Hip Laxity, Coxofemoral Laxity, Subluxating Hips, Femoral Head and Neck Excision, Triple Pelvic Osteotomy, Juvenile Pubic Symphysiodesis, Total Hip Replacement, Hip Arthritis
Canine Hip Dysplasia (CHD) is a condition that begins in dogs as they grow and results in instability or a loose fit (laxity) of the hip joint (Figure 1). The hip joint laxity is responsible for potential clinical signs (symptoms) of hip pain and limb dysfunction and progressive joint changes. The hip joint is a ball and socket joint and continual abnormal movement of the femoral head (ball) deforms the acetabulum (socket). The long-term response to this joint laxity is the progressive loss of cartilage, the development of scar tissue around the joint, and the formation of osteophytes (bone spurs) around the ball and socket (Figure 2).
The cause of CHD is multifactorial; however, hereditary (genetics) is the biggest single risk factor. Rapid weight gain and growth through excessive nutritional intake can complicate the development of CHD. Hip dysplasia occurs most commonly in large breed dogs.
Signs and Symptoms:
The symptoms of CHD are lameness (limping), reluctance to rise or jump, shifting of weight to the forelimbs, loss of muscle mass on the rear limbs, and hip pain. Generally, divide dogs with CHD into two groups showing symptoms of CHD:
Group 1: Younger dogs without arthritis, but with significant hip laxity
Group 2: More mature dogs that have developed hip arthritis due to CHD
Dogs may show symptoms at any stage of disease’s development, although many dogs with CHD do not have any obvious symptoms.
Examination is the first test and includes an evaluation of gait changes and evidence of hip laxity. A thorough orthopedic evaluation is critical because a number of neurologic and other orthopedic problems cause symptoms similar to those seen with CHD. X-rays are important to help diagnosis CHD (Figure 3). In order to get the best X-rays, the dog may need to be sedated or anesthetized for proper relaxation and positioning. The Orthopedic Foundation for Animals, a screening agency for canine hip dysplasia, will certify a dog after two years of age. Stress radiographs are used to detect breed susceptibility to hip dysplasia as early as four months. However, many dogs have evidence of CHD on X-rays, yet another problem causes their symptoms; which is why proper examination is so critical.
There is no single best treatment for CHD. Treatment recommendations will depend on the dog’s age, body weight/size, degree of discomfort/dysfunction, examination, and X-ray findings, your expectations for your dog and your budget. Additionally, not every pet diagnosed with CHD requires treatment. Approximately 75% of young dogs with CHD can maintain acceptable function well into maturity without developing significant symptoms of hip pain. Medical and surgical options are available for young and mature pets with CHD. Most dogs are initially treated with medical management.
Medical treatment entails a combination of multiple modalities to improve your pet’s comfort as much as possible without surgical intervention and includes the use of aggressive weight loss/management, consistent exposure to lower-impact activities (walking, swimming etc.), nonsteroidal anti-inflammatory drugs, physical rehabilitation, fish oil supplements, and disease modifying osteoarthritis drugs. Dogs in Group 1 (see Signs and Symptoms) generally do not respond as well to medical treatment as do dogs in Group 2 (see Signs and Symptoms). For this reason, earlier surgical intervention with procedures such as juvenile pubic symphysiodesis (JPS) or pelvic osteotomy may be indicated.
JPS is a technique for stopping the growth of the pubis (part of the pelvis) to alter the growth/shape of the pelvis, while increasing the ball’s degree of coverage by the socket to diminish hip laxity. It is a relatively minor surgical procedure and puppies less than 18 weeks of age must have it performed. However, since most puppies of this age do not show symptoms of CHD, early diagnosis by way of examination and special X-ray techniques is critical.
Another option for immature dogs (ideally less than 10 months old) with CHD but no arthritic changes is a double or triple pelvic osteotomy (DPO/TPO) surgery. These procedures involve cutting the pelvic bone in two (DPO) to three places (TPO) and rotating the segments to improve coverage of the ball by the socket and decrease hip laxity (Figure 4). The TPO has been used in dogs for decades. Recent advancements in implant (locking plates and screws) technology now allow similar results with only two cuts made in the bone.
Immature dogs with evidence of hip arthritis are not ideal candidates for TPO/DPO, nor are dogs with very severe hip laxity. Dogs need to be screened by examination and X-rays to determine if they may benefit from these procedures. Manage non-candidates medically until they are mature enough for total hip replacement (THR) or femoral head ostectomy (FHO) surgeries.
Young dogs not meeting the criteria for TPO/DPO or JPS procedures, or Group 2 dogs who do not respond satisfactorily to medical treatment alone may benefit from FHO. This technique involves removing the femoral portion of the hip joint (i.e., the ball) in order to reduce the pain produced by abnormal hip joint contact and the stretching of the soft tissues around the joint due to laxity (Figure 5). Following an FHO, a “false joint” develops with the muscles around the hip now transferring the forces from the leg to the pelvis during limb movement. The goal of an FHO is to relieve the pain associated with CHD, not to maintain/recreate normal hip function. This latter fact is why FHO is generally considered less desirable in larger dogs.
THR is another option for Group 1 and 2 dogs. This procedure eliminates hip pain and, unlike an FHO, reproduces the mechanics of a normal hip joint producing, more natural range of motion and limb function. As with humans, canine THR involves replacement of both the ball and socket with metal and polyethylene (plastic) implants (Figure 6). These components are fixated in place with bone cement, metal pegs, or “press fit” (bone ingrowth) methods.
Aftercare and Outcome:
Risk of complications after JPS are very low; almost all are minor in nature. Success rates for JPS eliminating hip laxity are high and aftercare is very brief, usually just entailing basic incision care and short-term activity restriction.
Reported complications after DPO and TPO include screw loosening, change in limb range of motion, and pelvic canal narrowing. However, the incidence of complications is low and reports of long-term function are expected to be good to excellent.
THR results in an excellent chance of markedly improved limb function. Potential complications after THR include infection, hip dislocation, “loosening” of the implants over time, nerve injury, and femur fracture.
Following both DPO/TPO and THR, the dog’s activity should be restricted to leash exercise outdoors and confinement to a small area indoors until the procedures are deemed healed (via examination and X-rays), generally six and eight weeks respectively. Most pets are weight bearing soon after surgery and require supervision to prevent overuse of the leg during the healing period. If necessary, use a sling for initial assistance with walking. The dog should avoid stairs, slippery surfaces and interactions with other dogs. To get back to normal, slowly increase activity after the initial period of restriction.
Results after FHO vary and are highly dependent upon patient size and proper postoperative physical rehabilitation. While many dogs will have varying degrees of lameness, function should improve when compared with preoperative status. After FHO, pets are encouraged to use the limb as soon as possible in a controlled manner. Aggressive physical rehabilitation and controlled exercise to increase hip range of motion are essential for an optimal outcome. It may take up to six weeks or longer after surgery for some dogs to show improvement.
Content by the American College of Veterinary Surgeons