About Rata Procedures Refer a case Resources Feature cases Contact FAQ's
Hip Dysplasia Surgery Overview
Hip dysplasia cat

Information on the condition and its management options.

Hip Dysplasia

The Condition

Hip Dysplasia (HD) is a term that describes the abnormal development of the hip joint that results in excessive movement, or laxity, of the joint. This laxity results in patient developing inflammation, pain and osteoarthritis of the hip joint. It is a common condition in many dog breeds, but it appears to be more of a clinical problem in large breeds, such as German Shepherds, Labradors, and Rottweilers. HD can occur in cats, but it is far less common.

Clinical Signs

These include lameness, reluctance to exercise, stiff gait, bunny hopping, swaying hips whilst walking, muscle wastage and frequent sitting whilst walking.

What Causes Hip Dysplasia?

The true cause of HD is unclear however it is accepted that HD is caused by a number of different genes as well as environmental influences. This means it is very difficult to successfully breed the condition out. It is not uncommon to see puppies with significant HD despite coming from parents with good hip assessments. Of the breeds that have high incidence of HD some are more likely to develop secondary osteoarthritis and pain. For example, German Shepherds with HD are five times more likely to develop osteoarthritis than Labradors with HD.

Environmental factors that have shown to influence hip dysplasia patients are:

· Diet and obesity have been shown to have a big role in the development of HD. Recent studies showed that Labradors that were fed restricted food (25% less than the control group) in their first 2 years of life were associated with reduced incidence of HD and later onset of secondary osteoarthritis in later life.

· Opportunity to have frequent off-lead exercise in a grassy park or on soft, undulating ground until 3 months of age was associated with lower incidence of HD in later life.

· The daily use of steps and being restricted to smooth, slippery surfaces over the same 3 month period was associated with a higher incidence of HD in later life.

How do we diagnose this condition?

Diagnosis is usually achieved through combination of clinical exam and x-rays of the pelvis. In the UK[1] , dogs older than 12 months of age can have their hip x-rays[2] assessed under the British Veterinary Association/Kennel Club (BVA/KC) hip dysplasia scoring scheme. Dogs with scores lower than the breed average and without arthritis are recommended for breeding. Improvement in HD rates under this scheme has been slow.

Treatment

Conservative management is advised for most cases of HD initially and the patient’s response is monitored before deciding upon surgery. Conservative management involves a combination of therapies such weight loss (if overweight) as well as low impact, controlled exercise, such as lead walks, hydrotherapy, treadmill and physiotherapy. Pain relief with non-steroidal anti-inflammatories, +/- other analgesia such as paracetamol are usually continued for a minimum of 4 weeks. Supplementing the diet with essential fatty acids such as omega-3 has been shown to reduce pain and is advised. Ice packing the hips for 10-15 minutes after exercise is an effective natural way of reducing inflammation.

If the patient has a minimal response to conservative management then surgical options may be considered. Total Hip replacement (THR) is considered the gold standard for treatment of unremitting hip pain and lameness. The prognosis for return to function following THR can be excellent, although as with any surgery the procedure does carry a risk of complications. The average cost of THR in the UK in 2019 was £4500.

Femoral Head and Neck Excision (FHNE) is the alternate salvage procedure that involves removal of the femoral neck and head, creating a fibrous pseudo joint. Clinical outcome following FHNE can be less predictable than following THR, although studies show a high rate of client satisfaction post operatively. Patient selection is key to achieving a good clinical outcome, and not all patients are good candidates for this procedure.

Preventative surgeries are performed in some young dogs and preserve the hip joint. Triple Pelvic Osteotomy (TPO and double pelvic osteotomy (DPO) aim to achieve greater coverage of the femoral head. These procedures can only be performed if very strict patient criteria are met. These procedures are not without a risk of complication.

Juvenile Pubic Symphysiosdesis is a procedure that can be performed in certain breeds with mild to moderate hip laxity. It aims to alter the way that the pelvis grows in dogs up to 16-18 weeks of age, resulting in increased femoral head coverage. Most patients with clinical signs of HD present after 16-18 weeks of age, and so patient selection for this procedure can be challenging.