1. Dilemmas in Canine Hip Dysplasia: Surgery vs Rehab
Krista Halling, DVM, CCRP, Dip ACVS
Kristine Lee, PT, CCRT

2. Hip Dysplasia Most common orthopedic condition in dogs Multifactorial
Hip joint laxity

3. Canine Hip Joint Normal at birth Dysplastic changes as early as 30 d
Lengthening of round ligament
Subluxation
Osteoarthritis

4. Hip Dysplasia
Coxofemoral laxity is the key ingredient

5. Diagnosis Extended hip radiographic view Low sensitivity
High specificity at 6 mo

6. Diagnosis OFA Static image during extension
Congruency and 2ary changes
Normal, Borderline, Dysplastic (mild, mod, severe)
> 2 yrs old

8. Diagnosis
PennHIP
Distraction in neutral position

9. Diagnosis Distraction Index Correlates with OA (primary risk factor)
> 16 wks old

10. Diagnosis: Ortolani Sign

11. Disease Progression Linear progression of disease
Biphasic presentation

12. Puppy Phase Subluxation Tearing of joint capsule
Stretching of round ligament
Microfractures of acetabulum
Muscle strain

13. Puppy Phase 5 to 12 mth old Sudden onset hind limb lameness
Bunny hopping
Swaying hind end gait
Reluctance to rise, ambulate, do stairs

14. Puppy Phase

15. Puppy Phase: Resolution
12 to 18 mth old
Fibrosis of joint capsule
Healing of microfractures and thickening of acetabular rim
Decrease or resolution of clinical signs

16. Adult Phase Mature (> 2 yrs old) Progression of OA over time
Laxity may persist
Acute, subacute, chronic signs

17. Adult Phase Difficulty rising Reluctance to walk, do stairs
Uni- or bilateral lameness
+/- Ortolani sign
Ddx torn CCL

18. Adult Phase

19. Adult Phase

20. Management of Hip Dysplasia
Treat the patient, not the radiographs

21. Management of Hip Dysplasia
Treat the patient, not the radiographs

23. Disease Progression

24. Non-Surgical Management
Goal in puppies: control pain d/t laxity
Goal in adults: control pain d/t OA
Pharmaceuticals
Mesenchymal stem cell therapy
Body weight
Rehabilitation (“Prehab”)

25. Pharmaceuticals Symptom-modifying:
Decrease inflammation of synovial lining and fluid, mitigate stimulation of pain pathways
NSAIDs: 2 to 4 weeks
Analgesics: gabapentin or tramadol for 7 to 14 days

26. Pharmaceuticalss Structure-modifying:
Protect cartilage matrix and chondrocytes from degredation
PS GAGs
Essential Fatty Acids
Chondroitin sulfate, glucosamines

27. Non-Surgical Management
Goal in puppies: control pain d/t laxity
Goal in adults: control pain d/t OA
Pharmaceuticals
Mesenchymal stem cell therapy
Body weight
Rehabilitation (“Prehab”)

28. Rehabilitation for Hip Dysplasia
Physical treatments, preventative therapies and rehab can play a large role in the management of the canine HD patient

29. Therapeutic Goal
To create the best possible musculoskeletal environment for pain free hip function and to slow the process of DJD

30. Approach Exercise Manual therapy Weight management Modalities
Education and home exercise/maintenance program

31. What does the human literature say?
Well functioning gluteal muscles are needed for walking ability, gait symmetry and prevention of OA

32. What does the human literature say? (cont’d)
Exercise program should be designed to strengthen gluteals and associated hip musculature

33. Strengthening Exercises
Gross motor strengthening
Leash walking in “Figure 8” pattern
Underwater treadmill walking
Sit-to-stand exercise
Incline/hill walking
Destination jumping

34. Strengthening Exercises (cont’d)
Fine motor control/muscle timing
3 legged standing
Diagonal leg standing
Exercises can be done in conjunction with Neuromuscular Electrical stimulation (NMES) on the gluteals of the weight bearing leg to facilitate a better contraction

35. Strengthening Exercises (cont’d)
Balance, coordination and body awareness exercises
Walking across raised plank of wood/beam
Wobble board
Mini trampoline with perturbations
Backwards walking
Obstacles/weaves

36. Manual Therapy (cont’d)
Joint compressions/approximations
Stimulates joint proprioceptive fibres and activates postural reflexes
Coxofemoral compressions applied dorsally through the shaft of the femur or medially through the greater trochanter and neck of the femur

37. Manual Therapy (cont’d)
Massage and soft tissue release of affected musculature
Manual therapy management of associated lumbar, sacroiliac and neurodynamic structures

38. Weight control
Conservative treatment does not “cure” hip dysplasia so development of osteoarthritis (OA) may still occur
Weight management is important in decreasing weight bearing stresses on joints and supporting tissues
Research indicates that obese puppies with hip dysplasia had more resultant DJD than those whose weight was well managed

39. Modalities Neuromuscular electrical stimulation (NMES)
Transcutaneous electrical nerve stimulation (TENS)
Laser
Heat

40. Evidence?
A long term study followed 68 dogs diagnosed with clinical HD that were managed conservatively for 10 years
76% of the animals were evaluated at the end of the study
63% had no discomfort with forced hip extension;
79% had normal ROM; and
72% had normal exercise tolerance

41. Summary
A conservative approach to the treatment of canine HD should include exercise, manual therapy, weight management and physical modalities
Further investigation is needed on the rehabilitation or physical therapeutic management of dysplastic dogs

42. Surgical Options Prophylactic: mitigate laxity before onset of OA
Salvage: mitigate end-stage pain from OA

43. Surgical Options: Prophylactic
Juvenile Pubic Symphysiodesis
12 to 16 weeks old
Mild to mod laxity only
Rotation of acetabulum
Decreases distraction
index

44. Surgical Options: Prophylactic
Triple Pelvic Osteotomy
< 10 mths old
Free of OA

45. Surgical Options: Salvage
Total Hip Replacement
Skeletally mature
Medium to large breed
Lifetime risk of
complications

46. Surgical Options: Salvage
Femoral Head Ostectomy
Any age
Any breed
Rehabilitation is
crucial

47. Decision Making Age Degree of laxity Clinical signs Radiographic signs
Concurrent morbidities
Response to nonsurgical therapy
Client’s expectations
Client’s financial ability

48. Thank you