What is hip dysplasia?
To understand hip dysplasia we must have a basic understanding of the joint that is being affected. The hip joint forms the attachment of the hind leg to the body and is a ball and socket joint. The ball portion is the head of the femur while the socket (acetabulum) is located on the pelvis. In a normal joint the ball rotates freely within the socket. To facilitate movement the bones are shaped to perfectly match each other; with the socket surrounding the ball. To strengthen the joint, the two bones are held together by a strong ligament. The ligament attaches the femoral head directly to the acetabulum. Also, the joint capsule, which is a very strong band of connective tissue, encircles the two bones adding further stability. The area where the bones actually touch each other is called the articular surface. It is perfectly smooth and cushioned with a layer of spongy cartilage. In addition, the joint contains a highly viscous fluid that lubricates the articular surfaces. In a dog with normal hips, all of these factors work together to cause the joint to function smoothly and with stability.
Hip dysplasia is associated with abnormal joint structure and a laxity of the muscles, connective tissue, and ligaments that would normally support the joint. As joint laxity develops, the articular surfaces of the two bones lose contact with each other. This separation of the two bones within the joint is called a subluxation, and this causes a drastic change in the size and shape of the articular surfaces. Most dysplastic dogs are born with normal hips but due to their genetic make-up (and possibly other factors) the soft tissues that surround the joint develop abnormally causing the subluxation. It is this subluxation and the remodeling of the hip that leads to the symptoms we associate with this disease. Hip dysplasia may or may not be bilateral; affecting both the right and/or left hip.
What are the symptoms of hip dysplasia?
Dogs of all ages are subject to hip dysplasia and the resultant osteoarthritis. In severe cases, puppies as young as five months will begin to show pain and discomfort during and after exercise. The condition will worsen until even normal daily activities are painful. Without intervention, these dogs may eventually be unable to walk. In most cases, however, the symptoms do not begin to show until the middle or later years in the dog’s life.
The symptoms are similar to those seen with other causes of arthritis in the hip. Dogs often walk or run with an altered gait. They may resist movements that require full extension or flexion of the rear legs. Many times, they run with a ‘bunny hopping’ gait. They will show stiffness and pain in the rear legs after exercise or first thing in the morning. They may also have difficulty climbing stairs. In milder cases dogs will warm-up out of the stiffness with movement and exercise. Some dogs will limp and many will become less willing to participate in normal daily activities. Many owners attribute the changes to normal aging but after treatment is initiated, they are surprised to see a more normal and pain-free gait return. As the condition progresses, most dogs will lose muscle tone and may even need assistance in getting up.
Who gets hip dysplasia?
Hip dysplasia can be found in dogs, cats, and humans, but for this article we are concentrating only on dogs. In dogs, it is primarily a disease of large and giant breeds. German Shepherds, Labrador Retrievers, Rottweilers, Great Danes, Golden Retrievers, and Saint Bernards appear to have a higher incidence, however, these are all very popular breeds and may be over represented because of their popularity. On the other hand, sighthounds such as the Greyhound or the Borzoi have a very low incidence of the disease. This disease can occur in medium-sized breeds and rarely in small breeds. It is primarily a disease of purebreds although it can happen in mixed breeds, particularly if it is a cross of two dogs that are prone to developing the disease.
What are the risk factors for the development of hip dysplasia?
Hip dysplasia is caused by a subluxation in the hip joint. This creates abnormal wear and erosion of the joint and as a result arthritis and pain develop. The disease process is fairly straightforward; the controversy starts when we try to determine what predisposes animals to contracting the disease.
Genetics: Researchers agree that hip dysplasia is a genetic disease. If a parent has hip dysplasia, then the animal’s offspring are at greater risk for developing hip dysplasia. If there are no carriers of hip dysplasia in a dog’s lineage, then it is highly unlikely he will not contract the disease. If there are genetic carriers, then he may contract the disease. We can greatly reduce the incidence of hip dysplasia through selective breeding. We can also increase the incidence through selectively breeding. We cannot, however, completely reproduce the disease through selective breeding. In other words, if you breed two dysplastic dogs, the offspring are much more likely to develop the disease but the offspring will not all have the same level of symptoms or even necessarily show any symptoms. The offspring from these dogs will, however, be carriers and the disease will most likely show up in their offspring in later generations. This is why it can be challenging to eradicate the disease from a breed or specific breeding line.
Nutrition: It appears that the amount of calories a dog consumes and when in the dog’s life those calories are consumed have the biggest impact on whether or not a dog genetically prone to hip dysplasia will develop the disease.
Experimentally, it has been shown that obesity can increase the severity of the disease in genetically susceptible animals. It stands to reason that carrying around extra weight will exacerbate the degeneration of the joints in a dog; including the hip. Dogs that may have been born genetically prone to hip dysplasia and are overweight are therefore at a much higher risk of developing hip dysplasia and eventually osteoarthritis.
Another factor that may increase the incidence of hip dysplasia is rapid growth in puppies during the ages from three to ten months. Experimentally, the incidence has been increased in genetically susceptible dogs when they are given free choice food. In one study, Labrador Retriever puppies fed free choice for three years had a much higher incidence of hip dysplasia than their littermates who were fed the same diet but in an amount that was 25% less than that fed to the free-choice group.
Feeding a diet that has too much or too little calcium or other minerals can also have a detrimental effect on the development of the hip joint. However, with today’s complete and balanced dog foods this has become a rare occurrence. The practice of feeding home-made dog foods is popular with some dog owners. These diets must be carefully monitored for proper nutritional balance; not only for calcium and the other essential minerals but for all nutrients.
Exercise: Exercise may be another risk factor. It appears that dogs that are genetically susceptible to the disease may have an increased incidence of disease if they over-exercised at a young age. But at the same time, we know that dogs with large and prominent leg muscle mass are less likely to contract the disease than dogs with small muscle mass. So, exercising and maintaining good muscle mass may actually decrease the incidence of the disease. Moderate exercise that strengthens the gluteal muscles, such as running and swimming, is probably a good idea. Whereas, activities that apply a lot of force to the joint are contraindicated. An example would be jumping activities such as playing Frisbee.
How is hip dysplasia diagnosed?
The diagnosis of canine hip dysplasia is typically made by combining: clinical signs of arthritis and pain, a complete physical exam, and radiographs (x-rays). If a dog is showing outward signs of arthritis, there are usually easily recognized changes in the joint that can be seen on radiographs. In addition, the veterinarian may even be able to feel looseness in the joint or may be able to elicit pain through extension and flexion of the rear leg. Regardless, the results are straightforward and usually not difficult to interpret.
However, about half of the animals that come in for a determination on the health of their hip joints are not showing physical signs, but are intended to be used for breeding. The breeder wants to ensure that the animal is not at great risk for transmitting the disease to his or her offspring. In the United States, there are two testing standards – OFA (qualitative) and PennHip (quantitative).
OFA: The method used by the Orthopedic Foundation for Animals (OFA) has been the standard for many years. The OFA was established in 1966, and has become the world’s largest all-breed registry. The OFA maintains a database of hip evaluations for hundreds of thousands of dogs. Radiographs are taken by a local veterinarian using specific guidelines and are then submitted to the OFA for evaluation and certification of the dog’s hip status. Since the accuracy of radiological diagnosis of hip dysplasia using the OFA technique increases after 24 months of age, the OFA requires that the dog be at least two years of age at the time the radiographs are taken. Because some female dogs experience additional hip subluxation when they are in heat, pregnant or nursing the OFA recommends that the evaluation should not be performed during these times.
To get the correct presentation and ensure that the muscles are relaxed, the OFA recommends that the dog be anesthetized for the radiographs. OFA radiologists evaluate the hip joints for congruity, subluxation, the condition of the acetabulum, and the size, shape, and architecture of the femoral head and femoral neck. The radiographs are reviewed by three radiologists and a consensus score is assigned based on the animal’s hip conformation relative to other individuals of the same breed and age. The OFA then places the evaluated dogs into one of seven categories. Normal hips are graded as: excellent, good or fair. If the consensus is unclear the dog is graded as borderline dysplastic. And dogs with obvious radiographic signs of hip dysplasia are graded as: mild, moderate, severely dysplastic. Dogs with hips scored as borderline or dysplastic (mild, moderate, severe) are not eligible to receive OFA breeding numbers.
The OFA will also provide preliminary evaluations (performed by one OFA radiologist) of dogs younger than 24 months of age to help breeders choose breeding stock. Reliability of the preliminary evaluation is between 70 and 100% depending on the breed.
PennHIP: The diagnostic method used by the University of Pennsylvania Hip Improvement Program (PennHIP) uses unique radiographic views of the dog’s hips to more accurately identify and quantify joint laxity. This program was conceived in 1983 and became a usable system by 1993. To assure quality and repeatability among diagnostic centers using the PennHIP technique, veterinarians must take a special training course to become certified. Radiographs of the hips are taken with the dog under heavy sedation. These radiographs can be taken on a dog as young as 16 weeks. Two views are obtained with the hind limbs in neutral position to maximize joint laxity. These are known as the distraction and compression radiographic views. Weights and an external device are used to help push the head of the femur further into or away from the acetabulum. The amount of femoral head displacement (joint laxity) is quantified using a distraction index or DI. The DI ranges from 0 to 1 and is calculated by measuring the distance the center of the femoral head moves laterally from the center of the acetabulum and dividing it by the radius of the femoral head. A DI of 0 indicates a very tight joint. A DI of 1 indicates complete luxation with little or no coverage of the femoral head. A hip with a distraction index of 0.6 is 60% luxated and is twice as lax as a hip with a DI of 0.3. A third radiographic view is taken using the same positioning as the OFA. The “hip-extended” view is used to obtain additional information regarding the possible presence of degenerative joint disease (DJD) in the hip.
When the PennHIP DI was compared to the OFA scores for 65 dogs, all dogs scored as mildly, moderately, or severely dysplastic by the OFA method had a DI above 0.3.
Hip laxity as measured by the DI is strongly correlated with the future development of osteoarthritis. Hips with a DI below 0.3 rarely develop osteoarthritis. Although hips with a DI above 0.3 are considered “degenerative joint disease susceptible,” not all hips with a DI greater than 0.3 will develop osteoarthritis. It is known that some hips with radiographically apparent laxity do not develop osteoarthritis. A means of differentiating lax hips that develop osteoarthritis from those that will not is important in developing a prognosis and making treatment or breeding recommendations. In one study, the DI obtained from dogs at four months of age was a good predictor of later osteoarthritis, though the 6 and 12-month indices were more accurate.
The PennHIP method has gained popularity and more and more veterinarians are becoming certified.