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Canine Hip Dysplasia

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Robert Gracia

Hip dysplasia is an abnormal development of the hip joint where the femoral head does not fit snugly into the acetabulum. It most commonly affects large breed dogs. Clinical signs in young dogs include lameness and pain, while adult dogs exhibit loss of muscle mass, difficulty rising, and arthritis. Radiographs are used to diagnose hip dysplasia and grade its severity based on a scale from mild to severe. Treatment options include weight control, physical therapy, supplements, braces, anti-inflammatories, and in some cases surgery such as triple pelvic osteotomy or total hip replacement.

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By Robert Gracia
According to the authors of Small Animal Orthopedics and Fracture Repair, Hip dysplasia is an abnormal development or growth of the hip joint, usually occurring bilaterally. It is manifested by varying degrees of laxity of surrounding soft tissues, instability, malformation of the femoral head and acetabulum, and osteoarthrosis. Definition
Mostly confined to large working and sporting breeds. Can have a relative incidence of up to 47% in Saint Bernards Rare, but can occur in small dogs weighing under 12 kg usually caused by trauma. Incidence
Polygenic predisposition to congenital subluxation of the hip. Environmental factors such as nutrition and growth rate as puppies also contribute to disease. Muscle growth fails to keep up with skeletal growth, causes joint laxity. Pathogenesis
Failure of congruity of articular surfaces between femoral head and acetabulum leads to bony changes. Increased weight on adult dog with hip dysplasia will worsen condition. Decreased muscle mass. Occurrence can be reduced but not eliminated. Pathogenesis Continued
Young Dogs (4 12 mo) Sudden onset. Unilateral or bilateral disease. Soreness and pain in hind limbs. Clinical Signs
Unwilling to remain active. Decreased musculature of thigh and pelvic region. Choppy gait and bunny hopping. Microfractures of the acetabular rim Tension and tearing of nerves of periosteum. Positive Ortolani sign (reduction angle) > 30 degrees. Young Dog Clinical Signs
Ortolani Sign < 20 degrees
Chronic Degenerative Joint Disease. Slowly developing lameness. Lameness after increased activity. Loss of thigh and pelvic musculature. Slow to rise. Adult Dog > 15 mo
Crepitus, restricted range of motion. Spinal problems, degenerative myelopathy. Shoulder muscle hypertrophy. Prefers sitting over standing. Stifle problems, cruciate rupture. Adult Dog Clinical Signs
Radiographic Diagnosis
Normal Hips
50 % or greater of femoral head should be covered by the acetabular rim. Normal Hips Continued
Abnormal Hip
Loss of normal demarcation of acetabular rim due to osteophyte formation. Subluxation. Flattening of the acetabulum and loss of concavity. Morgans Line (osteophyte formation along the femoral neck). Roentgen Signs
2 years of age for official results. 7 grade qualitative assesment. 1. Excellent: Nearly perfect conformation. 2. Good: Normal conformation for age and breed. 3. Fair: Less than ideal but within normal radiographic limits. Orthopedic Foundation for Animals OFA
4. Borderline: A category in which minor hip abnormalities often cannot be clearly assessed because of poor positioning during radiographic procedures. It is recommended that another radiograph be repeated in 6 to 8 months. OFA Continued
1. Mild: Minimal deviation from normal with only slight flattening of the femoral head and minor subluxation. 2. Moderate: Obvious deviation from normal with evidence of a shallow acetabulum, flattened femoral head, poor joint congruency, and in some cases, subluxation with marked changes of the femoral head and neck. 3. Severe: Complete dislocation of the hip and severe flattening of the acetabulum and femoral head. OFA Hip Dysplasia
OFA 1
OFA 2
OFA 3
The University of Pennsylvania Hip Improvement Program. Uses three views. Uses a Distraction Index, which measures passive hip joint laxity. Radiographs taken with coxofemoral joint under stress to evaluate laxity. Range from 0 to 1 where 0.4 is cut off. Penn HIP
Distraction Index
Extended LegVD
DistractionView
CompressionView
Measures hip joint laxity. Angle between the center of the femoral head and the craniolateral aspect of the dorsal acetabular rim. Angles of greater than 105 degrees considered normal. Norberg Angle
Norberg Angle continued
FrogView Dorsal Acetabular RimView OtherViews
Treatment of CHD
Weight Control PhysicalTherapy (PROM, massage, acupuncture, laser, thermal, electrostimulation) Medical Management
Supplements Diet Activity Braces Anti-Inflammatories Medical Management Cont.
Preventative treatment in juveniles showing no signs of osteoarthrosis. Juvenile pelvic symphysiodesis Triple pelvic osteotomy Surgical Management
Triple Pelvic Osteotomy TPO
Total hip replacement (curative) Hip capsular denervation (alleviate pain sensation, palliative) Femoral head and neck ostectomy (remove pain sensation by eliminating articulation, palliative) Other Surgical Approaches
Total Hip ReplacementTHR
Femoral Head and Neck Ostectomy FHNO
All pictures from AtlanticVeterinary College Lectures, (Dr. Beraud and Dr. Matthews), AVC teaching hospital, and Handbook of Small Animal Radiology and Ultrasound. AVC Lectures. Dennis, Kirberger, Barr and Wrigley. Handbook of Small Animal Radiology and Ultrasound 2nd Edition. Elsevier Limited 2010 Brinker, Piermattei, and Flo. Handbook of Small Animal Orthopedics and Fracture 4th Edition. Elsevier Inc. 2006 Resources
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Canine Hip Dysplasia

  • 2. According to the authors of Small Animal Orthopedics and Fracture Repair, Hip dysplasia is an abnormal development or growth of the hip joint, usually occurring bilaterally. It is manifested by varying degrees of laxity of surrounding soft tissues, instability, malformation of the femoral head and acetabulum, and osteoarthrosis. Definition
  • 3. Mostly confined to large working and sporting breeds. Can have a relative incidence of up to 47% in Saint Bernards Rare, but can occur in small dogs weighing under 12 kg usually caused by trauma. Incidence
  • 4. Polygenic predisposition to congenital subluxation of the hip. Environmental factors such as nutrition and growth rate as puppies also contribute to disease. Muscle growth fails to keep up with skeletal growth, causes joint laxity. Pathogenesis
  • 5. Failure of congruity of articular surfaces between femoral head and acetabulum leads to bony changes. Increased weight on adult dog with hip dysplasia will worsen condition. Decreased muscle mass. Occurrence can be reduced but not eliminated. Pathogenesis Continued
  • 6. Young Dogs (4 12 mo) Sudden onset. Unilateral or bilateral disease. Soreness and pain in hind limbs. Clinical Signs
  • 7. Unwilling to remain active. Decreased musculature of thigh and pelvic region. Choppy gait and bunny hopping. Microfractures of the acetabular rim Tension and tearing of nerves of periosteum. Positive Ortolani sign (reduction angle) > 30 degrees. Young Dog Clinical Signs
  • 8. Ortolani Sign < 20 degrees
  • 9. Chronic Degenerative Joint Disease. Slowly developing lameness. Lameness after increased activity. Loss of thigh and pelvic musculature. Slow to rise. Adult Dog > 15 mo
  • 10. Crepitus, restricted range of motion. Spinal problems, degenerative myelopathy. Shoulder muscle hypertrophy. Prefers sitting over standing. Stifle problems, cruciate rupture. Adult Dog Clinical Signs
  • 13. 50 % or greater of femoral head should be covered by the acetabular rim. Normal Hips Continued
  • 15. Loss of normal demarcation of acetabular rim due to osteophyte formation. Subluxation. Flattening of the acetabulum and loss of concavity. Morgans Line (osteophyte formation along the femoral neck). Roentgen Signs
  • 16. 2 years of age for official results. 7 grade qualitative assesment. 1. Excellent: Nearly perfect conformation. 2. Good: Normal conformation for age and breed. 3. Fair: Less than ideal but within normal radiographic limits. Orthopedic Foundation for Animals OFA
  • 17. 4. Borderline: A category in which minor hip abnormalities often cannot be clearly assessed because of poor positioning during radiographic procedures. It is recommended that another radiograph be repeated in 6 to 8 months. OFA Continued
  • 18. 1. Mild: Minimal deviation from normal with only slight flattening of the femoral head and minor subluxation. 2. Moderate: Obvious deviation from normal with evidence of a shallow acetabulum, flattened femoral head, poor joint congruency, and in some cases, subluxation with marked changes of the femoral head and neck. 3. Severe: Complete dislocation of the hip and severe flattening of the acetabulum and femoral head. OFA Hip Dysplasia
  • 19. OFA 1
  • 20. OFA 2
  • 21. OFA 3
  • 22. The University of Pennsylvania Hip Improvement Program. Uses three views. Uses a Distraction Index, which measures passive hip joint laxity. Radiographs taken with coxofemoral joint under stress to evaluate laxity. Range from 0 to 1 where 0.4 is cut off. Penn HIP
  • 27. Measures hip joint laxity. Angle between the center of the femoral head and the craniolateral aspect of the dorsal acetabular rim. Angles of greater than 105 degrees considered normal. Norberg Angle
  • 29. FrogView Dorsal Acetabular RimView OtherViews
  • 31. Weight Control PhysicalTherapy (PROM, massage, acupuncture, laser, thermal, electrostimulation) Medical Management
  • 32. Supplements Diet Activity Braces Anti-Inflammatories Medical Management Cont.
  • 33. Preventative treatment in juveniles showing no signs of osteoarthrosis. Juvenile pelvic symphysiodesis Triple pelvic osteotomy Surgical Management
  • 35. Total hip replacement (curative) Hip capsular denervation (alleviate pain sensation, palliative) Femoral head and neck ostectomy (remove pain sensation by eliminating articulation, palliative) Other Surgical Approaches
  • 37. Femoral Head and Neck Ostectomy FHNO
  • 38. All pictures from AtlanticVeterinary College Lectures, (Dr. Beraud and Dr. Matthews), AVC teaching hospital, and Handbook of Small Animal Radiology and Ultrasound. AVC Lectures. Dennis, Kirberger, Barr and Wrigley. Handbook of Small Animal Radiology and Ultrasound 2nd Edition. Elsevier Limited 2010 Brinker, Piermattei, and Flo. Handbook of Small Animal Orthopedics and Fracture 4th Edition. Elsevier Inc. 2006 Resources