Hip Dysplasia
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Article Written by Dr. Daniel A. Degner, Board-certified Veterinary Surgeon (DACVS)

Key Points

Hip dysplasia is the abnormal development of the hip joints and usually has a genetic basis.

A variety of medications are available to temporarily relieve pain associated with the hip joints. Surgery, however, frequently is needed.

Femoral head and neck excision is usually reserved for small patients; triple pelvic osteotomy is used for immature dogs that have minimal to no arthritic changes of the hips; total hip replacement is a salvage procedure that is used in large breed dogs.


Anatomy

The pelvis is made of four bones: the ilium, acetabulum, pubis, and ischium. In the immature animal, these bones are not fused together, but as the pet matures, these bone fuse together in one confluent bone. The ilium joins the lower part of the spine called the sacrum.

The hip joint consists of a ball (femoral head) which is at the end of the femur bone and socket (acetabulum). This joint joins the hind limb to the pelvis. The joint is held together with a very strong round ligament (sometimes called the teres ligament) and the joint capsule. The muscles that surround the hip joint also provide very good support to the joint.

 

 

 

 

 

 

 

 

What is hip dysplasia?

HIP = coxofemoral joint

DYSPLASIA = abnormal development

Hip dysplasia is an inheritable orthopedic condition, meaning that defective genes are passed from the parents to their offspring. In affected puppies, the soft tissues that support the hip are looser than normal and the muscles that support the hip are poorly developed. Some suggest that there is disproportionate development of the bones versus the muscles (i.e. bones grow too fast and muscle development is retarded). As a result, the femoral head slips in and out of the joint (called subluxation) when the puppy is ambulating. Because the bones of puppies are very soft, the subluxation of the joint causes the acetabulum, which is normally a deep cup to become shallow like a saucer. The femoral head, which is a round ball, assumes flattened shape like a mushroom. In addition, the "roof" of the acetabulum can develop painful microscopic fractures from the subluxating femoral head. Secondary arthritis develops in the hip joint which results in lameness, stiffness, and pain.

 

Signs

Dogs show signs of hip dysplasia from 5 to 8 months of age, but some dogs are in their early adult years or during the geriatric stage of life. Commonly affected breeds include German Shepherds, Labrador retrievers, Golden retrievers, Rottweilers and many other large breed dogs. Small breeds also develop this problem with Pugs and cocker spaniels commonly affected. The main clinical signs include lameness, bunny hopping when running, difficulty getting up after rest, reluctance to exercise, and sometimes crying due to severe pain.

 

Diagnosis

A diagnosis of hip dysplasia is based on a combination of history, clinical signs, physical examination findings, and radiographs. Below is a set of radiographs from a dog that had hip dysplasia. The radiograph below left was made when the dog was immature, versus the radiograph below right was made a few years later (no treatment provided). Take note of the loose hips and the severe arthritis that has developed.

  

Preparation for surgery

The pet should be fasted prior to surgery, as instructed by the surgical team. Water is usually permitted up to the time of admission to the hospital. An antacid such as Pepcid AC may be prescribed and should be administered by 6 AM on the day of surgery; this treatment will help reduce the risk of esophagitis (heartburn) in the postop period. The surgical team should be informed of any medications that your pet is currently receiving. The pet should not receive any aspirin within 1 week of surgery, as this medication will thin the blood and increase the risk of bleeding. Just prior to surgery, your pet will receive a sedative, have an intravenous catheter placed for the administration of intravenous fluids and intravenous medications, be induced under general anesthesia with medication(s), and have a breathing tube (endotracheal tube) placed to allow delivery of oxygen and gaseous anesthesia. The surgical site will be clipped and cleansed with an anti-septic solution in preparation for surgery. While under general anesthesia, the pet's breathing will be assisted with a ventilator and vital parameters such as heart rate, respiratory rate, core body temperature, blood pressure, oxygenation of the blood (pulse oximetry), exhaled carbon dioxide (capnography), and heart rhythm (EKG) will be monitored to ensure the pet's well being. Pain will be controlled both during and after surgery with analgesics (pain-controlling medication); we routinely place an epidural catheter for administration of narcotics during surgery and for two days after surgery. Please note that each surgical and anesthesia team may elect to chose a different, but effective analgesia protocol.

 

Treatments

A variety of medications are available to temporarily treat pain associated with the hip joints. Surgery, however, frequently is needed. There are three surgical procedures that may be recommended. If your pet does not have arthritis in the joint a reconstructive procedure (triple pelvic osteotomy) can be done to make the socket fit better over the ball of the femur bone. If your pet already has arthritis one of two procedures is recommended: femoral head and neck excision or total hip replacement. The femoral head and neck excision involves cutting off the ball and neck of the femur so that it does not rub against the socket of the hip. In this situation, the body forms a false joint and the pain is relieved. This procedure is recommended for medium and small dogs and cats. Large and giant breed dogs may not do as well with this type of surgery.  Total hip replacement is recommended for the large and giant breeds of dogs. This procedure involves replacement of the hip socket with a polyethylene cup and replacing the head of the femur with a metal implant.

 

Medical treatments

A number of nonsurgical measures can be taken to help alleviate signs of hip dysplasia and these include achieving an ideal body weight (weight loss for most pets), low impact regular exercises (swimming is excellent), provision of a a warm, soft bed (infrared beds may be helpful), avoidance of cold flooring such as cement floors, administration of pain relieving medication (tramadol, nonsteroidal anti-inflammatories), administration of high levels of omega fatty acids (Joint diets or Welactin), administration of glucosamine/chondroitin products, extra-corpreal shock wave therapy, therapeutic laser, acupuncture, and rehabilitation therapy by a professionally trained therapist.

 

Success rate of the surgery

Total hip replacement is about 90% successful. In large breed dogs femoral head and neck excision usually does not return the function of the limb to perfectly normal, but can significantly decrease the pain that the pet is experiencing. Cats and small dogs do very well with this procedure. Triple pelvic osteotomy is about 90% successful, however, some arthritis may develop, as the pet gets older.

 

Potential complications

HIP REPLACEMENT. Infection at the surgical site can occur soon after surgery or months to years later. If your pet gets an infection following total hip replacement, usually the implants will need to be removed. To prevent infection from developing, your pet should be administered antibiotics prior to and following any surgical procedure or dental work. This will help prevent bacteria from entering the blood stream and getting into the cement of the prosthesis. Following hip replacement, the prosthetic hip can become dislocated if your pet is too active during the healing phase. Too much activity can cause the cup or the femoral prosthesis to loosen from the bone, thus requiring a second surgery.

FEMORAL HEAD AND NECK EXCISION. Infection is an uncommon, but potential complication. Second, if your pet does not get enough exercise after surgery the hip will lose mobility and the false joint does not form properly. This will result in poor limb function after healing has taken place. Therefore rehabilitation therapy is very important.

PELVIC OSTEOTOMY. Infection is an uncommon, but potential complication. If your pet is too active during the first 2 months after surgery, the implants securing the pelvis can loosen and the repair may break down. Some hip arthritis will develop in most dogs receiving a triple pelvic osteotomy surgery, but usually does not cause pain or stiffness. If the hips develop debilitating arthritis total hip replacement may be needed.

 

rev 9/25/11

Frequently Asked Questions After Surgery

When should my dog have the first bowel movement after surgery?

  • Many dogs will not have a bowel movement for the first 4 to 5 days after surgery
  • Reasons that a dog will not have regular bowel movements after surgery include:
    • The dog has been fasted prior to surgery
    • Dogs do not eat well during the hospital stay
    • They frequently do not eat well when they go home
    • They are fed highly digestible food that produces little stool
    • Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating
  • If a pet does not have a bowel movement on the 5th day of being home, a stool softener such as metamucil can be fed
    • Dose of metamucil is 1 tsp per 25 Kg mixed in with each meal (canned dog food); feed immediately after mixing, as the metamucil will gel the food and may make it less palatable

My pet had surgery and will not eat.  What can be done?

  • Dogs
    • Most pets will not eat their regular dog food after surgery, especially if it is kibble.
    • Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source.  The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked).   The carbohydrate can be pasta, potato or white rice.
    • Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
    • Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal
    • Try Hill's A/D diet available at most veterinary hospitals
    • Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
    • Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
    • Remember that most pets will not eat the first day or two after they get home from surgery
  • Cats
    • Offer smelly foods that contain fish such as tuna or smelly cat foods
    • Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
    • Hand feeding:  with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
    • Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
    • Some cats will only eat dry food, try kibble if your cat normally has been fed that food
    • Petting and stroking your cat frequently will help to stimulate appetite
    • Remember that most pets will not eat the first day or two after they get home from surgery
    • Appetite stimulants such as cyproheptadine may be helpful
    • If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop

My pet is vomiting.  What can be done?

  • The first thing for you to discern is whether your pet is vomiting or regurgitating.  Both will result in fluid or food being brought up.  Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus.  Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled.  Usually the regurgited material will be clear or brown colored fluid. 
  • Next is to identify the cause of the vomiting or regurgitation.
  • Causes and treatment of vomiting after surgery
    • When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
    • Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery.  In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart.  Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to.  The antibiotic in some cases may be changed to a different one, or may be discontinued. 
    • Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days. 
    • An uncommon cause of vomiting after surgery is internal organ failure.  Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
    • If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present.  Do not ignore this sign.
    • Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days.  In order to decrease the acidity of the stomach, Pepcid AC 0.5 mg/kg can be given by mouth twice daily for 5 days.  Metoclopramide and Cerenia are good anti-vomiting medications for dogs and cats.  You should always consult a veterinary healthcare professional before administering medication.
  • Causes and treatment of regurgitation after surgery
    • The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia.  Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis.  This results in poor motility of the esophagus, therefore water and food will accumulate in this structure.  In most cases, esphagitis is self-eliminating and will resolve within two or three days. 
    • If the esophagitis is severe the esophagus may develop one or more strictures.  A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week.  This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope).  If an esophageal stricture is chronic surgery is needed.
    • Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other).  Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.

How do I know that my dog is in pain following surgery?

  • Signs of pain include
    • crying
    • biting if you get near the surgical site
    • grimacing (lips are pulled back and the the dog looks anxious)
    • tragic facial expression
    • panting
    • restlessness and unable to sleep; pacing
    • if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
    • the worst pain will be for the first 2 to 3 days after surgery

What can I do to control my dog's pain?

  • Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
  • Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
  • If an orthopedic surgery has been done cold packing the surgical site may be helpful
    • A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack.  An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern.  Cooling the surgical site helps to numb the area.

How do I know that my cat is in pain following surgery?

  • Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
  • Signs of pain in a cat include the following:
    • biting if you get near the surgical site
    • growling or deep cry
    • not wanting to eat
    • hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)

What can be done for pain at home for my cat?

  • Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
  • Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
  • Anti-inflammatories can be used, but the dose is much less than dogs

Is it okay for my pet to lick the incision?

  • If a dog licks the incision, the healing process may be delayed.
  • Licking can remove stitches and cause the incision to open
  • Licking can become a severe habit that is difficult to break
  • Licking can cause infection as the mouth has many bacteria
  • Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.
  • To stop your pet from licking the following can be tried:
    • Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
    • Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
    • A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
    • A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
    • Bitter apple can be applied around the incision; many dogs will continue to lick  after application of this topical
    • Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
    • Antipsychotic medication in some cases is needed

Board-certification by the American College of Veterinary Surgeons

What does it mean?

  • Four years of advanced training in surgery beyond the Doctor of Veterinary Medicine Degree

  • Experience in the development of new surgical treatments

  • Rigorous examination by the American College of Veterinary Surgeons to ensure competency in advanced surgical techniques

  • Assurance that a veterinarian is a surgical specialist

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