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Home » Pumi health

Diagnosis and treatment of canine hip dysplasia

Submitted by on Mar 24, 2010 – 3:13 PMNo Comment
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In the second part of our series, we will examine the different diagnostic and treatment methods of canine hip dysplasia.

For decades, attempts have been made to find the best methods to diagnose CHD in dogs at the earliest age possible. Hip joint laxity can be estimated with the Barlow maneuver and the Ortolani test. The Barden’s sign is an estimate of maximum lateral passive hip laxity but is difficult to compare between studies and to measure accurately. The Ortolani test detects subluxation by palpation. These physical exam test methods, however, are subjective and rely mainly on the skills of the examiner. The presence or absence of hip dysplasia, therefore, cannot be objectively detected by observation and physical examination – one can never be positive that a dog is disease-free without a pelvic x-ray taken under anesthesia. It is recommended (but mostly required) that the dog is at least 12 months of age at the date of the radiograph, but in some larger breeds often as much as 24 months of age is necessary for a credible result. Radiography of estrus females should be avoided due to possible increased joint laxity (subluxation) from hormonal variations.

It is recommended that radiographs are taken one, but preferably two months before or after a heat cycle. Physical inactivity because of illness, weather, or the owner’s management practices may also result in some degree of joint laxity. A dog should always be examined when it is in a good physical condition. The x-ray should be taken in a well-equipped animal clinic by a professional who preferably has some good references from other breeders and therefore can be trusted to know the ins and outs of CHD radiography. Radiographs would then normally be submitted to a certifying orthopedic organisation, like OFA in the United States or MKOE in Hungary. Radiographs therefore must follow the guidelines for positioning as issued by the certifying organisation. Since hips in Hungary are evaluated based on the criteria of the Federation Cynologique Internationale, we will continue our article by analysing the so-called ventrodorsal view (involves extending the legs with the dog on its back) which is accepted world wide for detection and assessment of hip joint irregularities and secondary arthritic hip joint changes.

To obtain this view, the animal must be placed on its back in dorsal recumbency with the rear limbs extended and parallel to each other. The knees (stifles) are rotated internally and the pelvis is symmetric. Because the position required to take a diagnostic x-ray is a somewhat unnatural one, even very gentle, cooperative dogs cannot relax enough to be x-rayed properly. However, to have an x-ray that yields the information you’re trying to discover the dog must be perfectly relaxed since if at the time of exposure of the x-ray the dog is not positioned precisely with no movement, the x-ray will not be credible. Therefore, chemical restraint (anesthesia) to the point of relaxation is recommended. Should your vet recommend x-raying your dog while it is wide awake, I recommend you take it as a warning sign and look for another clinic.

Positioning of the dog is very important, yet is often over looked by the vet that is shooting the films. Therefore, I recommend that you make yourself acquainted with the requirements of a credible hip x-ray and ask your vet to show you the film before forwarding it for evaluation. So how do you know if a hip x-ray is done properly on your dog’s hips?

Good x-ray
Bad x-ray

Good positioning

Bad positioning

The first thing to look at in an x-ray is to see if it is of diagnostic quality – it should be rich in details with no blurs and good contrast, neither too light nor too dark. You should be able to clearly distinguish the bones from soft tissues. Second, check if the legs come straight down from the hips with the knee caps square and looking alike. You don’t want to see one leg straight and the other going off at an angle. The legs should be parallel with each other as well as with the spine (see the yellow vertical guiding lines). Third, the position of the pelvis needs to be symmetric. The size of the pelvic wings (1) should be roughly the same and they should look exactly alike. The holes in the bone structure (2 & 3) on the left side should be the same shape and size as the holes on the right side.
Finally, if you look at the pelvis, you can see that with the legs fully extended straight down, the legs overlay the very corners or tips of the pelvis (4). Needless to say, the amount of pelvis bone that is covered by the leg bones should be exactly the same on the left and right side.

Should you have any reservations with the positioning on the x-ray, DO NOT forward it for evaluation. Tell the vet your concerns and ask for a second opinion about the positioning. Better still, ask for a new x-ray!

Hip structureAccording to the FCI Scientific Committee, hips are classified into five grades based mainly on
- the shape and congruence of the femoral head (FH) and cranial acetabulum edge (CrAE), basically the outer edge of the socket;
- the presence and severity of arthritic changes;
- the coverage of the socket over the ball, a.k.a. the Norberg-Olsson Angle, made by a line drawn between the centres of the femoral heads and a second line drawn from the femoral head to the cranial edge of the acetabulum (CrEAM, meeting point of CrAE and DAE) on each side. Norberg angles typically range from 55 degrees to 115 degrees, with the smaller numbers representing looser hips.
It is also well recognised that the acetabular fossa (AF) and caudal acetabular edge (CdAE) are sites of bone proliferation in unstable hips.

Description of classes (A to E), applicable
to dogs aged between one and two years, provided correct positioning:

Norberg angleA – No signs of hip dysplasia
The femural head and the acetabulum are congruent and the acetabular angle according to Norberg (adapted for Pos. 1) is 105degrees or more. The craniolateral rim appears sharp and slightly rounded. The joint space is narrow and even. In excellent hip joints the craniolateral rim encircles the femoral head
somewhat more in laterocaudal direction.

B – Transitional or borderline hipjoints
The femural head and the acetabulum are slightly incongruent and the acetabular angle according to Norberg adapted for Pos. 1) is 105 degrees or more, or the acetabular angle according to Norberg is less than 105 degrees and the femural head and the acetabulum are congruent.

C – Mild hip dysplasia
The femoral head and the acetabulum are incongruent, the acetabular angle according to Norberg is more than 100° and/or there is a slightly flattened craniolateral rim. Irregularities or no more than slight signs of osteoarthrotic changes of the margo acetabularis cranialis, caudalis or dorsalis or on the femoral head and neck may be present.

D – Moderate hip dysplasia
Obvious incongruency between the femoral head and the acetabulum with subluxation. Acetabular angle according to Norberg more than 90 degrees (only as reference). Flattening of the craniolateral rim and/or osteoarthrotic signs.

Norberg angleE – Severe hip dysplasia
Marked dysplastic changes of the hip joints, such as luxation or distinct subluxation, acetabular angle according to Norberg less than 90 degrees, obvious flattening of the margo acetabularis cranialis, deformation of the femoral head (mushroom shaped, flattening) or other signs of osteoarthrosis.

Though especially Grade E may sound (and is) painful, the good news about hip dysplasia is that for many animals, canine hip dysplasia is a manageable condition, and they can lead relatively normal and active lives given that caution is exercised. Very few dogs today have to be put to sleep to alleviate suffering. There are always choices
to be made, but the vast majority of affected animals can live quite comfortable lives.

Treatment is always directed at the stage of the disease. In the young suddenly showing discomfort, treatment is usually combined with rest. Medical therapy (aimed at reducing pain/inflammation from arthritic changes) combined with cage rest for five to seven days is usually adequate to “put out the fire” until the next flare-up. Favorable results have been reported from non-traditional treatments like acupuncture, chiropractic, nutritional and vitamin therapy (generally Vitamins C & E & selenium), although
these results have not been validated by controlled trials.

Although a few patients can be maintained for long periods, even years, with pain medication and anti-inflammatory drugs, this is usually not the answer. As the dog matures, surgery is the solution of outward signs of discomfort are consistent. There are three basic surgeries, all of which attempt to eliminate or reduce the pressure between the two arthritic surfaces.

The first surgery involves the cutting of the pectinious, which is one of the muscles that try to add stability to the joint by forcing the two bones back together. When it is cut or has a portion removed, the two bones
move apart. We have had varied success with this procedure in our practice. It sometimes eliminates all pain and further surgery is not required.

SurgeryThe second type of surgery is the removal of the femoral head. No bony attachment between the leg and the rest of the body sounds radical, but the dog’s body will compensate as the outer muscles in the area become stronger and hold the leg in place. This allows near-normal motion and use. Remember that the front leg of the dog is held to the body by muscles only; there is no bone-to-bone connection between the front legs and the rest of the skeleton. By removing the femoral head we eliminate the pain of the two bones coming in contact with each other. There are many active dogs that were able to continue their active lifestyles because of this surgery.

The final surgical technique available to a patient with dysplasia is total replacement with an artificial joint made of steel and high-impact plastic. This is very expensive and rarely necessary. Throughout all of this, please remember that the individual dog affected with dysplasia can usually be helped to live a life that is generally free of pain.

Sources and further reading

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