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What is CHD?
Canine Hip Dysplasia (CHD) involves instability or laxity (loose fit) of the ball and socket joint of the hip. Abnormal movement of the ball, which forms the head of the femur, deforms the acetabulum which is the socket of the hip. This can lead to loss of cartilage, the development of scar tissue around the joint, and the formation of osteophytes (bone spurs) within the joint. These changes in turn can lead to hip pain and dysfunction of the hind limb.
CHD can arise from multiple factors, however the animal's genetics play the largest role with large breed dogs being the most commonly affected. Rapid growth due to excessive nutritional intake in puppies and rapid weight gain can also increase the risk of hip dysplasia.
Many dogs with CHD do not have any obvious symptoms, but signs of hip dysplasia can include lameness (limping), shifting of weight to the front legs, loss of muscle mass on the hind legs, reluctance to stand up from sitting/ lying down, reluctance to jump, and hip pain.
CHD is diagnosed by a combination of specific palpation methods and specially positioned radiographs (x-rays), both of which require mild sedation to perform. The palpation method is called the Ortolani Sign, and while it is not quantitative, if it is present in a puppy, it indicates that they will usually have hip arthritis by the time they are a year old. Many small animal primary care veterinarians can check for the Ortolani Sign, and it can be done as early as 10–16 weeks during regularly scheduled vaccination visits with their vet. If the Ortolani Sign is not noted, there is the possibility of a false negative result, which can be resolved by using the PennHIP method. The PennHIP distraction method is a quantitative x-ray method that measures the actual amount of hip laxity. It accurately predicts whether a puppy will develop hip dysplasia and helps determine what surgical options would be best suited to prevent arthritis. Special equipment and training are required for this test, and PennHIP will provide independent written confirmation of CHD for the veterinarian and pet owner.
The American College of Veterinary Surgeons has stated that the Orthopedic Foundation for Animals (OFA) x-ray exam used by many breeders is not accurate and predictive of CHD in young puppies. The OFA recommendation is a preliminary exam at 1 year and final exam at 2 years of age. However by that age a dog with CHD will likely already have experienced significant joint changes and they will have missed the window for several surgical interventions that can greatly reduce the long-term impact of hip dysplasia. The best way to help prevent cartilage damage from joint laxity is early recognition and surgical treatment. Puppies as early as 10 weeks old can be diagnosed with abnormal joint laxity accurately by using the PennHIP method and checking for the Ortolani sign, so these are better options than the OFA x-ray exam.
Treatment options include both surgical and non-surgical methods. If CHD is caught early enough, surgical intervention is usually the gold standard for treatment, as it can help reduce the risk of arthritis and other complications due to hip dysplasia. Non-surgical medical management is also available, depending on the circumstances and patient needs.
Juvenile Pubic Symphysiodesis (JPS) is a minor procedure that reduces hip laxity by stopping the growth of the pubis (part of the pelvis) to alter the growth/shape of the pelvis, while increasing the degree of coverage of the head of the femur by the socket of the hip joint. JPS is only an option for puppies younger than 18 weeks of age, so early diagnosis by a vet is essential, since most puppies that age do not show symptoms of CHD.
Double or Triple Pelvic Osteotomy (DPO/TPO) is an option for puppies less than around 8–10 months old who have CHD with no visible arthritic changes on x-ray. If a puppy is spayed or neutered between 6–8 months old, the veterinarian can take an x-ray and check for an Ortolani sign at that time, and the puppy would still be young enough for this option. These surgeries involve cutting the pelvic bone and rotating the segments to decrease hip laxity by improving coverage of the ball by the socket. A DPO involves using implants (locking plates and screws) that allow for a less invasive procedure, with only two cuts made in the bone instead of the three cuts used in a TPO.
Total Hip Replacement (THR), can be performed in dogs who are not eligible for JPS or DPO/TPO surgeries due to their age or the severity of their joint disease. Puppies must be managed medically until they are old enough for this procedure, as it is only appropriate for dogs who are at least a year old. THR helps to eliminate hip pain by replacing the ball and socket with implants that can restore normal limb function and range of motion of the joint.
Femoral head ostectomy (FHO) surgery is typically a last-resort surgical option for dogs who are not eligible for any of the other surgeries, as the goal of this surgery is to relieve pain associated with CHD, not to maintain/recreate normal hip function. Dogs who have FHO surgery must remain slim and follow a restricted exercise program. They cannot hunt, participate in most dog sports, or do a lot of running, and generally must stick to leash walks for exercise. For dogs who are very active or participate in dog sports, FHO would not be recommended, as THR would be a better option and allow them to continue with their activities. FHO can be done at any age, and in dogs weighing less than 60-70 lbs can often eliminate the need for daily use of anti-inflammatories. This surgery involves removing the head of the femur, allowing for the formation of a “false joint” by the muscles around the hip. This reduces the pain produced by the wearing away of cartilage and the stretching of the soft tissues around the joint due to laxity.
If surgery is not an option, medical management with anti-inflammatories, other pain medications and rehabilitation therapy is necessary to help dogs with clinical signs of CHD have a good quality of life. It should be noted that in young or middle-aged dogs, the cost of lifelong medication and monitoring of lab work needed to check for liver or kidney side effects from medication can exceed the cost of surgical intervention.
The dog’s weight, age, activity level/ lifestyle, the degree of hip laxity, access to rehabilitation therapy and the owner’s financial considerations all play a part in determining if surgery or medical management are the recommend treatment for CHD.
Medical management is sometimes used in overweight middle-aged or older dogs with CHD who live a sedentary life style, as weight loss, rehab and pain medication can help reduce pain and improve quality of life.
In contrast, puppies with severe hip dysplasia and no functional hip joint normally require surgery to help prevent long term pain and limitation of exercise. Dogs with less severe hip laxity in which the signs of CHD don’t occur until middle-age can sometimes be managed medically, as the cartilage damage progresses more slowly due to less severe hip laxity.
Highly active dogs, dogs with very active owners or those who live with another active dog/child in their home are generally better off having surgery to manage CHD and allow for more exercise, as with medical management only a relatively sedentary lifestyle is possible.
Medical management entails the use of non-steroidal anti-inflammatory drugs (NSAIDs) and other pain medications, as well as regular blood work to help monitor for signs of kidney or liver side effects from the medication. The goal is to keep the dog on the lowest dosage and dosage interval of medication that can keep them comfortable. Dogs with CHD, regardless of treatment method, should be kept slim throughout their lives, as extra weight greatly increases the risk and degree of complications due to CHD and weight management is the least expensive and most effective long term method of keeping dogs with hip dysplasia as comfortable as possible. Joint supplements such as Omega-3 fatty acids and cartilage protective supplements are recommended, as is veterinary rehabilitation therapy. Encouraging joint movement and muscle strength can help keep pets comfortable and mobile, helping to maintain a good quality of life. Rehabilitation therapy is also used before and after surgery for CHD, as it helps increase the speed of recovery.
With our holistic approach to orthopedic care, WEVR is committed to enhancing the quality of life of dogs with hip dysplasia. We provided specially tailored rehabilitation therapy programs designed to help manage pain, improve mobility, and build strength and muscle. Our treatment plans involve the use of modalities such as acupuncture, laser therapy, massage, Tui-na, TENS (Transcutaneous Electrical Nerve Stimulation) and PEMF (Pulsed Electromagnetic Field therapy) to help manage pain and inflammation, as well as therapeutic exercises. WEVR provides these services directly at your pet’s regular veterinary clinic, with no need for a referral to a specialty centre. Each treatment is specially designed for your pet to help meet their needs and help them feel their best. We will update your pet’s regular veterinary team and provide home care for you to help keep your pet feeling good between sessions. WEVR can assist pets with milder CHD to live comfortably and remain active, and also offers rehabilitation for dogs undergoing hip surgery both before and after the procedure to improve outcomes.
Schedule a free 15-minute virtual consultation with us and learn how we can help your pet!