When my dog Sweetie — whose silhouette is on my logo and whose picture is on my website — was 5 ½ months old, she was diagnosed with hip dysplasia. This is a very painful, inherited disease that eventually results in osteoarthritis (OA) in dogs. Large breed dogs are generally affected, but any size dog can have hip dysplasia.
The hip (coxofemoral) joint is a ball and socket joint. In order to work correctly, the ball (femoral head) has to sit tightly in the socket (acetabulum). It must have lots of cushion and should be well lubricated. For puppies with this disease, the hips develop in such a way that the ball doesn’t sit nice and tight in the socket. This laxity in the joint causes a cascade of events, leading finally to painful OA. Once there is OA present, there is no going back.
You can find out more about hip dysplasia at ACVS.org.
I discovered that something was wrong when she was trotting next to me one day and I heard a clicking as she moved. I was a third year veterinary student at the time. I made an appointment with an orthopedic surgeon the next day. The surgeon watched her trot and walk up and down the hallway multiple times. Watching the dog go is important so that the doctor can observe the entire body. Next, the surgeon did a thorough neurologic and orthopedic examination. There is a fair amount of overlap between orthopedic and neurologic disorders, so it is important to do a complete exam. The surgeon was able to find laxity in both of Sweetie’s hips. Then we went to radiology and had X-rays done.
To diagnose hip dysplasia, at least two radiographs should be done AND the positioning of the dog must be straight. At 5 ½ months, Sweetie already had OA. There was a surgery available for puppies called a triple pelvic osteotomy (TPO), which changes the angle of the hip socket so that the head of the femur sits deeper in the socket. This decreases the likelihood of OA, but doesn’t prevent it. Unfortunately, Sweetie was not a candidate for this surgery because she already had OA.
You can find out more about TPOs at ACVS.org.
After I shed more than a few tears, I sprung into action, learning as much as I could about hip dysplasia and how to stave off the inevitable. I kept Sweetie’s growth rate slow by feeding her adult dog food. A fast rate of growth has been linked to more severe outcomes in dogs with hip dysplasia. I made sure to keep her on the thin side — being able to easily feel her ribs. Less weight potentially means less OA and less pain. I also started her on a joint supplement.
Although I was close to graduating from veterinary school, it was still difficult for me to know which supplement was best for my dog. The surgeon gave me a list of his favorites — all dog approved brands — and I stuck with the one that worked best for her. Next, I bought a life preserver and snuck her into the swimming pool in my condominium complex, where each day we worked on swimming (which she hated). She swam for 30-45 minutes, five days a week. Our saving grace was that she would do anything for a small freeze-dried liver treat, so I was able to train her to do laps as I ran from one end of the pool to the other to reward her. This kept the muscle mass in her hind limbs nice and strong to support those weak hips. When I graduated, we deliberately purchased a house with a large pool so that we could continue her conditioning.
By the time Sweetie was four years old, she was on a daily, low dosage, non-steroidal anti-inflammatory medication (NSAIDs). She was still very active and swimming, but the pain was starting to catch up. For example, when we went to a herding clinic and she practiced a lot of short stops and starts for three days straight, she would be painful for a day after. We rested on those days and she recovered quickly. In addition, she would bunny hop when she was running (a common clinical sign), and her hocks (ankles) were hyperextended in both hind legs, making her look like she was on her tippy toes. She shifted her weight to the front of her body, and despite all that we were doing, she was losing muscle around her hips.
Besides the pain of the OA, she was at greater risk of dislocating one of her hips while playing with her friends. Because we were now administering NSAIDs daily for pain, I started to look into surgical options for her. There were two options for dogs with her condition. First, we could do a total hip replacement (THR). When this surgery goes well, it is a miracle for the dog. When it doesn’t go well, it can be horrific. As a result, the surgeons wanted to wait to do her surgery until her clinical signs were worse. The other surgery that was available was a femoral head and neck ostectomy (FHO). This surgery involves removing the femoral part of the hip joint. Many dogs move well and have a great quality of life after this surgery, with no pain at all.
When we moved to Pennsylvania in 2003, we didn’t have a house with a pool, so I had to find other options. I got involved in canine rehabilitation by taking some additional courses and purchasing rehabilitation textbooks.
You can find out more about canine rehabilitation at the University of Tennessee's Canine Rehabilitation program.
I began teaching her proprioceptive exercises, such as standing on three legs and dancing on two legs. I used clicker training to teach her to lie on her side for passive range of motion and stretching exercises. Using the same techniques, I taught her to lift her legs high to flex her hip joint in active range of motion exercises. We hiked twice a week and walked on the other days. We walked deliberately and slowly up steep hills with lots of food treats as motivation so that she could learn to place each leg carefully and bear weight on it. We found a rehabilitation facility with an indoor wave pool where she swam twice a week. We also started acupuncture treatments three times a week. Sweetie learned to lie still and get her treatments for tiny treats. At this point, we also started to add in other medications to help relieve her pain. For two more years, we avoided surgery. As is always the way, the disease progressed.
Again, we went to the surgeons to see about surgery. The surgeons wanted to do a THR, and I felt that we were ready. It was time.
Well, it was a miracle. That hip was clearly pain free. We started rehabilitation in earnest with a certified canine rehabilitation therapist (CCRT) who used all kinds of modalities. We used the underwater treadmill (we taught Sweetie to target a plastic lid with her nose for food so that she would walk on the treadmill), swimming, proprioceptive exercises, passive and active range of motion exercises, ultrasound therapy, icing, warm compresses, electrical stimulation therapy, and other strengthening exercises.
Two years later, we replaced the other hip and Sweetie was finally off all medications for pain. The surgery was the best thing that I could ever do for her. To see her run without any pain whatsoever was incredible, and the last years of her life were medication and pain free. She deserved it.
Sweetie passed away in 2009, and not a day goes by that I don’t think about her.
Dr. Lisa Radosta
Image: Sweetie by Dr. Lisa Radosta