Canine hip dysplasia
Updated: Oct 8
I want to start this blog entry by saying: I AM NOT A VETERINARIAN. If you suspect hip dysplasia, you should always first start with a consultation with your vet for an in depth exam so a correct diagnosis can be made. Before we begin, we should know WHAT we're talking about and HOW a diagnosis is made.
What is hip dysplasia
Hip dysplasia is a combination of several factors: genetics, growth rate, breed conformation, and excessive caloric intake. Most commonly, what causes the condition is a combination of a shallow or flattened acetabulum (ball joint/ cup of the hip), abnormal growth/development of the pelvis, and a poorly formed femoral head (rounded end of the femur). These factors can result in a bad union of the femur as it joins with the pelvis which leads to a domino effect of joint inflammation, cartilage loss, muscle inflammation, arthritis, compensation patterns, and eventually partial or full joint dislocation. This condition is more commonly found in growing puppies, but can also be found in older dogs that are overweight.
Hip dysplasia is very common in large breed dogs such as labs, golden retrievers, Rottweilers, Danes, Dobermans, German Shepards, boxers, and more. It can easily be managed if caught early, but can often leads to future problems if not managed properly. It is important you know what signs to look for and work on preventative care early if you suspect your dog may be at risk. Many times, this problem also affects both hips.
What you need to look for:
I want to start off by saying ALL PETS ARE DIFFERENT. You may not see all of these signs in your dog. The video above is a great visual on some of the things mentioned below.
-Pacing/ambling instead of trotting: Dogs with hip problems are often unable to maintain symmetrical gaits such as trotting and will refer back to the amble because it is asymmetrical and lends well to muscular compensation patterns.
-Asymmetrical tail carriage/walking with the butt off to the side: The tail and the butt are used as balancing mechanisms. Think of a tightrope walker with a stick for balance. The abnormal tail carriage will help lessen the forces of gravity to the hip while the asymmetrical walk will take the weight on to the other hip.
-Bunny hopping: Pets will bunny hop up as a way to use their low back musculature to compensate for what the hips can't do.
-Difficulty climbing stairs: Going up stairs is likely to be the hardest as it requires the muscles of the hip to activate (gluteals). If you have a chronic inflamed hip, your pet is likely going to question whether they really want to go up stairs.
-Excessive hip swaying side to side: Your pet will swing the hips side to side in order to create a pendulum effect because it will create inertia that will lessen the demand on the gluteals to activate each time the pet takes a step.
-Asymmetrical stance front to back: Your pet will be unable to stand square. The front legs will often be closer together than the back legs when standing.
-Frog sitting: Your pet will be unable to sit square because it will cause impingement of the inflamed hip. It might also caused painful relocation of the hip into the socket, which may cause grinding of pre-existing bone spurs. It is also a way to guard a "susceptible" area so further damage or harm doesn't come to it from other doggy siblings.
-Difficulty going from laying to standing: This goes without saying. If your pets glutes are constant spasm from trying to support and protect the inflamed hip, going from laying to standing is like trying to get up from a chair after doing an intense leg day at the gym. It hurts.
-Exercise intolerance/lethargic behavior: Your pet is going to not want to cause more pain, and will therefore choose not to engage in physically demanding behavior.
Diagnosing hip dysplasia:
80% of any diagnoses comes from history. When you suspect hip dysplasia, you should explain all the signs and symptoms you have noticed to your vet so they can decide what kind of examination is necessary. Sometimes, the hip may not be the only thing wrong with the animal.
80% of the time (if the problem seems more of a mild complaint), vets will just do a history and a gait evaluation and simply make recommendations based on what they see and have heard from you, the owner. However, I believe you should also have someone evaluate the structures with orthopedic and neurological tests. This is especially true in moderate-severe cases. A thorough vet will palpate the hip, feeling for tone of the muscles and the bony structures of the hip. They may also check the nerves by checking sensation with pin pricks, withdrawal reflex via toe squeezes, or checking a paw knuckling response by flipping your pet's paw upside down a few times.
They will then very likely tell you they need to take your pet back for further examination where they may need to use sedation. The will likely perform the Ortolani test, as shown below, which will forcefully push the hips apart which will cause a painful relocation of the dysfunctional hip into socket. This often causes an audible click or thunk. Most pets DO NOT like this and will cry out due to pain (hence sedation.) While your pet is sedated, they will likely proceed with x-rays.
Your vet will take x-rays and will usually send them off to be read. From there, your dog will be given a "OFA score." Orthopedic Foundation for Animals (OFA) scores are given to dogs usually when they are in adolescence or before they are "cleared" for breeding. The scale is given in order from: excellent, good, fair, borderline, mild, moderate, and finally severe. You can scroll down to the sources to evaluate what they look for when determining their scores.
Simply stated, your vet is looking to see that:
1. Everything fits and is where it should be: is the femoral head in the cup of the acetabulum? Does the cup cover the entire head of the femur? 2. Joint space is even all the way around: Is there too little or too much joint space? Is it the same along the entire joint surface? 3. Everything is the right shape: is the acetabulum cup and the femoral head round? 4. There isn't any arthritis: are their bony changes? Are there bone spurs? Is there joint erosion in the acetabulum?
What to do moving forward:
If hip dysplasia is caught early, you can easily manage it with conservative measures; if caught late, surgery is often recommended. That's why early diagnosis is key! Please do your research, though, and make sure to explore all of your options.
-Conservative measures focus at PREVENTING development of a disease process.
-Palliative measures focus at DULLING PAIN and PREVENTING PROGRESSION of a disease process.
-Curative measures focus at CORRECTION of a what is caused by a disease process.
1. Adjustments: to improve mobility of the hip and possible relocation of the hip back into socket. Maximizes function of the hips, low back, and pelvis so the body knows proper alignment. Can also improve proper muscle tone and balance by correcting compensation patterns. 2. Supplementation/diet changes: to improve on and provide for building blocks so the body can use them to strengthen pre-existing structures. Also can be targeted for weight loss. -Common supplements include glucosamine, chondroitin sulfate, colleagen, and omega 3's. 3. Exercises: designed to strengthen the muscles of the hips and pelvis and/or work on weight management. 4. Massage: to work on correction of muscle tone and balance.
1. NSAIDs: (AKA carprofen, rimadyl, dermaxx, previcox,meloxicam) Medication designed to prevent the release of inflammatory chemicals in the body. Some pets CANNOT take these as the are harmful in large doses. They can be harmful to the kidneys, liver, stomach, and heart. 2. Muscle relaxers: (AKA flexeril, gabapentin, tramadol, methocarbomol) Medication designed to allow muscles to relax and reduce painful spasm. Can often cause drowsiness, heart problems, and gastrointestinal upset/constipation. 3. Adequan: (AKA polysulfated glycosaminoglycan) This medication and/or injection is designed to target and turn OFF specific enzymes that erode joints. This can come with risk of infection due to the use of needles. 4. Steroids: (AKA prednisone) This medication is designed to stop ALL inflammation of the body. It can cause immune suppression, kidney damage, and weight gain. Long term steroid use is FROWNED UPON. Do not use steroids longer than 3-4 months if preventable. 5. Stem cell or platelet rich plasma injections: This procedure is designed to inject new cells or plasma into the joint so the body can replace the old damaged cells. This does not prevent the new cells from undergoing the same arthritic changes. Can come with the chance of infection due to use of needles. 6. Cold laser: This procedure goes down to a cellular level and tells the mitochondria to make more energy so the cells can heal better and faster. 7. Acupuncture: This procedure works at clearing "chi." In layman's terms, it corrects the flow of lymph, hormones, and blood flow by stimulating nerves through needle placement and/or electric current. Acupuncture also provides pain relief by stimulating "pressure points" that send endorphins throughout the body.
*Do notice that adjustments, massage, and rehabilitation can also go in this section.
*Manual adjustments should NOT be used as an intermediate measure if your dog has severe comorbities. Comorbidities should be evaluated by your vet and discussed with your other providers. There are instrument assisted adjustments that are MORE GENTLE and can be used at discretion and evaluation of your vet and/or chiropractic provider.
Invasive/curative There are several surgical options for hip dysplasia. Please discuss what is right for your pet with your veterinary surgeon if you are at this point.
1. Triple pelvic osteotomy (TPO):This surgery is seen as "conservative" as it cuts the pelvis in three places, allowing for more growth and possible relocation of the femur in the acetabulum. Severe hip dysplasia dogs are not a good candidate, as they are too far gone for this procedure to work. This is most recommended in puppies under 6 months (before they hit their growth spurt). There is still a chance that the hip dysplasia can still occur after this surgery. Your pet will also require a period of cage rest. This procedure can also come with arthritis later in life.
2. Hip replacement/ arthroplasty: This surgery is exactly what is sounds like, a new hip joint made of bionic parts! It's the same surgery as done in people. Can come with bodily rejection of the new part, so steroids are often recommended post surgery. Often require post surgical rehab.
3. Femoral head osteotomy (FHO):This surgery cuts off the head of the femur completely and allows for the body to form a new pseudojoint made of scar tissue. When in doubt, just cut it all out! Most dogs do well with this surgery, surprisingly, as the problem cannot reoccur. This surgery naturally lends itself to scar tissue formation. Requires less rehabilitation than other surgeries, but still can cause very noticeable asymmetries in muscle tone. Will often lend to compensation patterns and low back pain later in life.
Can my dog still get adjusted after a hip dysplasia surgery?
YES! Your pet can still be adjusted after a surgical revision. Adjustments help to promote proper alignment and balance needed for healing and better overall function!
However, please let your provider know the type of revision by providing records. This will help them to know where to and where not to adjust. It may also change their techniques from a manual adjustment to a more gentle instrument assisted adjustment. Adjustments may also focus not so much on working with the hip, but with the supporting structures of the low back, pelvis, and sacrum in order to stabilize the altered anatomy.
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When choosing adjustments for your pet, choose someone licensed, trained, and certified.