free from other health conditions. Consider that senior dogs struggling with arthritis pain are the most likely patients to receive Librela but are also nearly guaranteed to have other conditions that may be complicated by Librela. Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated before starting Librela. This should include bloodwork and radiographs at a minimum and may require evaluation with a neurological or orthopedic specialist. Electing to give your pet Librela without prior diagnostic screening is a gamble!

Librela is not indicated to treat post-operative pain, nor is it labeled for treating pain related to any other types of chronic pain other than Osteoarthritis. Librela does not cure Osteoarthritis. Dogs on Librela sometimes feel so good (since they can’t feel the pain) that they overdo it and cause further injury to themselves. It is best to introduce Librela alongside a structured exercise plan to avoid injury and only after thorough diagnostic screening to rule out auto-immune and neurological conditions.

Supplements

Dasuquin Advanced with MSM is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, and other ingredients to support joint health and it comes in a tasty, chewy treat, making it an easy addition to your daily routine.

Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly.

Myos Canine Muscle Formula is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Myos has been credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. It has also been shown to help skin, coat, cognitive, and bone health.

Weight Management

Keeping your dog at a lean body weight is the most important aspect of managing this condition.

Fortunately, it’s also one of the easiest! Sometimes, it’s as simple as adjusting their meal portions. Other times, a complete switch to a new food is necessary. These days, there are a wide variety of AAFCO formulated Weight Management or Weight Loss diets readily available for purchase. Some are even specifically formulated for Senior Pets or for those needing extra Joint Support. Be sure to look for diets that are high in Essential Fatty Acids.

Generally speaking, your goal Body Condition Score for a dysplastic dog is a 4 out of 9, a little on the skinny side.

If you'd like more information about managing your dog's weight, be sure to read through our article, Body Condition Score & Canine Weight Loss.

Exercising at Home

As part of your Consultation with us, you will be provided with Veterinarian Prescribed Rehab Exercises (your dog’s Homework). These exercises will help keep your dog limber and improve their strength and stamina while maintaining their range of motion. Always have your pet warm up before exercise and cool down after exercise.

There should never be sudden changes between inactivity and exercise.

Osteoarthritis flare-ups are common and can even be caused by changes in the weather. Regular walks, tailored to your pet’s abilities are an important part of keeping those arthritic joints moving, reducing stiffness. Make sure to do shorter, more frequent walks instead of one long walk every day.

Avoid becoming the “Weekend Warrior” as over-exercising and acrobatic activities such as ball and Frisbee chasing are recipes for pain and stiffness later. Unfortunately, this also applies to rough play with housemates and other animal friends. Your dog may have once been the rough and tumble, go-go-go type, but it’s important to think of an Hip Dysplasia dog as an antique luxury car. They’re still wonderful and should be taken out to enjoy the world, but great care should be applied when doing so. Regular maintenance and preparation will make all the difference for your dog’s experience.

Swimming is frequently thought of as a low impact and helpful exercise for Hip Dysplasia dogs, however it commonly causes significant abuse to the elbows, shoulders, and hip joints leading to inflammatory flare-ups.

The act of swimming can also put a lot of stress and extra movement on the spine. Opt instead for walking in warm water at your dog’s armpit level. Do this at very slow intervals to decrease the repetitive grinding of any arthritic joints. Swimming exercises typically do not help pets become better or stronger at walking outside of the water. To learn more, check out our Medical Library article, The Deep Dive into Swimming.

Physical Rehabilitation

Participating in Physical Rehabilitation Therapy at CROC allows your dog to get exactly the exercises and pain relief that they need on a regular basis to keep them comfortable and mobile, while also slowing the progression of their osteoarthritis and atrophy.

Our team closely monitors your pet’s abilities and adjusts their sessions as needed while also keeping you updated as your pet progresses.

Therapy Sessions at CROC include multiple pain relief modalities like Thermotherapy, Cryotherapy, Laser Therapy, Therapeutic Ultrasound, PEMF, E-Stim, and Massage Therapy to be used as appropriate for your pet’s condition. Veterinary Medical Acupuncture is another option CROC offers to provide pain relief and increase circulation. Prescribed Target Exercises and Underwater Treadmill Hydrotherapy build muscle and maintain good range of motion while avoiding soreness or pain associated with other types of exercise.

Daily participation in at-home exercises wearing you down? Let us do some of that work for you and take your pet home feeling better than when you dropped them off.

As your pet ages, it will be even more important to maintain a lean body weight and good musculature to support their dysplastic joints. Resuming therapy before their mobility declines will help keep your pet strong and mobile well into their senior years. For FHO patients, this will be of particular importance since musculature is the only thing keeping their hind limbs functional.

Environmental Modifications

Use a good quality dog bed! Memory foam is an ideal material. Your dog’s bed should be at least 1 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40lbs of body weight. Encourage your dog to change position frequently, such as switching which side of their body they lay on. Laying in one position for extended periods of time will lead to significant stiffness and pain once they go to get up.

Slippery, hard floors are tough on Hip Dysplasia dogs. Rugs, yoga mats, and the like are extremely beneficial to help keep your dog on their feet and avoid slips and falls.

Can Hip Dysplasia be prevented?

Hip Dysplasia is the most common inherited condition, so efforts to reduce a dog’s risk of developing it begin with the breeder.

A responsible breeder will have their dogs’ hips evaluated using OFA and/or PennHIP standards and will only move forward with the breeding if both dogs have healthy hips. PennHip radiographs can only be performed by a veterinary professional that has been certified by the PennHIP program and sedation/anesthesia is required but it has been proven to be accurate for dogs as young as 4 months old. OFA requires that a dog be at least 2 years of age and while sedation/anesthesia is recommended, it is not required. 

A puppy’s risk for developing Hip Dysplasia can also be heavily impacted by exercise, nutrition, and body weight.

Puppies under 3 months old that exercise on hard, slippery floors or have access to stairs as well as dogs under 2 years of age that frequently play fetch are at higher risk. Excess body weight puts unnecessary strain on the body and during periods of growth, can negatively affect skeletal maturity. For this reason, it’s important to feed measured portions and to use puppy food that is nutritionally balanced and appropriate for your breed. Large breed puppy foods are formulated specifically for the immense growth they experience to give them the support they need without causing inappropriately accelerated growth.

To Summarize

Responsible breeding is the first step of reducing a puppy's risk for Hip Dysplasia and dogs should be evaluated using OFA or PennHIP standards before being bred. Body weight, activity level, and nutrition are significant variables for dogs of all ages. Hip Dysplasia can impact your dog's life, but there are options to relieve your dog's pain and keep them active such as medications, Physical Rehabilitation Therapy, and/or surgery. It can be difficult to know which are the right options for your pet but the CROC team is always available to discuss your pet's case specifically and to help you find a management plan that fits your lifestyle and your dog's needs.