N E B K C
Hip & Elbow dysplasia
WHAT IS HIP DYSPLASIA
Hip dysplasia is the medical term for a hip socket "acetabulum" that doesn't fully cover the ball portion of the upper thighbone "femur head" . This allows the hip joint to become partially or completely dislocated.
WHAT DO THE WORD DYSPLASIA MEAN
In other words the dreaded term dysplasia simply means malformed. Abnormal growth or development of tissue, cells, etc.," 1935, Modern Latin, from dys- + -plasia, from Greek plasis "molding, conformation," from plassein "to mold" (originally "to spread thin," from PIE root *pele- (2) "flat; to spread") + abstract noun ending -ia. Related: Dysplastic.
ORIGIN OF HIP DYSPLASIA
The causes of hip dysplasia are considered heritable, but new research conclusively suggests that environment also plays a role.To what degree the causality is genetic and what portion environmental is a topic of current debate.
Neutering a dog, especially before the dog has reached an age of full developmental maturity, has been proven to almost double the chance he or she will develop hip dysplasia versus intact dogs or dogs that were neutered after reaching adulthood. Please visit our HEALTH page, sub-menu "Alternative Neutering" on this subject.
Other environmental influences include overweight condition, injury at a young age, overexertion on the hip joint at a young age, ligament tear at a young age, or repetitive motion on forming joint (i.e. jogging with puppy under the age of 1 year).
As current studies progress, greater information may help provide procedures to effectively reduce the occurrence of this condition. The problem almost always appears by the time the dog is 18 months old. The defect can be anywhere from mild to severely crippling, and can eventually cause severe osteoarthritis.
It is most common and severe in medium-large dogs.
HOW TO PREVENT HIP DYSPLASIA
X-Ray screening of the breeding stock decreases risk of producing dysplastic puppies. X-raying the parents and compensating the subjects with medium conformation with good ones considerably reduces the risk of producing dysplastic puppies.
On the other hand, x-raying and continuing to mate dysplastic x dysplastic subjects does not bring any improvement. In addition, you should always also look at the hips of the parents and grandparents and great-grandparents since it can skip generations. Ideally, only dogs free of dysplasia or only slightly dysplastic will be used in a breeding program.
As the table below show, if you mate 2 dysplasic dogs, you will have about 93% dysplasic puppies, 7% free of dysplasy. If you mate 2 dysplasy free dogs, you will have about 76% free of dysplasy puppies and only 24 % dysplasic.
There is also the coefficient of the disease which must be considered and calculated over several generations. 2 parents free from hip dysplasia but out from 2 dysplastic parents may have another percentage of displastic puppies. It is therefore necessary to be consistent in the selection and to include a dyplastic dog only if it has exceptional qualities.
References Dr Jean-Marc Wurtz
Even an X-Ray made without sedation, will give you precious information on the conformation of the hips. An accurate score is not necessary in order to conduct a quality program. Any veterinarian should be able to tell you just by looking at the X-rays if they are optimistic or not.
The best guarantee is the purchase of a puppy from a reputable breeder who health tests his breeding stock & give a written health guarantee.
As a breeder, buying a puppy from parents who are not x-rayed can cause you to lose 2-3 years in your breeding program, if you are a reputable breeder and plan to x-ray this dog before using it for breeding.
Unfortunately, we have too often heard from breeders who x-rayed the hips of their dog and found out that he was severely dysplastic, that they would have done better not to x-ray, such a shame. This is not the right approach when you are considering breeding. If you get bad news, removing such a dog from a program is honorable, even if it boycotts years of work.
These people, despite a bad score, will not hesitate to use such a dog anyway. Others will even boast of having been able to produce a non-dysplastic puppy from such a dog, probably unaware that the litter will be mixed and that the percentage of affected dogs will be much higher than if only healthy parents were used. The table above speaks for itself.
HOW TO IDENTIFY A DISPLASIC DOG
Affected dogs can show clinical signs as early as 5-7 months of age, but most do not until 1 to 2 years of age. In part this is because the underlying hip problem may be mild or severe, worsening or stable, and the body may be more or less able to keep the joint in repair well enough to cope.
Dogs with hip dysplasia may exhibit the following signs and symptoms:
Decreased activity, the dog often refuses to play and remains trapped in his basket
Decreased range of motion
Difficulty or reluctance rising, jumping, running, or climbing stairs
Lameness in the hind end
Looseness in the joint
Grating in the joint during movement
Loss of thigh muscle mass
Noticeable enlargement of the shoulder muscles as they compensate for the hind end
Stiffness or soreness after rising from rest
Subluxation or dislocation of the hip joint
the dog sits in a bizzare position sometimes lifting a paw or avoiding to sit on a certain side
Swaying, “bunny hopping” gait like on the dog on the following video.
If your dog has canine hip dysplasia, your vet will explain a variety of solutions, ranging from how to make your dog more comfortable to surgery. Treatment for hip dysplasia in dogs varies depending on the severity of the condition. And the price can vary significantly.
If you have pet insurance for your dog and hip dysplasia was not a preexisting condition, your treatment costs should be mostly covered (check with your provider to gain a better understanding of what you should expect to be reimbursed with your policy).
In severe cases of canine hip dysplasia, surgery is often the best treatment. Surgery costs for dog hip dysplasia can range from Euros 1,300.- to Euros 4,500.-
1 Juvenile Pubic Symphysiodesis – A less invasive surgery that surgeons perform on dogs younger than five months old. This surgery, which involves the fusing of the two pelvic bones to allow the rest of the bones in the pelvis to develop properly, is designed to improve the movement of the hip joints by changing the angle of the hips.
2 Triple Pelvic Osteotomy (TPO) – With TPO surgery, an osteopathic surgeon breaks the pelvis to realign the head of the femur with the hip socket to correct the joint. Triple Pelvic Osteotomy (TPO) is best for dogs ten months or younger because it’s not effective once damage begins to occur to the hip socket. TPO is an expensive and painful procedure, and younger dogs tend to recover much more quickly. TPO is one of the most recommended surgeries for younger dogs with subluxation because it restores full function to the hip joints.
3 Femoral Head Ostectomy (FHO) and Neck Excision – A surgery that involves removing the tip of the femur (the neck and the head of the bone), replacing it with a fibrous joint. While this is a more affordable option than total hip replacement, it’s not always the best choice for some dogs. Vets usually recommended this surgery for lighter weight and older dogs. While this procedure relieves most of the dog’s pain, the joint’s original range of motion and stability isn’t fully corrected.
4 Total Hip Replacement (THP) – The most invasive surgical procedure, but it restores full function to the joint. Dog hip replacement cost is high and surgeons only perform this procedure on fully grown dogs that show signs of severe joint degeneration. The surgery involves a highly specialized surgeon removing the hip joint and replacing it with an artificial joint. Dogs that undergo a total hip replacement can recover to a pain-free life that allows them to function with a near-normal range of motion.
What is elbow dysplasia?
Elbow dysplasia means abnormal development of the elbow joint. This causes damage to the cartilage surface of the joint - a process called osteochondrosis or OCD. Elbow dysplasia and osteochondrosis collectively lead to the development of arthritis (osteoarthritis). Any of these three conditions may cause elbow pain.
Elbow dysplasia is a genetic disorder caused by the combination of genes from the parents (dam and sire). The exact detail of how the elbow develops abnormally is poorly understood. An uneven fit (or incongruency) is suspected and this results in abnormal distribution of weight within the joint. Points of increased pressure cause damage to the cartilage covering the bones, and fragmentation of cartilage and the underlying bone may develop (osteochondrosis).
What are the signs of elbow dysplasia?
Elbow dysplasia is a common condition, especially in large breed dogs. The key signs are fore limb lameness and stiffness. The latter is generally most evident after rest following exercise. Reduced weight-bearing on the limb and outward rotation of the paw may be evident.
Signs tend to develop when the dog is immature and growing (five to eight months of age) or when adult (perhaps a few years of age) due to osteoarthritis.
How is elbow dysplasia diagnosed?
Examination may reveal muscle wastage (atrophy). Manipulation of the elbow joints may cause increased pain. Swelling and restriction in range of movement may be evident.
X-rays (radiographs) are the most common method of diagnosing elbow dysplasia. They enable the presence and severity of secondary osteoarthritis to be assessed. The underlying elbow dysplasia and osteochondrosis are not always apparent. In some dogs no abnormalities are evident.
A CT scan is a form of X-ray that produces thin slices through the joint in any plane. These images can be reformatted to give a 3-D model of the joint. CT gives excellent detail of the shape (congruency) of the joint and enables detection of small bony fragments. Damage to the surface of the joint can be assessed by placing a small camera in the joint – this is called arthroscopic examination. It provides more detail of the joint surfaces than radiographs or a CT scan.
CT scans showing a fragment of bone in the elbow joint (arrows)
How can elbow dysplasia be treated?
Some dogs with elbow dysplasia can be managed satisfactorily without the need for surgery. Exercise often needs to be controlled to some degree. Each dog will have its own threshold of duration and type of activity beyond which elbow pain may increase. Hydrotherapy is often beneficial. Dogs that are overweight benefit from being placed on a diet. Tit-bits may need to be withdrawn and food portions reduced in size. Regular monitoring of weight may be necessary. Painkillers (anti-inflammatory drugs) may be indicated to make the dog more comfortable. Long-term drug therapy should be avoided if at all possible in view of potential side effects.
Dogs with elbow dysplasia that fail to respond satisfactorily to conservative treatment may need surgery. There are three key types of surgery: (1) fragment removal (2) incongruency surgery and (3) salvage surgery..
1 Fragment removal surgery.
This is the most common type of surgery for elbow dysplasia. It involves removing any loose fragments of cartilage and bone from the inside of the elbow joint. This can be done under guidance from a camera through a very small hole (arthroscopically) or via a direct surgical approach.
Recovery, especially from arthroscopic surgery, tends to be reasonably rapid. Unfortunately, lameness fails to improve in a number of cases. This may be due to the underlying abnormal development of the joint (poor fit or incongruency) or the secondary osteoarthritis.
2 Incongruency surgery
Attempts may be made to improve the shape of the elbow joint and make it a better fit (or more congruent). This can be done by either removing the key pressure point within the joint or cutting the bone at the back of the joint (the ulna) to change the shape of the joint. Recovery from the latter procedure is slow and thus this surgery is reserved for a few selected cases.
3 Salvage surgery
Salvage surgery for elbow dysplasia is rarely necessary. However, occasionally the combination of elbow dysplasia, osteochondrosis and osteoarthritis cause persistent elbow pain that cannot be controlled by other more conservative means. In these few cases there are three surgical options; sliding humeral osteotomy (SHO), total elbow replacement (TER) and elbow joint fusion (termed arthrodesis).
Sliding humeral osteotomy is reserved for dogs where the outer part of the elbow joint (the lateral compartment) is relatively healthy compared to the inner part of the joint (the medial compartment) where the majority of damage tends to be. The bone of the forearm (the humerus) is cut and realigned in such a way that more weight is transferred through the outer, healthy part of the joint and less through the inner, diseased part of the joint. A special plate with a ‘step’ is applied to the inside of the bone. Although recovery from surgery can be slow, the majority of dogs improve and have less elbow pain. There are possible complications, for example, breakage of the plate or screws.
X-rays showing a sliding humeral osteotomy
(SHO). The bone above the elbow has been
cut, re-aligned (arrow) and stabilised with a
Function with elbow joint replacement is generally better than with fusion of the joint, however, there are potential complications with TER surgery that need to be carefully considered prior to making a decision. Total elbow replacement surgery involves replacing the painful joint with metal and plastic components (humeral and radioulnar prostheses). Care following surgery is critical to reduce the possibility of complications, such as dislocation of the prostheses. (See also total elbow replacement surgery information sheet.
Fusion or arthrodesis of the elbow joint results in a pain-free limb, but limb, function is compromised – since the elbow no longer moves, dogs tend to have to swing their limb around, rather than straight forward, in order to walk.
What is the outlook with elbow dysplasia?
The outlook or prognosis with elbow dysplasia and the associated osteochondrosis/osteoarthritis is quite variable. Some dogs can be managed successfully with conservative treatment involving modification of exercise and weight, with or without the need for anti-inflammatory painkiller drugs. Others benefit from removal of cartilage and bone fragments or surgery to improve joint congruency. The majority of dogs lead satisfactory lives, although their exercise and weight may need to be closely monitored. A degree of stiffness and lameness, especially after exercise, is not uncommon. In a small minority of cases that fail to respond satisfactorily to conservative procedures, salvage surgery, such as sliding humeral osteotomy or total elbow replacement, may need to be considered.