What is Hip Dysplasia?
Hip dysplasia is an abnormal development of the hip joint that usually occurs bilaterally. It is most commonly seen in large and medium breed dogs. Although, it can be diagnosed in smaller dogs and even cats. There are many factors contributing to hip dysplasia including rapid growth, a genetic predisposition, or diet (overfeeding). Hips are normal at birth, but start to develop instability between 4 months to a year. Hip dysplasia can progress into arthritis as the pet ages.
Clinical signs of hip issues are difficultly rising, limping, decreased activity level, hind limb muscle loss especially in the gluteals and hamstrings, tight skirt gait, or a ‘bunny-hopping’ gate. Hip Dysplasia can progress into hip arthritis as the pet ages. If osteoarthritis develops, it can lead to crepitus, pain, decreased range of motion, a reluctance to exercise and a waddling gait. Furthermore, hip dysplasia can lead to a hip luxation.
How is it diagnosed?
Diagnosis is often achieve through radiographs (X-rays) and physical exam.
Exam is done by palpating the hip joint for laxity/subluxation. At Walking Paws Rehab we perform pain free exam. A lot of our exam findings are based on feel rather than looking for a vocal reaction. If we suspect hip dysplasia, we may perform a Barden lever test to see if the hip joint can push out. This is a gentle way to feel for instability in the hip joint. Furthermore, we may find tenderness and decreased flexibility on hip extension and abduction. There is typically atrophied gluteals, quadriceps, hamstrings, and sartorius. The pectineus muscle is often tight given that it is working hard at keeping the hip in place. The knees and ankles tend be hyperextended or straight secondary to a pelvic tilt. You may see shoulder muscles overbuilt and upper back trigger points from compensation. Progression of osteoarthritis is variable between patients and may occur as early as 1 year of age.
Radiographs show luxation or subluxation of the hip joint and arthritic changes to the acetabulum and femoral head. Often you see less than 50% coverage by the acetabulum over the femoral head. The neck of the femur is thickened and the femoral head is no longer smooth. For hip dysplasia, there are special radiographs that can be taken such as OFA (hips extended), PennHip (distraction), frog leg (hips abducted), and dorsal acetabular rim view.
Surgical Treatments for Hip Dysplasia
Surgical procedures are performed to correct the alignment of the joint by covering the head of the femur with the acetabulum or remove the joint and in doing so remove pain and slow the progression of osteoarthritis. The surgeries are total hip replacement (THR), triple pelvic osteotomy (TPO), femoral head osteotomy (FHO) and juvenile pubic symphysiodesis (JPS). Dogs are only candidates for the TPO if osteoarthritis has not set in. TPO is usually performed between 4 and 8 months of age. Juvenile pubic symphysiodesis is only performed in dogs less than 20 weeks old. JPS is age dependent whereas as TPO is stage dependent. The majority of cases aren’t caught as a puppy however. So femoral head osteotomy or total hip replacement are the common surgeries for hip dysplasia.
How can rehab help my pet with Hip Dysplasia?
The majority of patients with hip dysplasia or arthritis, however, are treated with physical therapy. We often only see surgery performed in a case caught very early when the more simple JPS surgical procedure can be performed, a dislocated hip, or a severely unstable and painful hip that needs a hip amputation for relief. Total hip replacements are rare given the higher rate of complications and often reserved as last resort. Patients that pursue surgery are often in physical therapy pre op and post op. No matter what route you chose for your pet whether conservative management or surgery, we can assist you.
Although we have no cure for hip arthritis, we are often able to manage the disease so that the pet can walk comfortably, rebuild muscles to stabilize the hip, and improve range of motion. First we start of with pain management. We utilize medications, laser therapy, acupuncture, massage, low grade mobilizations, electrotherapy, ultrasound therapy, PEMF therapy to provide pain relief, relaxation, and regeneration at the hip joint. We then progress into stretching the compensatory muscles such as the hip flexors or adductors. Improving range of motion passively and then actively is a focused goal. Lastly, we focus on rebuilding the stabilizers to the hip. Walking in the underwater treadmill is a great form of exercise for patients with hip dysplasia and/or arthritis. The treadmill promotes more hip extension while the water increases range of motion of the hip in a non weight bearing comfortable manner. Ultimately, we aim to get your pet pain free, limp free, and free to do their previous activities safely. It is also important to maintain a lean body mass to delay the progression of hip dysplasia into arthritis and reduce the risk of complications.
Supplements & Medications
We may utilize nutraceuticals and medications to delay the progression of arthritis. At Walking Paws Rehab, we can review the nutraceuticals and medications your pet is on and make suggestions or modifications.