PHYSIOTHERAPY | REHABILITATION | HYDROTHERAPY
HIP DYSPLASIA IN DOGS
In memories of all immobile dogs that were not given a second chance
What is Hip Dysplasia in Dogs?
Image taken from Orthopedic Foundation for Animals
https://www.ofa.org/diseases/hip-dysplasia
Hip dysplasia in Dogs is a disease of the hip in which the ball and socket joint is malformed. This malformation means that the ball portion and its socket don’t properly meet one another, resulting in a joint that rubs and grinds instead of sliding smoothly. This can eventually cause crippling lameness and painful arthritis of the joints. It is a genetic (polygenic) trait that is affected by environmental factors.
Hip dysplasia is one of the most common skeletal diseases seen in dogs. Gender does not seem to be a factor, but some breeds are more likely to have the genetic predisposition for hip dysplasia than other breeds. Large and giant breeds are most commonly affected, including the Great Dane, Saint Bernard, Labrador Retriever, and German Shepherd. Rarely, small breed dogs can also be affected, but are less likely to show clinical signs. Hip dysplasia often begins while a dog is still young and physically immature. Early onset usually develops after four months of age. There are also cases of later onset, where hip dysplasia develops later due to osteoarthritis, a form of joint inflammation (arthritis) that is characterized by chronic deterioration, or degeneration of the joint cartilage.
What causes Hip Dysplasia and are there certain breeds at risk?
What is the cause of Hip Dysplasia
In canines, it can be caused by a femur that does not fit correctly into the pelvic socket, or poorly developed muscles in the pelvic area. Large and giant breeds are most susceptible to hip dysplasia (possibly due to the BMI of the individual animal), though, many other breeds can suffer from it. For a list of top 100 breeds affected, by percentage, visit the ofa.
To reduce pain, the animal will typically reduce its movement of that hip. This may be visible as “bunny hopping”, where both legs move together, or less dynamic movement (running, jumping), or stiffness. Since the hip cannot move fully, the body compensates by adapting its use of the spine, often causing spinal, stifle (a dog’s knee joint), or soft tissue problems to arise.
The causes of hip dysplasia are considered heritable, but new research conclusively suggests that environment also plays a role. To what degree the causality is genetic and what portion environmental is a topic of current debate. Neutering a dog, especially before the dog has reached an age of full developmental maturity, has been proven to almost double the chance he or she will develop hip dysplasia versus intact dogs or dogs that were neutered after reaching adulthood Other environmental influences include overweight condition, injury at a young age, overexertion on the hip joint at a young age, ligament tear at a young age, repetitive motion on forming joint (i.e. jogging with puppy under the age of 1 year). As current studies progress, greater information may help provide procedures to effectively reduce the occurrence of this condition.
Hip Dysplasia affecting our dogs here in Singapore
Hip dysplasia is the leading cause of lameness in the rear legs of dogs here in Singapore, affecting large and giant breeds are most commonly affected, including the Great Dane, Saint Bernard, Labrador Retriever, and German Shepherd. Rarely, small breed dogs can also be affected, but are less likely to show clinical signs.
In Singapore, we see alot of Golden Retriever with Hip dysplasia and some of them are as young as 6 months old. This is generally because of local breeding among poor genetic parentage.
Signs and Symptoms of Hip Dysplasia in Dogs
Symptoms depend on the degree of joint looseness or laxity, the degree of joint inflammation, and the duration of the disease.
- Early disease: signs are related to joint looseness or laxity
- Later disease: signs are related to joint degeneration and osteoarthritis
- Decreased activity
- Difficulty rising
- Reluctance to run, jump, or climb stairs
- Intermittent or persistent hind-limb lameness, often worse after exercise
- “Bunny-hopping,” or swaying gait
- Narrow stance in the hind limbs (back legs unnaturally close together)
- Pain in hip joints
- Joint looseness or laxity – characteristic of early disease; may not be seen in long-term hip dysplasia due to arthritic changes in the hip joint
- Grating detected with joint movement
- Decreased range of motion in the hip joints
- Loss of muscle mass in thigh muscles
- Enlargement of shoulder muscles due to more weight being exerted on front legs as dog tries to avoid weight on its hips, leading to extra work for the shoulder muscles and subsequent enlargement of these muscles
Hip Dysplasia – The importance of a proper diagnosis process
The classic hip dysplasia diagnostic technique is with appropriate X-rays and hip scoring tests. These should be done at an appropriate age, and perhaps repeated at adulthood – if done too young they will not show anything. Since the condition is to a large degree inherited, the hip scores of parents should be professionally checked before buying a pup, and the hip scores of dogs should be checked before relying upon them for breeding. Despite the fact that the condition is inherited, it can occasionally arise even to animals with impeccably hip scored parents.
In diagnosing suspected dysplasia, x-ray is usually combined with an observation of the animal’s gait and posture. Evidence of lameness or abnormal hip or spine use, difficulty or reduced movement when running or navigating steps, are all evidence of a problem. Both aspects have to be taken into account since there can be serious pain with little X-ray evidence.
It is also common to X-ray the spine and legs, as well as the hips, where dysplasia is suspected, since soft tissues can be affected by the extra strain of a dysplastic hip, or there may be other undetected factors such as neurological issues (e.g. nerve damage) involved.
There are several standardized systems for categorising dysplasia, set out by respective reputable bodies (Orthopedic Foundation for Animals/OFA, PennHIP, British Veterinary Association/BVA). Some of these tests require manipulation of the hip joint into standard positions, in order to reveal their condition on an X-ray.
What can you do for your pet with Hip Dysplasia
Available Surgical Correction for Dogs diagnosed Hip Dysplasia in Singapore
There are several different types of surgery available here in Singapore to help dysplastic dogs. They are all mostly expensive and the results are mixed. The fact that there are so many dissimilar techniques being used on heavy breeds at the same time, suggests that none of them give as good a result and the pet owner will hope for.
This is because they all target the results of hip dysplasia – not the cause. The results of hip dysplasia are an improperly shaped hip. But the cause of hip dysplasia is weakness and looseness of the ligaments and cartilage that hold the hip together.
This older technique was popular in the 1970s. It involves cutting the pectinious muscle of the groin to lessen the pain of dysplasia. Cutting this muscle was said to decrease the normal pressure that presses the ball of the femur into the acetabular socket. Some veterinarians thought it might be helpful in certain cases of hip dysplasia. However, the relief provided was usually temporary and arthritic changes in the joint continued or possibly sped up. Few veterinarians still perform this surgery but it is no longer recommended by most veterinarians.
Juvenile Pubic Symphysiodesis is a less extensive, less expensive attempt to improve the dog’s hip structure. When the growth in one portion of the pelvis (the pubic symphysis) is surgically halted, a change occurs in the pelvis’ shape as the rest of the structure grows. Theoretically, this should improve hip function by creating a more stable joint. However, the same report in the January 15, 2007 issue of the Journal Of The American Veterinary Medical Association questioned this. When the surgery is performed, it must be done when the pup is young (16-20 weeks of age) and after the likely hood of future hip dysplasia is confirmed by a PennHip examination.
Dorsal Acetabular Rim Augmentation techniques uses bone grafts to enlarge the lip of your dog’s hip socket (the acetabulum) that holds the ball of its femur in place. There is insufficient information on how successful this procedure might be. The positive thing that is known is that if the DARA technique is not successful, other techniques could still be tried later. In 2016, the DARA technique is most commonly used in dysplastic dogs to try to give added support to a totally prosthetic (artificial) hip.
Triple Pelvic Osteotomy procedure has been used since the early 1990s. It works best when hip dysplasia is discovered very early – before degenerative changes and arthritis become noticeable on radiographs. Dogs need to be 7 – 8 month old or older to have this surgery and it generally does not yield good results when dogs are over 12 months old. The bones that form the hip are not mature enough to hold the screws and plates that are used when the puppy is too young. And the pet will not have the full potential to remodel the new joint structure if it has finished most of its growth. So the window or time when the surgery is most effective is quite small.
It is also very difficult to perform this surgery on dogs that weigh less than 45 pounds because the surgeon must work in such a tight space.
This surgery entails cutting free the socket or acetabulum at three points (A,B&C) and rotating it so that the pressure of the femoral head is directly into the cup and not pressing on it’s upper edge. Metal plates, screws and wire are used to reattach the acetabulum to the pelvis in its new position. Recovery from the operation, which is performed only on one leg at a time, is 6-10 weeks. Surgeons that perform this operation are quite enthusiastic about the results they obtain. However, “Results suggest that JPS and TPO have similar effects on hip joint conformation in dogs with moderate to severe hip dysplasia but that neither procedure eliminates the hip joint laxity characteristic of hip dysplasia or the progression of the degenerative joint changes. If you are considering this surgery for your pet, ask the prospective surgeon to discuss these 2007 University of Wisconsin results.
During Femoral Head Osteotomy surgery, the head and neck of the femur are removed. After that is done, a flexible , fibrous attachment (pseudo-joint) naturally forms between the end of the femur and the pelvis. This should allow pain-free experience use of your pet’s leg.
The surgery is straightforward. The results are usually excellent when the dog’s adult weight is 45 pounds or less. It does not work well for heavier dogs. It can take up to a year for full motion and weight-bearing to return. But it is a real joy to see these pets racing happily and pain-free once again. When hip dysplasia affects both legs, operating on both hips simultaneously is preferred. This forces the dog to use both rear legs soon after the operation and prevents them from just carrying the repaired leg.
In hip dysplasia, it is the friction and grinding of the head of the femur against the socket of the pelvis that causes the pain. When the head of the femur is removed, the surgeon places muscular and connective tissue between the two former joint surfaces. As this consolidates with additional new scar and cartilaginous tissue, this pseudo-joint becomes pain free and allows almost natural motion. The pet will maintain the knee on that leg slightly straighter to compensate for the slight shortening of the femur.
For the first few weeks after surgery, many veterinarians confine the pet to a small cage and have the owner frequently massage the muscles of the leg. By the fourth to sixth week after surgery, your veterinarian may encourage as much light activity as possible to prevent further atrophy (withering) of the muscles of the leg. Many have the owners passively flex and extend the leg and continue massages four times a day. Dogs and cats do quite well on three legs so it is difficult to get them to start using the repaired leg. Sometimes I resort to taping a sock onto their good rear leg to encourage them to use the newly reconstructed joint. It is also proven that swimming really hastens recovery and use of the affected leg.
Within six months of surgery almost all dogs run about as if nothing had happened.
A total artificial hip replacement or prosthetic joint is also an option for your pet. It replaces the painful arthritic joint and can be performed at any stage of the disease. This process has become routine in humans but cost limits its use in dogs. It is the only technique that works in dogs over fifty pounds with advanced dysplasia. The modular prosthetic hip replacement system used today has three components, a femoral stem, a femoral head, and the artificial acetabulum. Each component has many available sizes, which allow for a custom fit. The components are made of cobalt chrome stainless steel or titanium and ultra high molecular weight polyethylene or another advanced self-lubricating plastic.
This procedure is quite expensive and only performed at large veterinary centers. It has a high success rate and changes in the dog’s mobility are nothing short of miraculous.
The surgery can be performed on dogs of any weight and at any adult age – as long as their general health is good. It’s biggest disadvantage is its cost. Hips are usually replaced one at a time. Often, one replaced hip is enough to restore the pet’s mobility.
The technique for total hip replacement in dogs was pioneered by veterinary surgeons at Ohio State University. Their orthopedic group still performs more canine hip replacements than any other university or private practice in the World.
Proper home care and conservative management
If the Hip Dysplasia in your pet is not severe yet, it does not mean that you should not do anything. Early diagnosis allows pet owner to prepare and possibly prevent it from getting worst. Or if surgery is not an option, there are more natural ways to management and live with a dog diagnosed with hip dysplasia.
WEIGHT MANAGEMENT
Weight control is an important aspect of recovery and is recommended to decrease the pressure applied to the painful joint as the dog moves. You and your veterinarian will need to work together to minimize any weight gain associated with reduced exercise during recovery. Special diets designed for rapidly growing large-breed dogs may decrease the severity of hip dysplasia.
MANAGING ARTHRITIS
Arthritis arising from hip dysplasia is commonly known as secondary Osteoarthritis it is important to correct this condition as soon as it is recognized in order to delay the development of degenerative joint disease. If surgical correction is not an option, medical management of degenerative joint disease must include gentle and controlled exercise, weight management, nutritional support and medications to control pain and discomfort.
NUTRITION
It has been found that puppies that reach their final mature body weight a bit later in life do not develop the degree of hip dysplasia found in puppies that are allowed to eat as much as they will. The secret is to keep the puppies growing steadily but to feed them approximately twenty percent less than they would consume when fed free choice.
HOME ENVIRONMENT
There will come a time when it becomes too painful for your pet to climb stairs or go outside to relieve itself. Building a handicap ramp can be helpful and some pets can be paper trained. You will think of other ways you can make life easier for pets with advanced hip dysplasia, that includes lowering some of your furniture and placing rubber non-slip mats in your house.
When you take your pet for walks and exercise, try to stay on unpaved grassy areas that cushion his step. Avoid hard packed pavement and concrete surfaces. This will lessen shock-trauma to his hips as he walks or runs. And the worst thing for a dog with hip dysplasia is sleeping on a cold, hard floor. Wood floors and carpets improve matters, but the dog will be most comfortable with an overstuffed dog bed or something similar. Orthopedic foam is also excellent.
PHYSIOTHERAPY
Physical therapy can go a long way in reducing your pet’s pain and debility when dealing with hip dysplasia. Hire a professional or begin by kneading the muscles around the hips with your finger tips in gentle , circular motion. Gradually work your way around the surrounding muscles. There is an entire science of pet physical therapy which you can explore.
One of the most helpful forms of therapy for your pet is hydrotherapy and underwater treadmills using the beneficial effects of water to minimize the pain and debility of hip dysplasia. This form of treatment is quite effective in reducing swelling and pain.
Consult your local veterinarian who knows the limitations of your pet before starting a physical therapy program. Rely on the advice or assistance of someone who understands these techniques and their limitations and benefits.
BRACE SUPPORT
Offering a good (brace) support for hip dysplasia dogs is very important to prevent further injuries. A good brace can afford further stability and support which will aid in decreasing pain and inflammation for active dogs. It is especially useful for senior dogs who are arthritic or injured or recovering pets. It is also extremely useful for younger dogs prone to developing hip dysplasia or joint problems. Selecting a high quality mesh material and combat grade webbing is important so that they can be used often by your pet in any environment.
The importance of Rehabilitation and Physiotherapy for Hip Dysplasia in Dogs
Conservative Management of Hip Dysplasia
Physiotherapy has an important role in the management of hip dysplasia. Whilst hip dysplasia is a progressive disease, the condition can be affected by external factors. The main feature of the disease is joint laxity which leads to changes in the joint, abnormal wear and subsequent osteoarthritis.
Rehabilitation Aims
Initial symptoms that your dog may exhibit can be reduced exercise tolerance, problems going up and down stairs, difficulty rising and lameness after exercise. If your primary care vet or orthopaedic clinician should refer your dog to our rehabilitation service a full physiotherapy assessment is undertaken by one of our chartered physiotherapists. Findings might be – altered gait pattern, with or without lameness, reduced weight-bearing load on the affected limb, weakness of specific muscles (most commonly the gluteal muscles) pain manifested by intolerance to be touched in the affected area or during certain movements or postures and reduced range of movement (ROM). Your dog may exhibit all of or just a few of these clinical signs.
Rehabilitation aims to address the above findings and to maintain and/or prevent progression of the disease. After physiotherapy assessment is completed, a list of focus points is formed and a rehabilitation treatment plan is implemented.
Aims will include the following
- Reduce pain
- Strengthen the affected muscles
- Improve and maintain soft tissue flexibility
- Improve and maintain ROM
- Enhance gait patterning
Rehabilitation Options
Targeted exercises specifically for the gluteal muscles Balance and coordination exercises “Hands on” therapy such as massage and basic stretching for pain relief and improving flexibility Pain relief might be provided using laser therapy and ice.
Hydrotherapy Treatment Options
- Hydrotherapy, particularly underwater treadmill, can be a useful tool for strengthening specific muscles and improving gait patterns. The buoyancy of the water provides support to the body which in turn reduces the load on the affected joints whilst exercising the necessary muscles.
- Any physiotherapy program which is prescribed for your dog is constantly re-evaluated and progressed based on the response to treatment. Owner participation is key as so much of the therapy can be used on a daily basis and provided at home. Detailed instructions are always provided.
| Timeline | Physiotherapy Aims | Rehabilitation Therapy options |
|---|---|---|
| Week 0 to 2 | Reduce post operative swelling |
|
| Reduce muscular guarding and maintain soft tissue flexibility |
| |
| Allow careful limb loading |
| |
| Week 2 to 4 | Progress limb loading and gait re-education |
|
| Increase muscle mass | Low level exercise program and muscle stimulation | |
| Maintain soft tissue length and flexibility |
| |
| Management at home |
| |
| Week 4 to 6 | Continue as above, include core stability exercises | Progression of home exercise program to challenge balance, body awareness and strength |
| Advice on maintaining controlled exercise when dog feeling better | ||
| Week 6 to 12 | Increase exercise tolerance | Increase exercise level, considering land and water based options. |
| Continue to increase core stability | Home exercise program considering land and water based exercises | |
| Week 12 onwards | Return to full function or establish deficits and advise regarding long term management. | Progress to off lead exercise and previous exercise level if appropriate. |