Treatment and Prognosis of Hip Dysplasia in Dogs
While there is no cure for hip dysplasia, a number of surgical and non-surgical options are available to help alleviate a dog's pain and improve its quality of life. Surgery is usually reserved for severe cases, as the consequences of hip surgery can include pain and other debilitating symptoms that already are associated with the disorder. Left untreated, dysplasia will progress, the hip joint will continue to deteriorate and the dog’s symptoms will worsen and become more obvious. When an owner suspects that her dog is suffering from hip dysplasia, it is time to get a veterinarian’s assessment of the dog’s health and physical status. The therapeutic goals for treating hip dysplasia are to relieve pain, stabilize the hip joint, improve mechanical joint function, slow the progression of the disease and return the dog to normal or near-normal, pain-free function.
A veterinarian is the only one who can provide sound medical advice as to which treatment protocol is appropriate for any given animal. Some of the therapeutic options that a veterinarian might suggest include the following:
Dogs with mild cases of hip dysplasia may respond well to conservative, non-surgical medical management on an outpatient basis. Of course, which treatment protocol to adopt depends on the patient’s age, size and intended function (companion, hunting, agility, show, etc), the severity of hip joint laxity, the existence and degree of osteoarthritis, the veterinarian’s personal treatment preferences and the financial and other considerations of the owner. Non-surgical options may include physical therapy, hydrotherapy (swimming and water exercises), dietary management, weight control, exercise restriction and use of oral anti-inflammatory and pain management medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), and possibly opioids. Corticosteroids normally are not recommended as part of a treatment plan for dogs with hip dysplasia, because despite their beneficial anti-inflammatory effects they also can cause cartilage damage with long-term use. Corticosteroids should not be administered together with NSAIDs, as the combination can cause severe adverse gastrointestinal side effects.
A number of chondroprotective supplements are available, both over-the-counter and by veterinary prescription, to help protect and lubricate the cartilage in joints, These include polysulfated glycosaminoglycans, glucosamine, chondroitin sulfate, hyaluronan, Vitamin C, omega 3 and 6 fatty acids and MSM, among others. These medications and supplements can be quite effective in reducing inflammation and relieving pain. In many cases, weight loss alone can dramatically reduce the pain and other symptoms of hip dysplasia, as overweight dogs tend to suffer more from dysplasia that do fit dogs. Moderate, regulated exercise can stimulate cartilage growth and help delay joint degeneration, and long controlled walks in early or mild cases of dysplasia may help prevent loss of rear muscle mass as well.
Other less traditional techniques that may benefit affected dogs in addition to medical treatment might include: massage therapy to help reduce pain and stress, and reduce collateral strain from compensation; possible application of acupuncture and/or acupressure techniques; surgical implantation of gold beads at acupuncture points; use of herbal or other non-regulated supplements or homeopathic “remedies”; and other forms of supportive care that may help to ease pain, increase circulation, speed healing and otherwise promote wellness, relaxation and comfort. Some of these adjunct approaches lack controlled studies of their effectiveness and may not have established quality control methods or ways to assess their benefit to dogs with hip dysplasia or other degenerative musculoskeletal diseases.
When non-surgical treatment options for hip dysplasia do not accomplish the desired results, such as when the dog’s hip joints have become so severely damaged that less intrusive management techniques do not relieve the dog’s pain, there are a number of surgical options to consider. Depending upon the severity of the condition in a given dog, the veterinarian may attempt to modify the existing hip joint, or instead may opt for a total hip replacement. New and novel treatment approaches are always under development.
Surgical hip modification techniques can be quite effective but may not be adequate for older or heavier animals. They currently include:
- Juvenile Pubic Symphysiodesis – Electrocautery is used to fuse part of the pelvic bone called the pubic symphysis in very young dogs (3 - 4 months of age). This allows the head of the femur bone to be more completely covered by the hip socket (the acetabulum). The femur is the long bone in the thigh that joins with the knee on one end and the pelvis on the other, to create the hip joint. This is not a complicated procedure and can be highly effective if done in immature dogs.
- Dorsal Acetabular Rim (DAR) Arthoplasty – This technique is also available for young dogs. It involves augmenting the outer rim of the hip socket surgically, so that the head of the femur remains more securely inside that socket. The procedure is somewhat controversial.
- Excision Arthroplasty – This procedure is also called a “femoral head and neck ostectomy” (FHO). It involves surgically removing the entire head and neck of the femur bone to alleviate joint pain. Over time, the resulting scar tissue fills in the gap and essentially replaces the hip joint. Following this surgery, the dog’s weight must be managed throughout its life in order to maintain mobility, and a total hip replacement cannot thereafter be done. This is primarily a salvage procedure, used for dogs that have developed severe osteoarthritis in their hips, when medical management cannot control the dog’s pain, or when a total hip replacement is financially or otherwise unavailable. Excision arthroplasty is most successful in small, lightweight dogs with good pelvic muscle development. However, it can lead to complete freedom from pain and return to almost-normal function even in giant breeds. Some minor gait abnormalities may remain after this surgery, and owners will often see muscle atrophy in the pelvic area post-operatively.
- Triple Pelvic Osteotomy (TPO) – This corrective procedure involves surgically rotating the pelvis to improve the acetabulum’s coverage of the head of the femur. It is best done in young animals (6 – 12 months of age), before degenerative joint disease starts to develop.
- Intertrochanteric Osteotomy (ITO) – This procedure is possible in immature dogs with abnormal femoral neck angles, but it is controversial among orthopedic surgeons and is not routinely performed. A total hip replacement (THR) can also be performed in domestic dogs. Total hip replacement has the highest surgical success rate for dogs with hip dysplasia, especially in large or severely-dysplastic adult dogs that do not respond adequately to medical therapy. This is an intensive and expensive surgery which requires a long recovery time (approximately 2-4 months). However, pain-free hip function is reported in more than 90% of cases; even replacing only one hip joint can restore pain-free mobility.
Cryotherapy (ice packing) may be recommended after hip surgery, with passive range-of-motion exercises as soon as they can be tolerated. The surgeon or skilled technician will typically show the owner how to perform these exercises safely.
Prognosis for Dogs with Hip Dysplasia
Hip dysplasia is a progressive and irreversible disease. However, both surgical and non-surgical therapies can be highly successful in restoring affected dogs to almost-normal, pain-free function. With proper treatment and diligent attention by owners to the rehabilitation and recovery process, the prognosis for dogs with hip dysplasia fortunately is very good to excellent.