Coxofemoral luxation, or dislocation of the hip joint, occurs when the head of the femur displaces from the socket. This displacement disrupts the joint capsule that encapsulates the joint, as well as other supportive structures of the hip, including ligaments and cartilage. Additionally, your dog can partially dislocate the hip, a condition known as subluxation, often associated with hip dysplasia.
Hip luxation typically causes significant pain, affecting weight bearing and overall function. Dogs often tuck and rotate their affected leg either internally or externally, depending on the direction of the dislocation. Most commonly, the leg dislocates forward, causing them to tuck the leg up and turn the toes inward.
A vet or rehab therapist may diagnose a luxation from an exam alone. Several times a year, we diagnose a patient with a dislocated hip immediately upon their arrival at our practice. We most commonly perform radiographs to ascertain the placement and direction of the dislocation.
Non-surgical reduction of the hip (closed reduction) can be performed, which means your pet would be sedated and the veterinarian will manually reduce the ball back into the socket of the joint. Your pet’s affected limb then may be positioned in a sling for several weeks to allow the disrupted tissues to heal. This type of treatment has a 50% success rate.
Surgical reduction (open reduction) is another treatment option consisting of surgically putting the hip back into the socket and restoring the supporting structures. The surgeon may use techniques such as rod fixation, surgical anchors, and/or reconstruct the joint capsule. Success is high with surgical reduction.
Femoral head ostectomy (FHO) is performed when reducing the ball back into the socket is not appropriate or the hip keeps dislocating back out after reduction. An FHO removes the head of the femur which creates a “false joint”. There is generally mild loss of function, but with proper patient selection, good functional results are expected. Risk of recurrent luxation or implant complication is avoided with an FHO.
Total Hip Replacement (THR) is used when the joint is replaced with synthetic materials. There are several hip replacement alternatives and it depends on the extent of injury and surgeon preferences.
Rehabilitation is an essential part of your pet’s recovery after any surgical or non-surgical treatment. Initially, our goal is to reduce pain and swelling, relax tight muscles, and enhance weight bearing using modalities such as massage and passive stretches. Next, we focus on rebuilding the hip’s stabilizers through isometric exercises, progressing to concentric and eccentric strengthening exercises. The underwater treadmill serves as a valuable tool to promote weight-bearing through the affected limb during exercises and improve gait.
Vinny underwent a failed total hip replacement as a puppy, followed by a femoral head and neck ostectomy. Despite rehabbing for six months at another practice in the Denver area without improvements and still not bearing weight on his leg, a veterinarian referred Vinny to us.
When I first met Vinny, I prioritized pain management heavily, diagnosing him with allodynia—a condition that causes heightened sensitivity to pain and normal touch following major surgeries like an FHO or hip replacement. Just two weeks into pain management and therapy at our practice, Vinny began bearing weight again. We restored him to full strength and weight-bearing capacity in his hindlimbs and then fitted him with braces for his ankles, as tarsal hyperextension is often a common secondary issue to hip problems.
The lesson from Vinny’s story is clear: controlling pain is essential before a dog can start walking on their leg again!
