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Canine Hip Dysplasia

by Dr. Lucy Henney and Dr. Craig Riggs

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Normal Canine Hips

Canine Hip Dysplasia (CHD) is a developmental disorder of the hip that begins with joint laxity and progresses to arthritis over a period of several months to years. It is one of the most common skeletal diseases seen by veterinarians. The condition is very common in large breed dogs, but can be seen in any breed.

Multiple genes are involved in the inheritance of hip dysplasia, and many other factors influence its development, including body type, size, growth rate, and nutrition. overfeeding, and dietary supplementation for maximal growth has been shown to increase the incidence of hip dysplasia in young, growing, large breed dogs. Conversely the development of hip dysplasia can be delayed, and its severity diminished when the growth rate of pups is restricted.

Normal Hips

Severe Hip Dysplasia

Severe Hip Dysplasia

The diagnosis of hip dysplasia is based on history, physical examination, and radiographic evaluation. A typical history may include any or all of the following:
  • difficulty or stiffness upon rising
  • rising using front legs only and dragging rear
  • "bunny hopping"'gait
  • short stride in rear legs
  • reluctance to exercise or climb stairs
  • rear limb lameness
  • soreness in hips
  • waddling rear limb gait

The clinical signs commonly begin between five to eight months of age or after skeletal maturity. Some dogs don't have noticeable problems until eight to ten years of age or older. The onset of clinical signs may appear sudden or gradual. This variability is due to the individual severity of the disease as well as pain tolerance of the pet.

Most dogs with CHD are most painful when the hips are extended by pulling the rear legs back behind the body. Palpation of the hips usually reveals joint laxity, although anesthesia may be required to detect it in some cases.

Radiographs are necessary to confirm the diagnosis and evaluate the severity of CHD. In young dogs or in very mild cases, joint laxity may be the only detectable abnormality. Later in the disease arthritic changes are seen. The standard radiographic position is with the dog lying on its back with both rear legs pulled straight back and parallel to each other. Most dogs with CHD are too painful to tolerate this position awake, so sedation or anesthesia is usually necessary. Proper radiographic positioning is very important to accurately evaluate the hips and to determine the best treatment.

The Orthopedic Foundation of America (OFA) has been the standard for certification of dog's hips as being free of CHD. The radiograph is taken after the dog is 2 years of age and requires the hip extended position. Unfortunately, our progress has been disappointing in reducing the frequency of CHD using OFA alone. Recently the PennHIP program has emerged as a new scientific method for the early diagnosis of CHD. It measures the passive hip joint laxity or "looseness" of the hip ball in the hip socket under sedation or anesthesia. PennHIP is more reliable and has the advantage of being accurate on puppies as young as 16 weeks of age. Dr. Henney is trained and certified to perform the PennHIP procedure.

Medical and/or surgical treatment may be recommended for CHD, depending on the individual circumstances. Medical management usually consists of exercise restriction, body weight management, and symptomatic pain management with analgesics and anti-inflammatory drugs. A non-weight bearing activity like swimming is the preferred type of exercise since it places minimal stress on the joints.

Several surgical options are now available for treating the various stages of hip dysplasia. They include the triple pelvic osteotomy, femoral head and neck excision, and total hip replacement.

Triple Pelvic Osteotomy Triple Pelvic Osteotomy
The ideal candidate for this procedure is a young dog (5 months to I year of age) with clinical signs of CHD, including hip joint pain and laxity, but little or no radiographic signs of arthritis. In this procedure the acetabulum (hip socket) is rotated to a more normal position in relation to the femoral head. This seats the head more deeply into the socket. The pelvis is then stabilized in this new position with a specially designed pelvic osteotomy plate and bone screws. The procedure eliminates the joint laxity and corrects the abnormal conformation of the socket. Thus, the hip is able to develop more normally without developing arthritis. overall, with proper case selection, it appears that approximately 90% of dogs achieve good to excellent results and return to athletic endeavors. Owners have been uniformly very pleased with the results and have had no reluctance recommending the procedure to others. If a TPO is performed on the opposite leg, it is performed 3-6 weeks later.
Femoral Head and Neck Excision Femoral Head and Neck Excision
When arthritis develops in a dog with hip dysplasia the damage is irreversible, so a triple pelvic osteotomy will not restore normal hip function or eliminate the pain. instead, a salvage procedure is needed that removes the source of pain. Two such procedures are the femoral head and neck excision and the total hip replacement. The femoral head and neck excision is the most commonly performed procedure. It involves removing the femoral head, which is the ball portion of the joint. The body's reaction is to form a false joint, which along with the surrounding pelvic muscles minics joint function. Although this does not return the hip to normal, it significantly relieves the pain of arthritis. making the leg more functional and comfortable. Thus, the dog usually becomes more active. The advantage of this procedure is that it is relatively simple, has few complications, can be performed at any age, is relatively inexpensive and has good results in the majority of dogs. Best results are obtained in small and medium sized dogs.
Total Hip Replacement Total Hip Replacement
This procedure involves removal of both the ball and socket portions of the hip joint and replacing them with artificial implants. It is currently the best available treatment for severe hip dysplasia in large, mature dogs. Currently, the success rate is reported to be over 95%, and dogs with successful implants are able to perform almost any task performed by dogs with normal hips. Therefore, it is the treatment of choice for dogs used for working or sporting activities or when optimal hip function is desired.

Candidates for total hip replacement are typically large breed dogs with irreparable disease or injury to the hip joint. The dogs must be fully grown ( minimum 9 months of age), over 40lbs, free of any infections, debilitating conditions, or neurologic disorders. Their health is fully evaluated before surgery to minimize the risk of complications. Despite extensive precautions, complications are reported in approximately 10% of the cases. Many are correctable, but some serious complications may require removal of the implants. Proper home care after surgery is very important to the success of the procedure. Strict confinement and close supervision is required for the first eight weeks after surgery. 80% of cases require surgery on only one side. Ultimately most dogs regain full, pain free function after total hip replacement, and live normal active lives.

Copyright © 1996-2009 created by Laurie K. Tollifson