Early recognition of hip dysplasia and joint laxity is the key to preventing and managing hip dysplasia progression in your dog. By helping to reduce the risk of cartilage wear and damage to the hip socket, there is a chance of reducing the pain and lameness associated with hip dysplasia.
The two main treatment options are surgical and conservative:
- Conservative treatment is not a cure. It manages the pain and dysfunction with the possibility of delaying surgery.
- Surgery depends primarily on the age of your dog. There are two main surgical options that aim to prevent the progression of hip dysplasia, but early diagnosis is critical (<10 months of age). After 10 months the surgical options are usually indicated when all conservative measures have failed.
- The surgical options include:
- Juvenile Pubic Symphysiodesis (JPS)
- Double or Triple Pelvic Osteotomy (DPO / TPO)
- Femoral Head Ostectomy (FHO)
- Total Hip Replacement (THR)
- Conservative and surgical options will be discussed in detail below
There are a number of factors that need to be considered when deciding which treatment option is best for your dog:
- The age of your dog
- Your dogs weight
- The degree of hip laxity (PennHip DI)
- Not only your dog’s lifestyle, but also your own lifestyle
- Cost and future expenses associated with each of the treatment options
- Your ability to not only provide the necessary treatment, but also the ability to maintain said treatment
If your dog is just a puppy then the decision to perform surgery is sometimes much harder. The hip dysplasia diagnosis may have been in an OFA x-ray at the time of desexing with no clinical signs. Or the clinical signs may be mild or episodic. There is a small window however, when the relatively low risk JPS surgery can be performed. This surgery has a good chance or minimising the progression of hip dysplasia but needs to be performed <4 months old. Between 4-10 months old the DPO / TPO surgeries are an option however the complications need to be understood and will be discussed later.
After 10 months of age the preventative surgery window start to close. If at this time your dog has clinical signs of hip dysplasia, but an operation can be put off until after your puppy has stopped growing, then it may be best to delay any procedures until your puppy has finished growing. You can then discuss your options moving forward with your Vet.
Middle aged dogs are usually the ones that undergo either FHO or THR surgery for hip dysplasia. They have stopped growing, and with a generally long life ahead of them, they’re able to recover and bounce back fairly quickly. Your dog will still need lifelong preventative lifestyle changes, but in most cases a single operation is all it takes to give them back their quality of life.
If your hip dysplasia diagnosis is in an older dog, then putting them through an expensive procedure that is not 100% guaranteed to make their remaining years better, may not actually be the best course of action. In this case it may be a better option to manage them conservatively, with a combination of medication, lifestyle changes, and manual therapy to improve their quality of life. This is a discussion that you need to have with you Vet so that you’re fully informed moving forward.
Nutrition and Weight:
All dogs regardless of if they have hip dysplasia or not, should maintain a healthy weight. If this is practiced from very young, this could offer the most effective and least expensive long term method for keeping your dog as comfortable as possible, even in it’s old age.
Avoid over feeding your puppy, as they can grow faster than their body can handle if there is an excessive amount of nutrients available to them. This doesn’t mean you should stringently limit their food intake. Speak with your Vet to find out how much food is best suitable for your breed of dog.
Excess calcium in a growing puppy has also been linked to increased risk of conditions like hip dysplasia. If your dog is a large breed then make sure you feed them large breed puppy food, as this contains the correct ratio’s of nutrients like calcium. If you’re feeding your dog home food then talk to your Vet about a balanced diet for your dog breed and age.
Excessive Exercise as a Puppy:
Slipping and sliding on floors and excessive exercise are two risk factors that can increase the chances of your dog developing hip dysplasia. Strategies like using mats on your floors and learning about safe exercise levels in your puppy are important in managing your puppies development.
This link is an excellent source on safe exercise for puppies.
Degree of Hip Laxity:
The degree of hip laxity will heavily impact not only when your dog should be treated, but also the extent of treatment that they will likely require.
Remember it is the amount of hip laxity that usually determines whether the joint will become arthritic and painful.
A puppy with severe clinical signs of hip dysplasia at just 6 months of age is destined to live out their life in daily pain and discomfort without proper intervention, which is most likely surgical.
On the other hand, dogs that present with minimal hip laxity may be able to delay the onset of hip dysplasia signs until later in life. With the proper prevention methods, the progression of cartilage damage can be significantly reduced, and the weakening of the ligaments can be prevented to an extent.
Read my article on Hip Dysplasia in Dogs to learn more about hip laxity and the diagnosis of hip dysplasia using the PennHip and OFA methods.
Owners who have a highly active lifestyle will find that dogs with significant hip dysplasia can’t be as active or athletic without surgical intervention. The reality is that that dogs with hip dysplasia and excessive laxity, regardless of age, will struggle to maintain a comfortable, pain free active lifestyle.
Older dogs, especially those with chronic hip dysplasia, usually prefer to live more sedentary, low impact lifestyles. These sort of lifestyles can be conservatively managed, allowing for the owner to hold off on any surgical procedures, until the optimal conditions and arrangements can be made.
The elephant in the room. Not everyone has enough disposable income to easily cover the cost of an operation. Let alone the post-surgical costs that can range from time off work, to medication and physical therapy treatment plans. As much we want to do what’s best for our furry companions, sometimes we have to make hard choices.
If the costs of proceeding with an operation would mean that you will not be able to provide the adequate ongoing care for your dog, then it may be advisable to look at other options for managing your dog’s condition.
Talk to your Vet so that you understand all of the options and the costs associated. While some may not be ideal, they can give your dog a very good chance of leading a comfortable life.
Surgical Treatment Options
Joint Preservation Procedures:
Greater degrees of hip laxity increase the likelihood of developing secondary arthritis, but not necessarily clinical disability. There are two joint preservation surgeries that aim to improve the clinical signs associated with excessive hip joint laxity.
Juvenile Pubic Symphysiodesis (JPS)
JPS is a technique that is used to alter the growth of the pubis (part of the pelvis). By closing the growth plate located at the bottom of the pelvis, the surgeon is able to reshape the pelvis itself. As your puppy continues to grow over the next 4-6 months, the sockets should begin to cover more of the ball, which decreases the overall laxity in the hip joint.
Puppies will often be able to go home the same day of the procedure. Your puppies activities will need to be restricted until your follow up assessment with your surgeon. You want to make sure that the hip joint is being used during recovery to help prevent any stiffening of the joint and to help build the muscles around the area.
Prior to your puppies examinations at the age of 10 months they will need to be limited to short leash walks and hydrotherapy. Jumping and running should be heavily discouraged.
Considered to be a relatively minor, minimally invasive surgical procedure. Complications from JPS are rather low, with the high success rates for eliminating the hip laxity that leads to arthritic joint changes.
The recovery period and aftercare is very brief. Aside from the limitations to the aforementioned strenuous activities, aftercare usually consists of basic incision care, and weight management. Rapid growth and excess weight needs to be avoided, so a strict dietary intake needs to be followed. Your Vet will advise you one an aftercare plan that specific for your dogs situation and breed.
Double or Triple Pelvic Osteotomy (DPO/TPO)
This surgical option is indicated in puppies that are less than 8–10 months old with hip dysplasia, but that don’t present with lameness, severe hip laxity, or show visible arthritic changes.
If there are already arthritic changes in the dorsal acetabular ring then the DPO / TPO are no longer indicated as progression to arthritis is not improved by the procedure.
The surgical procedure involves cutting the pelvic bone in either two (DPO) or three (TPO) places, and rotating the segments to improve the sockets coverage over the ball, decreasing the hip’s laxity.
While TPO has been successfully used on dogs and children for decades. Recent technological advancements with locking plates and screws has allowed for similar results to be achieved with the DPO procedure, making the operation much less invasive.
Complications specific to the DPO and TPO procedures include:
- Damage to the nerve that controls movement to the leg
- Screws loosening
- Change in the limb’s range of motion
- Narrowing of the pelvic canal
Post-operative exercise restrictions are important until bony union is achieved, at which time a rehabilitation program aimed at building muscle mass can be initiated. Range of motion of the hip joint is generally preserved.
Long-term functions are expected to range from good to excellent, as long as the recommended post-operative treatment plan is followed.
Salvage procedures are surgeries that are indicated for clinical lameness associated with hip dysplasia / hip arthritis that does not respond to conservative treatment.
Total Hip Replacement (THR)
THR is a surgical option that is usually reserved for dogs that cannot be successfully treated with the JPS or DPO/TPO surgical procedures.
Young dogs that need to undergo a THR need their condition conservatively managed until they have matured enough that most of their growing has stopped. THR is ideally performed on older more mature dogs, or dogs that are no younger than a year old.
THR is a surgical procedure that can provide long-term pain free function in dogs with hip dysplasia. The procedure can eliminate hip pain by reproducing the hip joint’s natural movement, range of motion, and function. This is achieved by replacing both the ball and adjoining socket with implants.
Selection criteria for THR is strict, with common contraindications including obesity, other orthopedic disease (e.g. CCL rupture), neurological deficit, and infective conditions (e.g. bacterial pyoderma or infective arthritis).
THR has an excellent chance of markedly improving limb function, but it is not without risk. Potential complications following a THR are rare but include:
- Hip dislocation
- The implants weakening/loosening over time
- Permanent nerve damage
- Femur fracture
Post-operative management includes early weight-bearing followed by 4-6 weeks of close supervision. Rehabilitation during this time is often limited to ice therapy, laser therapy, and massage. Stretching, manual therapy, and exercise rehabilitation can be initiated after the first 4-6wks. Off-leash activity is restricted for the first 3 months.
Femoral Head and Neck Osteotomy (FHO)
FHO is a surgical procedure that can be done on most dogs, of any age.
- Young dogs with significant clinical lameness that can not undergo the JPS or DPO/TPO procedures may benefit from FHO.
- Older dogs that are not responding to conservative treatment alone, may also be considered for FHO. Especially if a THR is contraindicated.
- FHO may also be considered when finances influence decision making as an FHO is typically several thousand dollars cheaper than a THR.
The procedure is not used to recreate or to maintain normal hip function. It develops a false joint, as muscles around the hip are used to transfer movement forces from the leg into the pelvis. The procedure allows the surgeon to remove painful joint contact that is associated with hip dysplasia and hip arthritis.
Rehabilitation is important for a good functional outcome. Under supervision and in a controlled manner, your dog will be encouraged to use the limb approximately 3-5 days post-surgery. For the first 2 weeks increasing weight bearing is encouraged. Range of motion exercises can then be started at ~2 weeks. Once adequate weight bearing is achieved, strengthening exercises can be initiated. Hydrotherapy, especially underwater treadmill, is encouraged 2-3 weeks after surgery.
FHO recovery is often slightly longer than THR at approximately 4-6 months. Maintaining body weight at the lower end of ideal is very important in achieving a good outcome.
For the rest of its life, you need to manage your dog’s weight to keep it with in the ideal range. It may be necessary for intermittent use of daily anti-inflammatory drugs for up to two months following the surgery. If the dog weighs less than 60-70 lbs at the time of the operation, the use of daily anti-inflammatory pain medication may be able to be avoided.
A dog that has undergone FHO is usually limited to light exercise, leash walks, assisted swimming, and generally confined to the yard and house. This makes FHO more suitable to dogs that are living a more sedentary lifestyle. Excessive exercise may require more frequent use of pain management and anti-infammatory medications.
If you or your dog wants to continue with the following lifestyles or activities then a THR may be more beneficial moving forward:
- Athletic activities – running or jumping
- Hiking or climbing – long distance travel on foot or over rough/uneven terrain
- High level obedience courses – competitions and obstacle courses
- Not able to maintain a slim build
Conservative Treatment Options
Non-invasive treatments are available for dogs that’re unable or not indicated to undergo surgical procedures. While these treatments may not yield the same benefits as the surgical options, they can decrease your dog’s pain and improve function, as well as aiding in their post-op recovery. They’re also an excellent option in milder cases of hip dysplasia.
1) Maintaining Ideal Weight
Maintaining a healthy weight for your dog is just as important throughout its life, as it is for hip dysplasia recovery and prevention. Overweight dogs are more likely to develop arthritis associated with hip dysplasia as the extra weight can cause the cartilage in the joints to wear down faster.
Dogs that are recovering post operation also benefit from carrying less weight. The less that the hip joint needs to support, the quicker the recovery process can be.
2) Adjusted Exercise Routine
How much exercise is enough exercise? Excessive exercise is not always the best thing for a dog, especially a growing puppy. If your dog has early stages of hip dysplasia, it is best to avoid activities that can make the condition worse. This does not mean avoiding exercise all together as keeping your dog’s muscles strong is important in helping to support their hip joints.
Regular leash walks at a tolerable speed / distance is advised. Your want to avoid increasing lameness during the walk and /or increasing morning stiffness. If your dog’s lameness is significant you need to discuss a program with a Canine Rehabilitation Professional. This may include hydrotherapy as well as progressive exercises.
If your dog needs to lose weight prior to any procedures, consider a mix of leash walks at a length the dog can comfortably tolerate, hydrotherapy, and a balanced diet.
Speak with your Vet following any procedures, and make sure that you stick to the short term physical rehabilitation exercises, as well as any long term lifestyle changes that are suggested.
This link is an excellent source on safe exercise for puppies.
3) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
While drugs can be very effective in relieving pain, many NSAIDs can have significant side effects. If NSAIDs are used daily, your Vet may require your dog to undergo regular blood tests in order to monitor for kidney and liver damage.
Prescription medications like NSAID’s are often considered for young to middle aged dogs as a temporary treatment while they’re growing. In this case, the medication can make your dog more comfortable until it is old enough to undergo a procedure like a THR. Additionally, if the cost of the surgery, as well as the additional post-op expenses are too great, medications can be used to make your dog more comfortable.
Aside from keeping dogs that are awaiting surgery comfortable, medicating olders dog may be a more viable option, as opposed to an operation. Surgeries are not without complications, and the risk of something going wrong, may outweigh the benefits of operating on an older dog. With older dogs, keeping them comfortable is what matters most, so sometimes it’s worth discussing the risks and benefits with your Vet.
Supplements have been shown to reduce the reliance on NSAID’s by ~25%. Supplements include glucosamine and chondroitin, omega 3 fatty acids (e.g. fish oil / NZ green lipped mussels), avocado soybean unsaponifiables (ASU), and injectables like adequan and cartrophen. If you would like to read more about supplements for hip dysplasia click here.
5) Manual Therapy & Rehabilitation
Manual Therapy and rehabilitation programs are an important part of conservatively managing the pain and physical limitations of hip dysplasia. Manual therapy can be helpful for improving muscle tone and increasing pain free range of movement, as well as balancing the surrounding joints. If your Manual Therapist is also a Canine Rehabilitation Professional they’ll also be able to give you a rehabilitation program for home care.
Manual therapy / rehabilitation will also be an important part of your dog’s post-surgical care. Safely re-establishing range of motion, as well as improving muscle tone and strength will be important moving forward.
Owners who are time poor, may be able to find a local rehabilitation doggy daycare, that can both look after their dog while they are at wok, as well as provide them with the require postoperative care thats required for a speedy recovery.
Not all hip dysplasia leads to surgery. In more severe cases with excessive laxity surgery may be the best option, especially if it is diagnosed early. In milder cases however, the hip dysplasia may go undiagnosed throughout life, and / or be able to be managed conservatively.
The goal with juvenile surgeries (JPS, DPO / TPO) is to try to limit the progression of hip dysplasia to Arthritis. FHO and THR are generally indicated once a dog is fully grown, if conservative measures have failed. The surgeries are not without risks so it’s important to discuss the management options moving forward with your Vet.
If you would like to understand more about hip dysplasia, including how it presents and diagnostic tests, read this article here.