HIP DYSPLASIA

Canine hip dysplasia is among the most studied and the most frustrating diseases in veterinary medicine.  It is a developmental orthopedic disease.  When a dog has dysplasia, it has an abnormal development of the ball-in-socket joint that makes up the hip.  In a dysplastic hip, the ball (the head of the femur, or thighbone) and the socket (the acetabulum, a portion of the pelvis), do not fit together snugly.  The result is a painful and damaging friction. Progressive arthritis can result, and when it does, it can be crippling. 

Hip dysplasia is a legacy disease, passed through the genes. Environmental factors also play a role in hip dysplasia.  For example, it is well known that obesity is a risk factor for the development of arthritis.  In addition, dog food that has been over-supplemented with extra proteins, vitamins and minerals to make puppies grow faster can create orthopedic problems in extremely large breeds of dogs that may lead to hip dysplasia and arthritis. Also the over-exercising of young puppies can also have a large impact on hip dysplasia.

The Tamaskan Dog Register require all breeding dogs to be hip scored before they are used for breeding. So far the average hip score for dogs in the UK is 9.0 (based on the score of 78 dogs through the BVA). 

The maximum score the TDR allows for breeding dogs in the UK is 18. Litters will not be registered from dogs bred over this score.  So far no dogs in the UK have scored over 18 (the highest score recorded in the UK is 16, the lowest is 0).

The TDR requires hips to be done at no less than 12 months of age, because of issues with anesthetic.

Hip Score Comparison Table

System/Grades OFA (USA) FCI (Europe) BVA (UK) System assessment
Grade 1 Excellent A1 0 to 6 Excellent
Grade 2 Good A2 7 to 12 Good
Grade 3 Fair B1& 2 13 to 18 Acceptable
Maximum hip score for breeding Tamaskan. Scores below are a fail
Grade 4 Borderline C1 19 to 24 Poor
Grade 5 Mild C2 25 to 35 Mild Hip Dysplasia
Grade 6 Moderate D 36 to 50 Moderate Hip Dysplasia
Grade 7 Severe E 51 to 106 Severe Hip Dysplasia

 

SIGNS

Decreased activity; difficulty rising; rear limb lameness; reluctance to use stairs, particularly to go up; reluctance to jump or stand on hind limbs; swaggering gait;  bunny-hopping gait; pain from manipulation of the hip(s); decreased range-of-motion in the hips; crepitus in the hip joint; positive Ortolani sign; positive Bardenís maneuver; subluxation or complete luxation.

TREATMENT

There are conservative, or non-surgical methods for treating hip dysplasia, such as pain medications, weight loss programs, controlled exercise, and physical therapy. These methods can be very effective in certain cases. However, conservative treatments do have their limitations.

The other option is surgery

HOLISTIC TREATMENT

Conventional and Alternative Treatment Modalities

By

Larry A. Bernstein, VMD, CVH, CVA

Copyright ©2000 Larry A. Bernstein

Last article I talked about the genetic component of Canine Hip Dysplasia and why, I feel, there has been enough selective breeding to make me feel that there are factors other than simple genetics at work here.

 We discussed other measures, such as diet, exercise, homeopathic therapy and easing up on our vaccinations as ways to help prevent this problem.

 Now we will discuss some of the methods, both conventional and holistic to deal with the dog that has this problem.

Anatomy

In the simplest terms the hip (officially know as the coxo-femoral joint) is a ball that rests in a socket. The ball is at the end of the upper bone of the leg, the Femur. The socket is in the pelvis and known as the acetabulum . The shape of the ball, the depth of the socket, the muscles surrounding the joint and the joint capsule all serve to hold the ball in place.

Pathology

In Canine Hip Dysplasia a few different things can happen. The socket (acetabulum) can be too shallow, the ball (femoral head) can be flattened or at an improper angle or there can be any combination of these events. Since this creates an inherent instability in the joint, there can be pain, muscle strain or bony degeneration. Once the pain starts to affect the use of the back legs, the dog depends more on the front and the hind end weakens. The weakening of the muscles allows for more instability and it becomes a vicious circle.

Goals of Therapy

There are two basic goals to any therapeutic regimen. They are:

  • Reduce the pain and inflammation.
  • Strengthen the joint.

Each of these two main goals has a direct effect on each other. Reducing pain will allow (to some degree) more use of the leg and thus strengthen the joint through exercise. At the same time, strengthening the joint through surgical or holistic intervention can reduce the pain and inflammation. The point is that we must take the degenerative cycle turn it into a positive regenerative and healing cycle.

Conventional Drug Therapy

To do this many conventional veterinarians resort to pain killers and anti-inflammatory medications. This is usually the first step in conventional therapy. For inflammation the most popular medication has always been some form of steroid. Over the past few years, the NSAID's (Non Steroidal Anti-Inflammatory Drugs) have gained in popularity. They can be very effective. They can also create long term health problems like stomach ulcers, liver damage and kidney failure. Many veterinarians will use them for a limited time or during severe episodes.

Surgical Options

There are three basic conventional procedures for dealing with the dysplastic hip in the dog. These are:

  • Total Hip Replacement
  • Triple Pelvic Osteotomy
  • Femoral Head and Neck Ostectomy

There is also a procedure called a Bop Shelf Arthroplasty. This uses an artificial bios-active polymer block screwed onto the front of the acetabulum in young dogs to encourage the growth of bone and thus create a "deeper" socket.

BOP (Biocompatible Osteoconductive Polymer) has had some good results in larger breed dogs but has fallen out of vogue over the past few years.

The total hip and triple pelvic Osteotomy are usually reserved for larger breeds. One is self explanatory and the other (TPO) involves cutting the bones of the pelvis and rotating it to form more of a shelf. This also creates a "deeper" socket. The surgical fractures are then plated and left to heal.

The most common surgery used in the small dogs is the excision (removal) of the femoral head and neck. Called the FHO for Femoral Head Ostectomy. In this procedure the surgeon actually removes the ball and neck from the end of the Femur. This eliminates the ball from the ball and socket joint that comprises the hip. Since most dysplasia related pain comes from the loss of cartilage and the bone rubbing on bone, removal of the femoral head allows the empty space to fill with fibrous tissue. It then becomes like an elastic joint and the bone on bone pain is eliminates. In small to medium size dogs the muscles around the joint can create stability.. During my time in surgery I performed almost a thousand of these with about 90% success.  

Alternative Medicine Offers Less Violent Solutions

When one thinks of cortisone and surgical intervention, the first thing that should go through our minds is "What are my less traumatic alternatives?". This is one of the reasons that I became interested in holistic medicine in 1989. I felt there had to be other reasons for these problems to occur and other, gentler methods to help them resolve.

In our last article we discussed my feeling that the genetic component was only one factor contributing to Canine Hip Dysplasia. I alluded to the limitation on vaccinations, the importance of exercise and a proper diet to help prevent the problem.

We will now look at some of the different alternative medical views of Canine Hip Dysplasia and some of the common alternative modes of therapy. These include:

  • Supplemental Therapy
  • Diet
  • Herbs, Acupuncture and Moxabustion
  • Chiropractic
  • Homeopathic
  • Massage Therapy

Supplemental Therapy

Supplements for the joints are more popular now than ever and have even made it onto the shelves of the conventional veterinarian. Chondroiten Sulfate and Glucosamine are two of the most popular with alfalfa, mussel, antioxidants and yucca running a close second. Tahitian Noni juice is also being used more and more. These are aimed at repairing or marinating the cartilage, lubricating the joints and reducing the inflammation and pain. The use of a drug called Adequan (adequan polysulfated glycosaminoglycan ), is a pharmaceutical. It is chemically similar to the natural glycosaminoglycan of cartilage tissue, making a medical therapy that claims to treat both the symptoms and the underlying processes threatening to turn joint injury into joint degeneration. I have had a number of cases respond well to this therapy. It is injected into the muscle twice a week for a few weeks and then on a more conservative schedule.

Diet

There is so much to say about diet that it will become an article unto itself one day. I believe in as natural a diet as possible. I prefer a raw food diet whenever possible and I usually supplement with a high quality prepared food like Petguard, Flint River or Solid Gold when time and resources prohibit feeding solely a raw home prepared diet. I think this is still the number one thing one can do to allow our animal companions to reach their full potential. Many people are feeding so many different variants of the raw food diets that I will leave it to others to provide details. There is a reading list on our website that lists some of our favorite books on the subject.

Herbs and Acupuncture

Traditional Chinese medicine calls these arthritic changes the Bi Syndrome and feels that the degeneration and bone spurs associated with severe degenerative joint disease are the stagnation of the life force (Qi). Treatment is aimed at reducing the pain and inflammation by stimulating this motion. Severely painful cases often respond to a few sessions of acupuncture and do wonderfully. The dogs do not seem to mind the needles. Moxabustion involves burning the Chinese herb Artemis Vulgaris (Mugwort) and using the healing heat to warm the affected areas and some of the meridians. This is often done along with the acupuncture in the office and then continued at home by the client. Dogs love the attention and the herb has healing properties that make it far superior to hot packs and other heat sources.

Chiropractic

Chiropractic adjustment also aids in the animal moving better. It relieves pain and helps to create a better balance so that the animal will walk, exercise and regain the lost muscle mass that helps create the destructive cycle we mentioned earlier. Since the dysplastic dog is walking abnormally, the other areas of the body lose their natural alignment and regular adjustments can minimize this.

Homeopathy

I have found that homeopathic therapy , when used properly, can help to reverse the problems associated with Dysplasia. People often use homeopathic remedies like Arnica and Ruta to alleviate immediate pain in the joints but I find this is only temporary. It is better to find a trained homeopath, like you would a trained acupuncturist or chiropractor, and look at the deeper issues that contributed to the Dysplasia from birth.

Massage Therapy

Massage therapy is coming into its own as a treatment modality these days. A major part of the problem, as we mentioned earlier, is pain. Muscles get sore, they get contracted as they are unused. They atrophy. A good massage routine can limber up those muscles and help the dog move more freely and with less discomfort.

In Conclusion

The goal of this article was to acquaint the reader with some of the mechanisms of Canine Hip Dysplasia and to let them know that there are many available options for therapy that do not need to be as extreme or invasive.

Please remember that the best way to treat a problem is to prevent it. We use diet, constitutional homeopathy and careful breeding with our Cavaliers. What you do is, of course, your choice but if your dog does have these problems and they are mild, get help now before they worsen. If they are already bad then please explore these gentler forms of treatment. They work.

Elbow Dysplasia

Elbow Dysplasia is a condition involving multiple developmental abnormalities of the elbow-joint. It is a common condition of certain breeds of dogs. Most developmental elbow abnormalities are related to osteochondrosis (OCD), which is a disease of the joint cartilage. Osteochondritis dissecans refers to separation of a flap of cartilage on the joint surface. Other common causes of elbow dysplasia included ununited anconeal process (UAP) and fractured medial coronoid process (FMCP).

CAUSES

In OCD, the normal change of cartilage to bone in the development of the joint fails or is delayed. The cartilage continues to grow and may split or become necrotic. The cause is uncertain, but possibly includes genetics, trauma, and nutrition (including excessive calcium and decreased Vitamin C intake).

TREATMENT

In cases with significant lameness, surgery is the best option, especially with UAP. However, conservative treatment is often enough for cases of FMCP and OCD of the medial humeral epicondyle. The dogs are exercised regularly and given pain medication, and between the ages of 12 to 18 months the lameness will often improve or disappear. Control of body weight is important in all cases of elbow dysplasia, and prevention of quick growth spurts in puppies may help to prevent the disease. Surgery for FMCP consists of removal of cartilage and bone fragments and correction of any incongruity of the joint. Reattachment of UAP with a screw is usually attempted before the age of 24 weeks, and after that age the typical treatment is removal of the UAP. Without surgery, UAP rapidly progresses to osteoarthritis, but with FMCP osteoarthritis typically occurs with or without surgery. Osteoarthritis is also a common sequela of OCD of the humerus despite medical or surgical treatment. Elbow replacement surgery has been developed and can be an option for treatment

 

 

 

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