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
||0 to 6
||7 to 12
||13 to 18
Maximum hip score for breeding Tamaskan.
Scores below are a fail
||19 to 24
||25 to 35
||Mild Hip Dysplasia
||36 to 50
||Moderate Hip Dysplasia
||51 to 106
||Severe Hip Dysplasia
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.
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
The other option is surgery
Conventional and Alternative Treatment Modalities
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.
discussed other measures, such as diet, exercise, homeopathic therapy and easing
up on our vaccinations as ways to help prevent this problem.
we will discuss some of the methods, both conventional and holistic to deal with
the dog that has this problem.
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.
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.
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
BOP (Biocompatible Osteoconductive Polymer) has had some good
results in larger breed dogs but has fallen out of vogue over the past few
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
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:
Herbs, Acupuncture and Moxabustion
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.
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 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
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 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.
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.
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
which is a disease of the joint
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
In OCD, the normal change of
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
trauma, and nutrition
calcium and decreased
Vitamin C intake).
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
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