This article is a guest post kindly contributed by Dr Eloise Bright, who is the resident pet care expert at Love That Pet.
A diagnosis of hip dysplasia can be devastating and raises many questions about your dog’s future quality of life. Despite significant improvements in selective breeding to reduce hip dysplasia in many breeds, this debilitating condition continues to occur. And while it is more common in certain breeds, it can crop up in any breed of dog at any time. Know firstly that hip dysplasia is treatable and most dogs go on to live long and active lives. There are a number of medical and surgical interventions available and the choice of which treatments you undertake is entirely dependent on your individual situation.
What Causes Hip Dysplasia?
Hip Dysplasia is multifactorial, in that there are multiple genes and influencing factors that lead to the expression of the disease. Ultimately joint laxity between the femoral head and the acetabulum of the hip leads to remodelling of the hip and osteoarthritis. No dog is born with hip dysplasia. Multiple genes can lead to an increased susceptibility, but environment, growth rate, muscle mass, hormones and nutrition all interplay to determine which dogs develop the disease and more importantly which dogs develop debilitating osteoarthritis.
Breeds and Prevalence
The prevalence of hip dysplasia is almost 50% in some breeds. In one retrospective study 19.7% of purebred dogs and 17.9% of mixed breed dogs had radiographic signs of hip dysplasia, though these numbers may be artificially high due to study design. Larger stockier breeds such as Labradors have a higher risk of hip dysplasia, while slimmer, slighter, fleet-footed breeds such as Whippets are at a lesser risk. However, hip dysplasia can occur in any dog, whether large or small, purebred or mongrel.
The first thing your Veterinarian will recommend is radiographs. This may be under the assumption that your dog is at risk due to his breed, or due to clinical signs that indicate there may be a problem in the hips. It is estimated that as many as 30% of dogs have cruciate ligament rupture when presented for sore hips, so your Veterinarian will also check your dog’s knees. Many dogs with painful hips will develop an unusual gait or walk and will be lame or slow to sit down or rise. They may also dislike being touched around their rump or be a bit grumpy and less playful. Radiographs will need to be performed under general anaesthesia and depending on your individual situation, you can request that these occur at the time your pet is getting desexed. Your Veterinarian can also check your dog’s hips during his regular health checks.
As mentioned, the disease can crop up anywhere and anytime, so selective breeding does not completely eliminate the risk, but it certainly helps. If you are considering a large breed dog, it is worth asking your breeder if they have taken part in any screening and ask to see the hip scores of the parents before you buy a puppy. There is a standardised method of screening called the PennHIP method, which can be conducted from 16 weeks of age, but is often repeated at 2 years of age for confirmation. If breeders remove animals from the breeding pool who have hip dysplasia this goes a long way towards reducing prevalence. In one group of breeding German Shepherds a 39% incidence of hip dysplasia was reduced down to just 17% in only 3.5 years of selective breeding.
Nutrition and Exercise
It has long been recommended that dogs should not be allowed to free-feed and this is particularly the case in dogs prone to orthopaedic conditions. An often quoted study in Labrador Retrievers showed delayed onset and reduced severity of hip dysplasia in dogs fed a calorie restricted diet (25% less) compared to a control group. Over nutrition, fast growth and obesity certainly contribute to the development of hip dysplasia and the severity of the osteoarthritis that develops. Visit your Veterinarian and ask for a recommendation on feeding, particularly if you are home cooking your diet, or if your pet is already overweight. As a general rule, if you can’t feel your dog’s ribs and the little bumps of bone along the back, you need to look at weight reduction. Your dog should resemble a greyhound and have a waist-line, rather than having a barrel shape. Feeding 75% of what your dog can eat in 15 minutes is a good guide for lean weight management. In dogs that already have osteoarthritis, pet owners are often astounded by the improvements in comfort and mobility that can be achieved with weight loss alone. Learn more about arthritis in dogs here.
Calcium and Vitamin D
Excess calcium and vitamin D increase the risk of hip dysplasia and other developmental growth disorders. The jury is out on vitamin C supplementation, but it is though to be at best unnecessary and is not recommended.
Exercise and its effect on hip dysplasia has been less extensively studied than nutrition. The aim is to keep your dog as fit and mobile as possible to increase muscle strength and avoid obesity, but not overdo it so as to accelerate arthritic changes in the joints. Lots of small frequent walks are ideal, rather than a 10km run once a week. If your dog is already showing signs of osteoarthritis and pain, start with short walks twice daily and always stop before your dog shows signs of pain. If your dog is slowing down towards the end of a walk, is limping or wakes up stiff and sore the next day, you need to do shorter walks, or visit your Veterinarian to discuss management of his condition.
Why Are Some Dogs Worse Than Others?
Because so many factors influence the condition, some dogs are significantly uncomfortable in their hips at a young age, while many only develop pain in their senior years. Bone is constantly remodelling. There is constant breakdown at a cellular level, in response to mechanics, trauma and the forces placed on bones. This is why weight-bearing exercise is so important, particularly in the elderly and why a limb that is unused shrinks. In humans 100% of the skeleton is remodelled in the first year of life, and 10% is replaced each year. This fluidity of bone and of joints is the reason why diet and exercise play such an important role in hip dysplasia development.
The other very interesting thing about hip dysplasia is that individual pain sensitivity and perhaps anatomy play a part in how your dog responds to treatment. Some dogs have dreadful hips when radiographed, so bad you wonder how they can even walk. Some have very mild radiographic signs but are incredibly painful. There are many things you can do to improve the chance your dog will be in the ‘bad hips but comfortable’ category.
Can My Dog Be Placed in a Cast?
Humans who have hip dysplasia as babies in a brace or spica cast to immobilise the hips called and allow the hip joint to remodel. Theoretically if a puppy with hip dysplasia was forced to stay sitting in a cage for long enough, the same could be achieved. However, you would then end up with numerous other behavioural and developmental problems and an incredibly boring life for the poor puppy! Unfortunately the only method of early intervention to improve the mechanics of the hip joint in dogs is surgery.
What Surgery Is Available?
There are a number of surgical options available for your dog. If you have access to a specialist orthopedic surgeon, it is certainly worthwhile asking your Veterinarian to refer you for a consultation and discussion about the options, prognosis and suitability of each procedure for your dog. A specialist orthopedic surgeon will charge approximately $200 for a consultation (yes, similar to a human specialist!), and you can ask them to take a look at the radiographs from your general practitioner Vet. Many Vets will perform hip surgery in general practice, but not all Vets are qualified to perform every procedure.
Broadly, there are surgeries performed in young dogs who are still growing and older dogs who already have bad hips. In young dogs, surgery must be performed before arthritis develops. At 16-20 weeks a juvenile pubic symphysiodesis can be performed and at 8-18 months a triple pelvic osteotomy can be done by a qualified surgeon. In adult dogs a specialist can also do a total hip replacement. Another option that can work beautifully and is much less expensive is a femoral head and neck ostectomy (FHNO), sometimes called a femoral neck/head excision, performed by your general practitioner. In this surgery the head of the femur is removed, forming a false joint supported by the strong musculature of the hip. Dogs who have FHNO surgery can run and are comfortable, but would probably not be good at elite level athletics or yoga. The surgery works best in dogs that are not overweight.
What if Surgery is Not an Option?
The reality is that even the cheapest surgery will be around $1000. In some cases, surgery is not possible and medical management can achieve good outcomes. What we aim for in a dysplastic dog, is quality of life and this can often be achieved medically. The current recommendations are:
- Fish oils or omega 3 fatty acids, they come in Veterinary or human formulations, the ratio of omega EPA and DHA is important.
- Glucosamine and chondroitin – these two ‘building blocks’ for healthy cartilage are often supplied together in supplements such as Joint Guard and Sashas Blend or in the form of green-lipped muscle.
- Pentosan or Cartrophen is very safe and effective. It is usually given as a series of 4 weekly injections, repeated every 6 months.
- Non-steroidal anti-inflammatories (NSAIDs) provide an anti-inflammatory, pain-relieving effect for arthritic pets. They can be given as required or once daily.
Are NSAID’s Safe?
There are a number of known side effects from non-steroidal medications in pets. However, in a well animal with normal kidneys the benefits far outweigh any risks. Often your Veterinarian will recommend regular blood tests to ensure your dog has functioning kidneys. They should never be given with steroids such as prednisone. NSAIDs should also not be given if your dog has vomiting, diarrhoea or is not eating (though diarrhoea can be a variation of normal in many pets). Occasionally dogs will develop gastrointestinal ulceration from NSAIDs, but this is rare if all precautions are taken. If your dog is unable to take NSAIDs, there are other options available from your Veterinarian. Never use human medications in your pets without Veterinary advice!
Acupuncture, Physiotherapy and Massage
When performed by a qualified practioner acupuncture has shown great promise in the treatment of pain associated with hip dysplasia. Physiotherapy is also excellent to maintain muscle mass and maximise mobility. Both work best in conjunction with all of the above management strategies. The pain of hip dysplasia is not always in the joint, secondary muscular problems can develop due to altered biomechanics and these are often very responsive to stretching, massage, acupressure and heat packs. If your Veterinarian is not well-versed in these techniques, they can often recommend someone who is.
Bedding and Flooring
Many pets who develop osteoarthritis or have an altered gait due to hip dysplasia are insecure and more prone to slipping on polished floorboards or tiles. If you can, place rugs and mats in strategic places in your home to avoid injuries. Your dog will also appreciate a soft, preferably elevated bed, such as a trampoline dog bed. Arthritis is worse in cold weather so sleeping on cold concrete is not ideal. You could even consider a heated dog bed if you live in a particularly cool climate.
What Is the Long Term Prognosis for My Dog?
Many dogs who have hip dysplasia go on to live full and happy lives. While the condition is considered a chronic health disorder, there are now so many management options. The first step is to talk to your Veterinarian or perhaps even a specialist if you think surgery is an option, then work out a plan that suits you, your pet and your budget.
Keys to Comfort:
- Remember weight loss is important. Make sure you can easily feel your dog’s ribs.
- Continue with moderate exercise, short frequent walks are ideal.
- Supplement with fish oils, glucosamine and chondroitin, but NOT calcium or vitamin D.
- Cartrophen injections every 6 months (or as recommended by your Vet).
- Consider what pain relief your pet needs.
- Acupuncture or physiotherapy.
Dr Eloise Bright is the resident pet care expert at Love That Pet. When not working to keep her pet patients healthy, Eloise enjoys spending time with her family and pets. Connect with her on Google+.