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Hip Dysplasia is a term many pup parents dread, especially those with large or giant breed dogs. But though the words create a lot of anxiety, not everyone knows what the term means and what to look for.
In this article, we’re going to briefly go over the mechanics of the hip joint, why hip dysplasia causes issues for our pups and how arthritis factors in for your dog. Arthritis symptoms that result from hip dysplasia can be insidious, so we’ll focus on how to keep an eye out for them and review how your veterinarian will go about arriving at a diagnosis. Lastly, we’ll chat about some of the treatment and prevention options out there.
The Hip Joint 101
We’re not going to go into an in-depth anatomy lesson here, we’ll just look at some of the main points. A dog’s hip joint, just like our own, is a ball and socket joint that is intended to fit together in a flush manner. The “socket” is called the acetabulum and the “ball” is the head of the femur.
As with any joint, lubrication fluid, called synovial fluid, keeps that ball and socket moving smoothly, but the conformation of the head of the femur fitting into the acetabulum is crucial to proper function.
What is Hip Dysplasia?
Hip Dysplasia, at its core, is when that ideal conformation isn’t there. In other words, the ball and socket aren’t fitting together the way they need to and aren’t flush. And when this happens, no amount of lubrication fluid in the joint can prevent the bone on bone grinding that occurs, leading to pain, inflammation, and further damage.
This damage is known as osteoarthritis (OA), or degenerative joint disease (DJD). Arthritis is a perpetual cycle of inflammation, damage, and further inflammation. We all get arthritis with age, but when a joint is already out of sync, this can happen a lot earlier.
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What Causes Hip Dysplasia?
Hip dysplasia is a disease with many contributing factors, but the main underlying cause is genetics.
There are several breeds that are genetically predisposed to hip dysplasia. Classically, this includes German Shepherd Dogs, Labrador Retrievers, Golden Retrievers, Newfoundlands, and Rottweilers, but many others as well.
It’s important to note that while large breed dogs are at highest risk, small breed dogs, and in fact any dog, can develop hip dysplasia. According to the Orthopedic Foundation for Animals, almost 75% of Bulldogs and more than half of Pugs, have hip dysplasia. And based on x-ray evidence, I’ve seen hip dysplasia diagnosed in a Maltese and a Shih Tzu, two breeds you wouldn’t really expect to have hip problems.
Other than genetics, there are other factors that influence hip dysplasia. Hip dysplasia affects every dog differently, and so some dogs will show signs early on at just a few months of age, while others may not show obvious signs for most of their lives. Some of this difference can be caused by other influences that we’ll call “environmental factors”, which are reviewed below.
Puppies definitely have a lot of energy and they need calories to keep up. But overfeeding can contribute to an accelerated growth rate that puts a lot of strain on bones and joints. For this reason, it’s really important to feed an appropriate diet made for puppies and more specifically large breed puppies if you have one. These diets have the right formulation of calories, vitamins, and minerals to help a puppy grow appropriately.
To make sure you’re not overfeeding your puppy, be sure to follow the feeding recommendations on the bag at a minimum. Even better, ask your veterinarian to help you calculate calories for your puppy and provide advice on feeding guidelines.
This is very similar to the fast growth category, but we can apply it more to adult dogs. According to the Association for Pet Obesity Prevention (APOP), more than half of dogs in the US are classified as overweight and obese. This is especially concerning for our dogs with hip dysplasia, as excess weight places more strain on the joints. In dogs where the joints aren’t lining up properly to begin with, arthritis can set in even faster than in a normal dog.
The two biggest risk factors for obesity in pets is overfeeding and lack of enough exercise. It’s even more important for adult dogs to have their daily calorie needs calculated, since there’s no longer any wiggle room for growth. Your vet can help you figure out the right amount of calories your pup needs per day.
Exercise is important for keeping up metabolism and staying lean. However, too much of a good thing can be a bad thing. For puppies especially, it’s important to keep exercise within reasonable limits. Going for a couple of 30 minutes walks per day is fine, but I don’t advocate running miles with your dog until she reaches at least one year of age and even then we need to work up to that high intensity level gradually.
Putting too much pounding strain on the hips in dogs at risk for hip dysplasia can worsen that incongruity in the joints. Types of activities to be conservative about include running, especially on pavement, agility work, lots of jumping, and rough play behavior.
How Hip Dysplasia Develops and What We See
Because hip dysplasia can present at different ages, it’s important to know what to recognize at different times in a dog’s life. We’ll divide the signs we see into “young dogs” and “older dogs”.
All dogs with hip dysplasia are born with normal hips, but starting at just a couple weeks of age, changes in the pelvic joint can start to happen.
A puppy may show signs of hip dysplasia as early as 3-6 months of age. What typically happens during this age range is excessive laxity in one or both hips. This is in part due to the changing conformation of the pelvic joint but also due to the loose and flexible connective tissues typical of young dogs that are still growing.
Young dogs can show a variety of signs that may occur on just one side, or on both. This might be limping that starts to develop but never completely goes away, or perhaps it goes away and comes back over and over again in cycles.
“Bunny hopping” is also a common sign to see. It’s a term used to describe a gait where a dog hops with both hind legs at once, usually when trying to jog or run. This is probably a subconscious effort on the dog’s part to avoid full weight-bearing on one hindlimb.
Because of severe joint laxity that some puppies can have, you may also hear an audible “click” or feel a pop when he walks. This is from the head of the femur popping in and out of the hip socket, which is called “subluxation”.
While less common in puppies, difficulty standing from a sitting or laying-down position can also be seen, making your puppy look like an old dog. Arthritis symptoms can sneak up on you, so if you see early signs, even in a young dog, you’ll want to have him seen by your vet.
Signs of hip dysplasia may not appear for many years. This can be because as a puppy, a dog may not have had severe joint laxity to cause early problems. But over time, the physical incongruity and grinding bone on bone in the joint allows arthritis to develop and this is what we start to see in older dogs. These dogs can sometimes hide signs of minor pain for years, but eventually it will get bad enough to become visible.
A characteristic appearance of arthritis is a dog that has difficulty standing up from a sitting or laying-down position. With simple arthritis, once they get moving, signs may resolve in many a dog. Arthritis symptoms in the case of hip dysplasia, however will often continue with a noticeable limp in one of the back legs, especially after exercise.
You may notice your dog is less willing to do some of the same things she used to, like running, playing fetch, or jumping to catch a frisbee. Because of this progressively decreasing activity, dogs can lose muscle mass over their hips and thighs. This in turn leads to a stiff, stilted gait and a dog appearing weak in the hindlimbs. This is especially true with bilateral hip dysplasia where both sides are affected.
Where younger dogs that show signs of hip dysplasia usually do so over a shorter period of time, like 1-2 months, older dogs develop these signs much more slowly, over a few years.
When to Check In with a Check-up
When should you take your dog to the vet? In the case of a puppy, sure, sometimes they overdo it and limp a little from a mild muscle strain. But these usually improve in a couple of days with a little rest.
If you notice your young dog is trying not to bear weight on a limb, especially after exercise, this should be a red flag that something’s wrong. This is especially the case if the limp gets better then worsens in repeated cycles.
In the case of an older dog, any kind of slow, progressive stiffness and lameness should be evaluated. Oftentimes, we try to pick up on any kind of developing arthritis or hip problems during annual or biannual wellness visits, since these signs may not be overtly obvious at home but may be detectable on exam. So make sure to make your vet aware of any changes you see, even subtle ones.
Diagnosing Hip Dysplasia
When you get to the vet, he or she will first collect some historical information. Make sure to be specific about what you’ve seen and when you’ve seen it, and answer any follow up questions thoroughly. Very pointed questions are often asked to narrow down some possibilities and help guide the exam.
Your vet may ask to see your dog walk first, as this helps to characterize a lameness and get a better understanding for what you’ve been seeing.
Next, your vet will examine your pup’s hips, usually extending them, flexing them, and working them both through a full range of motion. This helps to determine if there is any pain (especially on full extension) and if any kind of “pop” or “click” occurs when rotating the head of the femur around in the socket.
Often with young pups with hip dysplasia that have a lot of joint laxity, the head of the femur will actually subluxate, or partially “pop” out during range of motion. This really heightens concern for hip dysplasia.
After the exam, your vet is likely to recommend x-rays (or more properly termed, “radiographs”). This is because while your vet may have a really high suspicion for hip dysplasia based on the historical information you provided and the physical exam findings, hip dysplasia can only be completely diagnosed with x-rays.
Now, it is very common to recommend having these x-rays performed under sedation. Most of the time, x-rays don’t require sedation, but when evaluating the hips, there’s two main reasons for this, focusing on comfort and the best possible results.
First, we need to get very specific views and they have to have nearly perfect positioning to be interpreted properly. If the hips are out of line just a little, it might be hard to make the call for subtle, early changes. Second, the positions required to diagnose hip dysplasia put a lot of strain and pressure on the hips, and this can be really uncomfortable for a pup with hip pain. Sedation allows a pup to relax while being positioned, which is less stressful and more comfortable for her.
It’s also common to send these x-rays out to be reviewed by a radiologist. While many cases can be identified by a general practitioner, hip dysplasia can have extremely subtle changes early on, and having an expert review the images can be very helpful to support findings. .
In addition to basic films that we do for hip dysplasia in general practice, there are two specialty studies to be aware of. These are more often performed as screening tools for pure-breed dogs, as there is a lot of science behind how they are taken and interpreted, which provides a definitive result, and good data to have for different breeds.
The Orthopedic Foundation for Animals (OFA) was founded in 1966 by a well-known philanthropist, sportsman, and dog-lover, John M. Olin. When hip dysplasia began to affect his own personal dogs, he developed the non-profit foundation to help research the condition, gather data, and reduce its prevalence in certain dog breeds, like German Shepherd Dogs and Golden Retrievers. The OFA still largely focuses on hip dysplasia, but has since expanded to gather data on a lot of other inherited genetic disorders in dogs.
The OFA method involves taking specific views, so that 9 separate anatomic areas of the hip are evaluated independently by three veterinary radiologists. Pursuing this method requires submitting an application, and cannot be performed until a dog is 2 years of age. If a dog passes with a clean x-ray review, he can then be OFA Certified. This document may be included with paperwork from breeders where they’ve had a puppy’s parents evaluated.
As the name implies, the PennHIP method was developed by veterinarians at the University of Pennsylvania Veterinary School back in the 1980s to have a scientifically accurate and standard method by which to evaluate dogs at risk for hip dysplasia.
This method has some differences from the OFA method. First, while sedation is only recommended for OFA, it is a requirement for PennHIP. This is because a specific device is used to maximize the “distraction”, or subluxation potential, of the hip joint. But because this specific device is used, this method may be used much earlier than with OFA, in dogs as young as 4 months of age.
Another difference is that any veterinarians or veterinary nurses involved with taking x-rays for PennHIP studies must take a special course and be properly certified. The last difference is that while OFA is a little more subjective of an evaluation, PennHIP is far more objective.
With use of the special device, an actual numerical risk of hip dysplasia can be calculated, ranging from 0 to 1.This is called the distraction index (DI). The index value of 0.3 is used as the threshold. Below 0.3, a dog has an extremely low risk of hip dysplasia. Once above 0.3, the risk goes higher the closer to 1 you get.
These methods can be used both to identify or assess the risk for hip dysplasia, as well as to help prevent hip dysplasia from being genetically passed down in future generations, which we’ll talk about more towards the end of the article.
So let’s say your dog has been diagnosed with hip dysplasia. What do you do? Well, it does depend on what signs are being seen, the severity, and of course your pup’s age. So as we did with the earlier section on symptoms of hip dysplasia, we’re going to divide treatment options into those appropriate for young dogs, and for older dogs as well as medical vs. surgical options.
Medical Options for Young Dogs
Let’s say your 6 month old Golden Retriever puppy had the PennHIP method done since this is a breed at risk for hip dysplasia, but she’s showing no current signs of disease. She had a distraction index of 0.4, which is just slightly above the threshold of 0.3, but still abnormal. What’s reasonable to do here, since the risk is low and there’s no signs of disease?
In this case, starting a good supplement as a preventative measure to help keep those young joints healthy for longer, is a great choice. A supplement that has glucosamine, chondroitin, omega-3 fatty acids, and antioxidants can work well before we see any serious concerns but should be continued for life because of the risk.
Now let’s say that you have a 6 month old puppy that started limping on her right hind leg off and on for the last month. At first you thought it was just a mild sprain injury from playing at the dog park, but it just hasn’t gone away. When you take her to the vet, x-rays show some moderate subluxation in one hip and early signs of degenerative joint disease/arthritis. Now what?
For most puppies, the subluxation phase, where there is a lot of joint laxity, will resolve by about one year of age as tendons and ligaments tighten up, removing a lot of discomfort and signs of limping. However, because hip dysplasia is still present, degenerative joint disease and arthritis will continue to insidiously develop over time, and in a few years you’ll start to see some of those same signs develop again.
In these cases, prevention is extremely key. Starting out with a more comprehensive joint supplement that contains MSM and Green-Lipped Mussel, can provide additional joint support that help to address active, current inflammation.
But while supplements are a great mainstay for helping maintain healthy joints, many dogs need more active pain therapy. For this reason, non-steroidal anti-inflammatory drugs (NSAIDs) are still the best standard of care medication to address both pain and inflammation.
Carprofen is the most common one used (Rimadyl, Rovera, and Novox) and is a COX-2 inhibitor, very much like most human NSAIDs. While the incidence of side effects is low (<2%), dogs can experience digestive upset. And while liver and kidney function issues are rare in young dogs, we can still see these issues as well, which is why we typically require bloodwork monitoring while on carprofen, at least yearly.
There is a newer NSAID medication call grapiprant (Galliprant), which is not a COX-2 inhibitor but a prostaglandin inhibitor. This means that some of the side effects seen with carprofen are not seen nearly as much with grapiprant and it may be a safer alternative, especially for younger dogs still growing into their livers and kidneys.
It is important to NOT use any human NSAIDs, like ibuprofen, acetaminophen, or naproxen-sodium, in dogs, as they are very sensitive to the effects and toxicities can occur easily. Buffered aspirin in the “baby aspirin” size can be a cost-saving alternative for some pup parents, but the safety threshold is still narrow, and getting advice from your vet is still necessary, even if it is over the counter.
Although there may be some risks to starting medication therapy early, the risk of not starting an NSAID with a dog experiencing pain and early arthritis, is that the disease will progress far more quickly.
Medical Options for Older Dogs
For older dogs that develop signs of hip dysplasia in their middle or advanced years, we’re kind of already playing a catch-up game. In these cases, hip dysplasia has always been present, but has been developing slowly and insidiously with progressive degenerative joint disease.
When we see dogs present this way, it’s best to start a good comprehensive supplement that contains as many beneficial ingredients as possible, like glucosamine, chondroitin, MSM, and Green-Lipped Mussel. It’s also important to start an NSAID ASAP as well, to get inflammation and pain as under control as possible right away. But it’s always important, especially with senior dogs, to make sure our bloodwork looks nice and healthy before using NSAIDs long-term.
Additional Pain Relievers
Our older dogs, already having a lot of arthritis in their hips by this time, may need additional pain medication on top of NSAID and supplement therapy. The most common ones we use include tramadol and gabapentin. It’s common to do trials of these for about one week to gauge efficacy before continuing. It is also common, now that both drugs are considered scheduled controlled substances thanks to the opioid abuse crisis in America, for veterinarians to be required to have recheck exams scheduled at certain intervals for any additional refills.
While the following practices are pursued more often for older dogs, they can work well for younger dogs too, especially if we’re trying to help them get through a more symptomatic hip laxity/subluxation phase.
Laser therapy is a helpful modality where a special “cold” laser that provides anti-inflammatory benefits is directed on affected joints for relatively short (15-20 minute) sessions. Many general veterinary practices now have therapy lasers and will offer packages based on how often sessions are needed. It is common to do an initial couple sessions, to see how a dog responds and for how long the beneficial effects will last, After an initial series, a pup may continue with sessions once to twice a week or every other week.
Acupuncture is an age-old healing therapy developed in China thousands of years ago that consists of placing tiny needles painlessly at certain points on the body (called “acupoints”) to increase blood flow and nerve stimulation
Acupuncture may seem a little hokey, but in the hands of a skilled, trained veterinary acupuncturist, it can work very well for arthritis. Just as with laser therapy, an initial trial period is often used to see how well a dog responds. Some dogs can be higher or lower responders, so it’s important to have some open expectations.
Whether young or old, the pain and disability of hip dysplasia may become more than medical therapy can counteract, and so surgical options may need to be discussed. There are a few procedures out there that can be beneficial, all having their own indications for use.
Pelvic Osteotomy (Double or Triple)
This procedure attempts to recreate the normal depth and coverage of the hip socket in relation to the head of the femur, by making precise cuts in the bone of the pelvis and altering their orientation.
This procedure used to be more common several years ago, and has largely been replaced by other surgical options that provide a better guarantee of success. This is because this procedure is usually performed in really young dogs before they have signs of hip dysplasia. But it can be really disappointing if several years later, it’s found that the procedure did very little. This is also why the procedure is reserved only for young dogs that have little or no subluxation and no signs of degenerative joint disease or arthritis.
Total Hip Replacement
This is now a more common procedure performed when severe hip dysplasia and signs of pain are present. This procedure can be performed as early as one year of age and is very similar to people in that implants are used to replace both the head of the femur and the hip socket of the pelvis.
It is very common for a veterinary surgeon that performs this procedure to require that an overweight or obese dog get to a far healthier weight before performing this procedure. As with people, too much unhealthy body weight can lead to implant failure.
Femoral Head Ostectomy (FHO)
A femoral head ostectomy involves completely removing the head of the femur, but does not involve any kind of implant. Muscle and scar tissue keep the limb in place and supported.
The FHO is a less intense procedure than a total hip replacement but is also considered something of a salvage procedure, where the pain from hip dysplasia is so bad, that removing the source of that pain is better than having no hip joint anymore.
This procedure can be performed at any time, even in young dogs, and is sometimes looked at as a lower cost alternative to a total hip replacement, especially by pet owners on a strict budget and for rescue groups. Dogs do pretty well with it, but you can see some movement abnormalities for life, as there is no true joint there anymore.
Since hip dysplasia is largely a genetic disease, the best prevention for hip dysplasia is to remove the genetic risk with selective breeding. Breeders of at-risk pure-breed dogs like German Shepherd Dogs, Golden Retrievers, and others, can see if their breeding dogs have hip dysplasia either through the OFA or PennHIP methods, and avoid using them in a breeding program if they do.
It’s important to ask your breeder if these steps have been taken, or to look for OFA Certification or PennHIP documentation with any documents you receive with your puppy. Genetics are complex and unpredictable, so do not take “I’ve never seen or had a problem with hip dysplasia in my dogs” as an acceptable answer.
For at-risk dogs, keeping weight down is crucial to slowing down signs of the disease. And as mentioned with causes in puppies, feeding appropriately to avoid excessive quick growth is very important. Make sure to speak with your veterinarian about your pup’s body condition and to help you with daily calorie requirements. If your dog is overweight, your vet can help develop a weight-loss plan with you.
Hip dysplasia is a serious concern, but with the knowledge gleaned here and with help from your veterinarian, it can be well-managed, keeping your pup happy, comfortable, and still doing the things you love to do together.