How to Treat Hip Dysplasia

Hip dysplasia is an orthopedic developmental disorder of dogs that commonly manifests as discomfort in young dogs (4–8 months of age) and then develops into osteoarthritis (OA) in the older dog. The clinical effects of hip dysplasia are highly variable. Many dogs have no or only mild clinical signs. Other dogs have significant deterioration in quality of life. This article reviews treatment options. Reducing pain and restoring limb function are the aims of treatment. Conservative management of the young dog includes exercise restriction, weight control, analgesics (usually nonsteroidal antiinflammatories), and physical therapy. Surgical procedures may either prevent or limit development of hip dysplasia (juvenile pubic symphysiodesis [JPS], triple pelvic osteotomy) or may be used as salvage procedures (excision arthroplasty, total hip replacement [THR]) to reduce or eliminate pain and improve function in OA. As this review concludes, many options are available for dogs with hip dysplasia and OA. It would be helpful to have better designed long-term studies to evaluate some of the options available. The breed susceptibility and potential lifestyle of the patient (pet vs working) should be considered in determining the approach to treatment.

Commentary: This author does a good job highlighting the current evidence for how hip dysplasia is treated. He points out the variability in clinical signs in affected dogs and that no published reports assess the effect of physical therapy on hip dysplasia. Overweight dogs have been proven to develop earlier and worse arthritis and obesity has been shown to increase inflammatory mediators. Surgically, both JPS and triple pelvic osteotomy were shown to work best in younger and less severely affected dogs, so proper case selection is paramount. Hip denervation, considered a palliative surgical procedure, improves pain in most dogs but does not slow OA progression. Femoral head and neck excision works best on small dogs, while THR results in good function in 90% of patients. One group reported performing THR in 4- to 8- month-old puppies with decent results. Miniature hip implants are available for small dogs and even cats. As in all aspects of veterinary medicine, more stringent, evidence-based studies are needed. Medications used in the treatment were not discussed, but many NSAIDs, joint supplements, and pain relievers are available.—Jonathan Miller, DVM, MS, Diplomate ACVS

Treatment of hip dysplasia. Anderson A. J SMALL ANIM PRACT 52:182-189, 2011.