Living with a Dog Suffering from Canine Hip Dysplasia
Real story by: Christine
Our dog, an English bulldog-Boxer mix, couldn’t have been more than a year-and-a-half old when we first noticed a certain occasional strangeness in her gait.
We’d adopted her at ten months old from a shelter—a built-tough but beautiful brindle pup. She loved to chase other dogs, jump and play, and did so with great zeal. It was a joy to watch. Sometimes, though, she seemed to limp a little—just a very little. We chalked it up to her growing body and her particular way of being.
Two years passed and her “limp” seemed to resolve.
After she was attacked by another dog at the dog park, she began to exhibit more aggressive tendencies herself. For her own safety and that of other dogs, we no longer visited the dog park or let her off-leash except in our own yard or under heavily supervised conditions. We tried to get her together with dogs she liked so her world would not completely close in around her. On one of these occasions, she was joyfully bounding about with a new friend. We were happy, thinking we had finally found a friend she could get together with often. She’s an energetic dog and needs such outlets. But, as we were finishing our walk, she took a spill, her hind legs sliding out from under her. After, she could barely walk. The next morning, she still could barely walk.
Alarmed, we took her to the vet. X-rays revealed that she had significant hip dysplasia—a condition in which the head of the femur bone sits abnormally in the pelvic sockets. Over time, the cartilage can erode, causing pain and dysfunction. Only three at the time of diagnosis, it’s a condition our dog undoubtedly has had since birth and one common in both bulldogs and boxers. The strange gait of her puppy-hood finally made sense. Odd that it took so long to manifest and then did so with such tenacity. Luckily, her anterior cruciate ligament (ACL) did not appear to be damaged.
The doctor prescribed pain medication (Rimadyl) for her and we were advised to severely restrict her activities for a period of six weeks to monitor her. So much for getting her together with friends. Any increased level of activity brought what appeared to be painful consequences. We were devastated she could no longer chase sticks—one of her favorite activities—or see her new pal again.
We were referred to an orthopedic surgeon for his evaluation and recommendations. It appears there are three options for dogs with hip dysplasia, in order of cost:
(1) manage the condition with pain medication, weight control, and activity management (i.e. allowing only activities that will not exacerbate the problem, such as non-impact exercise like swimming) for as long as the dog is able to be comfortable;
(2) conduct a type of surgery known as “femoral head ostectomy,” which consists of literally cutting off the rounded “heads” of each of the two hind femurs so that flexible scar tissue builds up around them and they don’t painfully rub in the socket (est. $3,000 total cost–$1500 each hip);
or
(3) surgically replace her hips (full hip replacement; est. $6,000 cost).
Of course, there’s always the ultimate option—putting her down—but we’re not considering that. She’s still young, her condition is not life threatening, and she’s full of vim and vigor. It wouldn’t be right and we simply couldn’t bear it.
We have, however, been struggling with what to do on the other fronts. She’s a young dog, presumably with many good years left (boxers live an average of ten years). We determined initially to go the management route and have been diligent about giving her medications and trying to keep her comfortable.
It’s so difficult, knowing how she loves to run, keeping her from doing so. But she pays if she does, oh how she pays. It’s brought me to tears seeing her struggle to get up or walk. Seeing how weak her hips have become. And the condition seems to be progressing little by little. Though she still has many good days, it’s becoming clearer that surgery may be the only option.
Of the two surgical choices—femoral head ostectomy or full hip replacement—obviously the latter is the best option, the “Cadillac,” once healed. Everyone would want that for a beloved pet, but the cost is extremely prohibitive. It also requires a long convalescence. I suspect, thus, that we will go with the other surgical option, which—though it has to be done one hip at a time—has a shorter convalescence. Indeed, the doctors want the dog to be active as soon as possible after surgery in order to build up the necessary scar tissue to replace the femoral heads. Apparently, dogs do very well with this type of surgery, though humans (because we stand upright, weigh more, and distribute weight differently) could not.
Unfortunately, an emergency expenditure has required us to put off the surgery a bit longer—one of life’s curve balls, which makes things so difficult sometimes. Hopefully the pain meds will stave off the worst for our dog until we can undertake the surgery.
We’re looking forward to seeing her outrun her new pal without painful consequences!
Comments
Wed, Sep 12 2007
Thanks, Our dog is exhibiting those exact symptoms. Thanks for your post. it was very helpful! I’ll keep this site posted on Hannas progress. She a Rhodesian Ridgeback and is 1 year and 10 months old.
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Developmental Hip Dysplasia
Despite many years of selective breeding, hip dysplasia remains one of the commonest orthopaedic diseases of dogs. It is often confused with osteoarthritis of the hips in older dogs which is incorrect; hip dysplasia is a developmental disease that can start within the first few weeks of life, whereas osteoarthritis is the consequence. Dogs with hip dysplasia usually fall into two categories when first being presented to the veterinarian for this condition:
1. When they are less than 12 months old, and pain arises due to the joint laxity, the key initiating factor in hip dysplasia.
2. When they are over 2 years old, and pain is due to osteoarthritis caused by the hip dysplasia.
Between these two stages, symptoms often decrease. This is because the joint laxity causes thickening of the joint capsule and surrounding tissues, thereby restricting movement. Increased muscular support also helps to mask the symptoms by providing external support.
It is well documented that developmental skeletal problems tend to occur in larger breeds of dogs, with force through the joint directly proportional to bodyweight. However, genes are not the only cause. Factors such as diet, bodyweight and exercise play a crucial role. It has been suggested that as few as 24% of young dogs with severe signs of hip dysplasia on xrays will actually develop symptoms of the disease if managed appropriately with regard to the factors mentioned above.
So, what are the signs to look out for?
Symptoms may range from mild stiffness on getting up, or a reluctance to jump, to the classic wiggle seen as the dog rotates its pelvis as it is walking, to reduce the extension of the hip which is painful.
On examination by a veterinarian, younger animals may show increased joint laxity, essentially looseness of the ball (femoral head) in the socket (acetabulum). Older animals typically show reduced flexibility of the hip joints, with a grating sound produced on manipulation of the joint (crepitus) and muscle wastage of the hindlimbs.
One must also bear in mind that there are other diseases that can affect dogs of this age, such as diseases of the nervous system (e.g. lumbosacral stenosis, degenerative myelopathy). Though rarer than hip dysplasia, they must be considered before making a diagnosis.
How is diagnosis confirmed by the veterinarian?
1. Clinical examination. Though joint laxity in the hips can often be felt with the dog conscious, it can be painful and therefore is best performed with the dog under general anesthetic or heavy sedation. This will also reduce the effects of muscle tension. There are 3 tests that vets can perform on the anesthetized dog to diagnose hip dysplasia: the Barlow test, the Bardens test and the Ortolani test. These tests invariably involve applying pressure and manipulating the hip in a certain direction to cause partial of full dislocation of the femoral head.
2. Xrays. Good quality, well positioned radiographs are required to assess hips for dysplasia and general anesthesia is a necessity to achieve this. If a dog is to be used for breeding, it is often hip scored prior to doing so. This is often done in the absence of any symptoms at all, in perfectly healthy dogs. The radiographs are then sent off to the national Hip Dysplasia Scheme assessors for examination, where the hip joints are scrutinized to predict the likelihood of the disease occurring.
My dog has been diagnosed with hip dysplasia. What are the management options?
This is relatively straight forward. Dogs can either be treated conservatively (without surgery) or surgically. Conservative management is NOT doing nothing, it should be a PROACTIVE option. A programme should be designed for the individual dog to address weight control, exercise management, physiotherapy and pain control.
CONSERVATIVE MANAGEMENT
1. Weight Control
Excessive weight should be prevented in puppies, and adults should be maintained at or below normal adult bodyweight. Simple weight reduction has been shown to result in a significant improvement in lameness in adult dogs with osteoarthritis secondary to hip dysplasia.
2. Exercise Management
A suitable level of exercise should be determined for each individual dog to maintain muscle development and fitness without exacerbating the clinical signs. Obviously this must be integrated with the owners lifestyle expectations. Regular, low impact exercise is preferable to intermittent, vigorous exercise. Several short walks a day is better than a huge walk every other day!
3. Physiotherapy
The benefits of physiotherapy in the treatment of musculoskeletal diseases of animals have only recently been recognized. Hydrotherapy is an excellent form of exercise for obese, unfit and disabled animals. This is because the buoyancy the water provides helps overcome the effects of gravity, and muscles are worked out without placing too much force through the joints.
4. Pain Control
Non steroidal anti inflammatory drugs (NSAIDS) are a key component of conservative management. They work by blocking the formation of inflammatory mediators which cause pain, specifically by blocking the cyclooxygenase enzymes COX 1 and COX 2. The modern NSAID drugs preferentially inhibit COX 2 enzymes, which reduces the side effects associated with them, such as stomach ulceration and kidney damage. The most commonly used NSAIDs are carprofen and meloxicam.
5. Nutraceuticals and cartilage protecting drugs
These are slow acting, disease modifying drugs that may help to control osteoarthritis. Orally administered forms of glucosamine sulphate and chondroitin sulphate have been shown to improve joint function in humans. Whilst the exact mechanisms of osteoarthritis may differ between dogs and humans, anecdotal evidence suggests they are beneficial and they have become popular with many veterinarians. Above all, they cannot do harm so are often prescribed, despite the absence of hard scientific evidence in their favor.
SURGICAL MANAGEMENT
Surgical treatment can be divided into preventative or salvage. Preventative treatments include the following:
1. Triple Pelvic Osteotomy (TPO)
This is indicated in young animals with painful hips that have failed to improve with conservative treatment. The operation provides stabilization of the hip, which reduces the progression of osteoarthritis. It can be performed on any age of dog, but dogs have to show minimal remodeling of the hip joint on xrays and so most that meet the criteria are less than 8 months old.
2. Perineal myectomy
This involves removing part or all of the pectineus muscle, the spasm of which is thought to cause pain in the growing dog with hip dysplasia. However, whilst this procedure does tend to produce some pain relief, it is now considered outdated by many.
3. Intertrochanteric osteotomy
Although effective in decreasing pain and reducing secondary osteoarthritis, it is less effective than TPO and there is a risk of fracturing the femur during the operation, meaning it is no longer recommended.
4. Pubic symphysiodesis
A new technique for young dogs considered to be at risk of developing hip dysplasia. The procedure is most effective in very young animals, which are usually not showing any symptoms at all, making it a controversial treatment option and not recommended at present.
Salvage options include:
1. Femoral Head & Neck Excision
This involves surgically removing the head and neck of the femur. Heavier dogs have a much poorer outcome than lighter dogs. It tends to give positive results in dogs less than 17kg in bodyweight. Obese dogs fare poorly. Younger, more active dogs can respond very well to this procedure.
2. Total Hip Replacement
This is not the solution for every dog with a painful hip. Owners must be aware that while the outcome is usually very good, complications can rarely occur and when they do they are disastrous.
The ideal candidate for a hip replacement is a well trained, sensible, medium to large breed dog, which was previously active, and has a painful hip that is unresponsive to medication. The owners should be sensible and compliant, with funds to spend not only on the surgery (which is expensive), but also on dealing with potential complications that may occur, which can be equally costly. If these criteria are not all met, it may be more appropriate to perform a femoral head and neck excision.
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