[Updated February 7, 2018]
Could you publish something about hip dysplasia? We have a 14-month-old pit bull mix (with German Shepherd, we believe) who has been diagnosed with hip dysplasia. She is a very sweet, loving, active dog whom we adopted when she was seven months old.
We asked Phyllis Giroux, DVM, of Goldvein, VA, to answer this question. Dr. Giroux is a certified member of the American Veterinary Chiropractic Association. She and her partner also breed and train retrievers at their home, Deep Run Farm. Dr. Giroux’s response:
First, I need to make it clear that there are many types of rear end lamenesses that may end up being diagnosed as hip dysplasia, but you really can’t accept the diagnosis of hip dysplasia without hip x-rays. Hip dysplasia is a radiographic diagnosis, not a clinical diagnosis. That may be splitting hairs, but I see many dogs with conditions such as ruptured and improperly healed cruciate ligaments or lower back arthritis that have been diagnosed with hip dysplasia. Only radiographs can determine whether or not a dog has hip dysplasia.
Radiographs are not necessarily definitive, however. Sometimes what we see on the radiograph does not correlate with the dog’s clinical signs. For instance, sometimes we see dogs that exhibit severe lameness but have only minimally visible arthritic changes in their hips, and sometimes we see dogs that exhibit minimal signs of discomfort yet have severe changes showing in the radiographs. A lot of it has to do with the individual, his tolerance for pain, and his exercise level. But in the case of a dog with severe lameness whose X-rays look OK, I am really tempted to keep looking for some other cause of his pain.
Typically the diagnostic radiograph for hip dysplasia is taken with the dog lying on his back with his legs extended. This is a non-anatomic position for the dog, but it offers one of the best views of the hip joints.
What is Hip Dysplasia?
In the dog’s hind legs, the head of the femur (or thigh bone) is shaped like a ball, and it is supposed to fit tightly into the acetabulum (socket); it’s a classic ball and socket joint. Hip dysplasia is a catch-all term for a variety of problems with that ball and socket joint.
Sometimes, we can see the socket appearing shallower than normal, so that the ball can not get well seated in the socket. The ball may become flattened or become distorted. Many times we can see changes where the joint capsule attaches to the neck of the femur; there may be calcium deposits collecting there. In more advanced cases, we can actually see the arthritic deposits in the radiographs, where excess calcium has been deposited along the rim of the socket, and sometimes on the head of the ball itself.
In a classic case, you may also see a number of accompanying signs, including a bunny-hopping gait in the rear limbs, a dog shifting a large proportion of his weight to his front legs, wasting of the muscle mass in the thigh area, stiffness and soreness when the dog gets up after resting, and a reluctance to jump up – to either jump up on his hind legs, or to jump up onto a couch or into a car.
Prevention Starts Before Birth
I raise retrievers, and so I have pretty strong feelings about preventing hip dysplasia. I believe that hip dysplasia prevention starts way back when a puppy is only theoretical – when the breeder plans the mating! If you are going to buy a purebred dog, as opposed to getting a rescued dog, you should start by looking for a puppy with good, healthy, sound parents. Take the time to do some research on the parents, and to make sure you are buying puppies from OFA-certified stock. (OFA is the Orthopedic Foundation for Animals, established in 1966. It is a not-for-profit organization originally created to assist breeders in addressing hip dysplasia.) In certain popular breeds, such as Labradors, I think only those dogs with the higher ratings (OFA-Excellent, OFA-Good) should be bred. I won’t consider breeding even an OFA-Fair Labrador.
The OFA ratings are extremely helpful in selecting breeding stock, but you have to remember that the rating is not accurate forever. Hips, like all body parts, are dynamic. Many dogs who get an OFA rating at two years old, especially if it is one of the lower ratings, like OFA-Fair, will continue to show degenerative changes in those hips throughout their lives. Many dogs that will get a passing score with OFA at two years old are not able to pass when they are aged five, six, or seven.
In the best possible world, we would require recertification later in life, perhaps every 24 to 48 months. I think would give us a better handle on what we are doing. When you breed dogs at two years old, you don’t really know what is going to happen to them when they are eight.
I also suggest using dogs that have been evaluated by the University of Pennsylvania Hip Improvement Program (PennHIP). A dog that is OFA-Excellent and scored in the top 90th percentile on the PennHIP scale is a good choice for breeding stock, assuming they have all the other qualities you want! Breeders have a responsibility to get as much information as they can about their breeding stock. They should feel confident that all the dogs that are breeding will remain sound throughout their lives. And if the offspring starts showing problems that appear to have some hereditary nature, the owners should stop breeding the parents.
Good Nutrition for Good Hips
Once you get your puppy or young dog, there are a number of things you can do to reduce the likelihood that he develops dysplasia, or improves the condition in the case of a dog who already has dysplasia. Proper nutrition is the first and foremost consideration.
All puppies and dogs should be fed a good quality diet with a balanced calcium-phosphorous ratio (about 1.2:1.0). Entire books have been written about what constitutes a “good quality diet,” but since this issue of WDJ already contains an article about choosing good dry dog foods, I’ll just say that good foods are rarely inexpensive. Quality sources of protein, carbohydrates, and fat – that is, foods that are highly digestible, easily absorbed and utilized by the dog – are more costly than low quality foods; there is just no way around it.
I use a couple of dietary supplements as a matter of course, including the antioxidant vitamins C and E. I have also had success using Perna canaliculus supplementation (I use a supplement called Glyco-Flex).
Perna is a food product containing 57 nutrients, among them glucosamine precursors. Perna seems to be effective for our joints in the same way aloe is good for wounds in the skin: as a complex of nutrients for which the whole result is greater than a sum of the parts. We start all of our puppies on Perna when they start on food, at five weeks, and keep them on this supplement throughout their whole lives. The puppies receive about 20 mg. per pound of body weight crushed in their food. I continue this throughout their lives, although I may double or even triple that dosage if they show evidence of certain problems.
Research has certainly proven that dogs that are kept significantly lean during their first year of life have a reduced risk for developing hip problems later in life. All young dogs should be kept thin – I call it painfully thin. They should look skinny. People who grew up in my era, people who were children in the 1950s, tend to feel very uncomfortable looking at puppies who are that thin. In our era, babies and puppies were all supposed to be chubby. Here at our farm, we keep our young dogs thin and active, and this approach has been very successful.
Hope for Dysplastic Dogs
But the reader’s dog has already been diagnosed with hip dysplasia; the horse is already out of the barn. Don’t panic; there are many things you can do for a dysplastic dog.
Start with all the things I mentioned for preventing dysplasia. A better diet, glucosamine supplements, and supplemental antioxidants will all help this dog. So will keeping the dog thin. Do not underestimate the importance of keeping the dog thin. I owned a Labrador who was a field champion – and, later in his life, severely dysplastic. The dog lived to be 12, and what made the biggest improvement in his quality of life during his last two years was being thin. When he weighed 73 pounds, he could not get up off the floor. He would stumble and fall, and we would have to resort to giving him cortisone injections to be able to get around at all. When he was down around 65 pounds, he got around well, he was quite mobile and felt good. Joints are made to move. If they do not move, they degenerate further.
Pain Relief is Therapeutic
Speaking of anti-inflammatories and other analgesic agents: My opinion is that if a young dog requires them in order to feel more comfortable and be more active, I think he should receive them. It’s true that these drugs can cause side effects when used over a long time. But exercise will build up the dog’s muscle tone, and strong muscles help support joints, whether they are normal or weak. Dogs who are kept quiet will only get worse and feel worse. Give the dog at least enough to get him fit and comfortable, and then taper or eliminate the dosage whenever possible.
Even if they are in pain, these dogs need exercise. Swimming is a great thing for dysplastic dogs, because it is nonconcussive.
Many veterinarians will tell you to let the dog rest, but that opinion is changing. I graduated from veterinary school in 1977, and at that time, they were still teaching us that abnormal joints need rest, just like broken bones and other injuries need rest. Today, we realize that we did a lot of harm with that advice. Certainly, as a chiropractor, I know that joints have to move. For a long time, deep in my soul, I knew that resting these things was not making them better. Even if we can’t make the joints right, we need to make them functional, so that we can help the dog preserve good muscle tone, good nerve tone, and good energy flow throughout the body.
To that end, regular chiropractic care can be of huge benefit to dysplastic dogs. Certainly it helps keep the body balanced and the joints functional. Many of these dogs are also helped by acupuncture, which is very effective to alleviate pain in dysplastic dogs. Plus, acupuncture has no deleterious side effects, and can be used for as long as it provides good results. And even if a patient quits responding to acupuncture, one could explore other possibilities, such as gold bead implants at acupuncture points.
There are a number of surgical procedures that are of benefit to some dogs with certain types of dysplasia. Since this in itself is a rather large topic, I’ll discuss it in the next issue.