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Diagnosis, prevention, and management of canine hip dysplasia: a review

May 2015
Veterinary Medicine Research and Reports 6:181-192

DOI:10.2147/VMRR.S53266

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CC BY-NC 3.0

Authors:

Emma R Schachner

University of Florida

Mandi Lopez

Louisiana State University

Canine hip dysplasia (CHD) is a polygenic and multifactorial developmental disorder characterized by coxofemoral (hip) joint laxity, degeneration, and osteoarthritis (OA). Current diagnostic techniques are largely subjective measures of joint conformation performed at different stages of development. Recently, measures on three-dimensional images generated from computed tomography scans predicted the development of OA associated with CHD. Continued refinement of similar imaging methods may improve diagnostic imaging techniques to identify dogs predisposed to degenerative hip joint changes. By current consensus, joint changes consistent with CHD are influenced by genetic predisposition as well as environmental and biomechanical factors; however, despite decades of work, the relative contributions of each to the development and extent of CHD signs remain elusive. Similarly, despite considerable effort to decipher the genetic underpinnings of CHD for selective breeding programs, relevant genetic loci remain equivocal. As such, prevention of CHD within domestic canine populations is marginally successful. Conservative management is often employed to manage signs of CHD, with lifelong maintenance of body mass as one of the most promising methods. Surgical intervention is often employed to prevent joint changes or restore joint function, but there are no gold standards for either goal. To date, all CHD phenotypes are considered as a single entity in spite of recognized differences in expression and response to environmental conditions and treatment. Identification of distinct CHD phenotypes and targeting evidence-based conservative and invasive treatments for each may significantly advance prevention and management of a prevalent, debilitating condition in canine companions.

Anatomy of canine hip dysplasia. Notes: ( A – C ) Canine hip-extended radiographs, and corresponding images of the joints ( D – F ) from different individuals demonstrating mild ( A and D ), moderate ( B and E ), and severe ( C and F ) joint changes. Light photomicrographs of normal ( G ) and fibrillated ( H , arrow) articular cartilage.

…

Schematic illustration of the Ortolani test. Notes: image demonstrates the coxofemoral joint prior to distraction (A), while force is applied from the stifle toward the hip along the axis of the femur to displace the femoral head (B), during abduction of the femur to reduce the joint (C), and with the femoral head snapping back into place with an audible click, ie, the Ortolani sign (D). Arrows indicate the direction of the applied force. Adapted from Chalman JA, Butler HC. Coxofemoral joint laxity and the Ortolani sign. Journal of American Animal Hospital Association. 1985;21:671-676. 28

…

Representations of anatomical landmarks and evaluation mechanisms to assess canine hip dysplasia. Notes: Coxofemoral joint anatomical characteristics considered by the Orthopedic Foundation for Animals ( A ): craniolateral acetabular rim ( 1 ), cranial acetabular margin ( 2 ), femoral head ( 3 ), fovea capitis ( 4 ), acetabular notch ( 5 ), caudal acetabular margin ( 6 ), dorsal acetabular margin ( 7 ), junction of femoral head and neck ( 8 ), and trochanteric fossa ( 9 ). ( B ) British Veterinary Association/Kennel Club canine coxofemoral joint characteristics scored during evaluation. 10,34 Schematic superimposed on a hip-extended radiograph demonstrating the Norberg angle ( C , arrow). Illustration of the Pennsylvania Hip Improvement Program (distraction index, the distance between the centers of the femoral head and acetabulum during distraction ( D ) divided by the radius (r) of the femoral head (d). 41 Depiction of the dorsolateral subluxation score ( E ) calculated as 100 multiplied by the percentage of femoral head medial to the cranial acetabular rim (d) divided by the femoral head diameter ( θ ), d/ θ × 100%). Abbreviations: AF, acetabular fossa; An, acetabular notch; CaAE, caudal acetabular edge; CrAE, cranial acetabular edge; CrEAR, cranial effective acetabular rim; DAE, dorsal acetabular edge; Fh, femoral head; Fv, foveal defect.

…

Measurements and three-dimensional models for evaluating the dysplastic canine hip. Notes: ( A ) Volume rendered model of the canine pelvis generated from two-dimensional computed tomography images ( B and C ). The blue line in ( A ) indicates the level of the cross-sectional image in ( B ) and ( C ). ( B ) and ( C ) Representative measures performed on two-dimensional computed tomographic images of the canine coxofemoral joint. Acetabular index is the ratio between the width and the depth of the acetabulum; d/w × 100. For further information see Lopez et al 42 and Andronescu et al. 47 For details on these measures see Lopez et al. 42 Abbreviations: AAA, acetabular anteversion angle; AI, acetabular index; CEA, center edge angle; CPC, percentage of femoral head coverage; DASA, dorsal acetabular sector angle (dorsal coverage of the femoral head); HASA, horizontal acetabular sector angle (total acetabular coverage of the femoral head); HTEA, horizontal toit externe angle (orientation of the acetabulum); VASA, ventral acetabular sector angle (ventral coverage of the femoral head).

…

Radiograph illustrating a bilateral total hip replacement. Notes: Blue line indicates femoral implant, pink line indicates acetabular implant. Image courtesy of Dr Jeffrey D Brourman.

…

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REVIEW

open access to scientiﬁc and medical research

Open Access Full Text Article

http://dx.doi.org/10.2147/VMRR.S53266

Diagnosis, prevention, and management

of canine hip dysplasia: a review

Emma R Schachner

Mandi J Lopez

Department of Veterinary Clinical

Sciences, School of Veterinary

Medicine, Louisiana State

University, Baton Rouge, LA, USA

Correspondence: Mandi J Lopez

Department of Veterinary Clinical

Sciences, School of Veterinary Medicine,

Louisiana State University, Skip Bertman

Drive, Baton Rouge, LA 70803, USA

Tel +1 225 578 9918

Email mlopez@lsu.edu

Abstract: Canine hip dysplasia (CHD) is a polygenic and multifactorial developmental disorder

characterized by coxofemoral (hip) joint laxity, degeneration, and osteoarthritis (OA). Current

diagnostic techniques are largely subjective measures of joint conformation performed at dif-

ferent stages of development. Recently, measures on three-dimensional images generated from

computed tomography scans predicted the development of OA associated with CHD. Continued

reﬁnement of similar imaging methods may improve diagnostic imaging techniques to iden-

tify dogs predisposed to degenerative hip joint changes. By current consensus, joint changes

consistent with CHD are inﬂuenced by genetic predisposition as well as environmental and

biomechanical factors; however, despite decades of work, the relative contributions of each

to the development and extent of CHD signs remain elusive. Similarly, despite considerable

effort to decipher the genetic underpinnings of CHD for selective breeding programs, relevant

genetic loci remain equivocal. As such, prevention of CHD within domestic canine popula-

tions is marginally successful. Conservative management is often employed to manage signs of

CHD, with lifelong maintenance of body mass as one of the most promising methods. Surgical

intervention is often employed to prevent joint changes or restore joint function, but there are

no gold standards for either goal. To date, all CHD phenotypes are considered as a single entity

in spite of recognized differences in expression and response to environmental conditions and

treatment. Identiﬁcation of distinct CHD phenotypes and targeting evidence-based conservative

and invasive treatments for each may signiﬁcantly advance prevention and management of a

prevalent, debilitating condition in canine companions.

Keywords: canine hip dysplasia, orthopedics, joint, osteoarthritis

Introduction

Canine hip dysplasia (CHD) is a complex developmental disorder characterized by joint

laxity and osteoarthritis (OA) in one or both coxofemoral (hip) joints (Figure 1A–C).1

The polygenic, multifactorial etiology2 of CHD has challenged veterinarians and

researchers since the condition was described in the 1930s.3 Joint changes characteristic

of CHD are also associated with environmental factors such as nutrition,4–6 exercise,7

and the process of skeletal ossiﬁcation.8,9 The condition affects essentially all breeds,

with an estimated prevalence ranging from 1% to 80% according to the Orthopedic

Foundation for Animals. It appears to occur at a relatively high rate in large-bodied

and brachycephalic dogs as well as those with high body length to height ratios.10,11

The periodic appearance of OA in joints other than the coxofemoral joint12,13 has led

some to propose systemic contributions to CHD expression.1 These complexities,

among others, complicate attempts to manage the CHD by selective breeding despite

strict reporting and guidelines.14

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Schachner and Lopez

There are many theories to explain CHD joint degenera-

tion, but joint laxity and irregular or delayed endochondral

ossiﬁcation are among the most popular. The conditions are

not mutually exclusive, and their phenotypic expression is

variable within and among breeds.15 Partially ossiﬁed hip

structures may become distorted during development due

to mechanical stresses in joints with delayed endochondral

ossiﬁcation.8,16 Joint components may be more vulnerable to

deformation and damage from normal joint kinetics before

they are fully ossiﬁed.8,9,17 Abnormal and delayed endochon-

dral ossiﬁcation in the coxofemoral joint has been identiﬁed

in 15-day-old dogs that developed CHD by the time they were

12 months old,8,9,18 and in Great Danes with experimentally

induced hip dysplasia.19 In contrast, comparably earlier joint

ossiﬁcation appears to occur in Greyhounds, a breed with

one of the lowest incidences of CHD. While it is clear that

variation in the process of endochondral ossiﬁcation may play

a role in the development of CHD, the exact relationships

between ossiﬁcation patterns, abnormal joint structure, and

development of OA remain unclear.20

Affected joints usually develop varying degrees

of synovial inflammation, articular cartilage damage

( Figure 1), osteophytes, and subchondral bone sclerosis and

remodeling.21–23 While there is no single, overarching descrip-

tion of the sequence of events in the process, there are changes

that occur in many forms of dysplasia. Recently, the dorsal

acetabular rim angle (a measure of the dorsal slope [angle] of

the subchondral articular acetabular surface relative to hori-

zontal) was reported to be signiﬁcantly larger (less femoral

head coverage by the acetabulum) in dogs with coxofemoral

joint laxity versus normal dogs as early as 1 week of age.17

Subluxation of the femoral head and delays in ossiﬁcation

Figure 1 Anatomy of canine hip dysplasia.

Notes: (A–C) Canine hip-extended radiographs, and corresponding images of the joints (D–F) from different individuals demonstrating mild (A and D), moderate (B and E),

and severe (C and F) joint changes. Light photomicrographs of normal (G) and brillated (H, arrow) articular cartilage.

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Canine hip dysplasia

of the craniodorsal acetabular margin are often visible by

8 weeks, and, in many cases, subluxation of the femoral

head increases by around 12 weeks of age.18 Degeneration

and microfractures of the articular cartilage, and thickening,

inﬂammation, and deterioration of the joint capsule, tendi-

nous insertions, and ligaments are often apparent by 5 months

of age.18 Despite the presence of these degenerative traits in

many dogs with degenerative coxofemoral joint changes,

clinical signs are variable.21

A direct relationship between joint capsular collagen

composition and mechanical properties was proposed over

30 years ago.24 Altered capsular collagen composition has

been identiﬁed in children with congenitally dislocated

hips25 and dogs with hip joint laxity.26 Joint capsular collagen

ﬁbrils were found to be more heterogeneous in 8-month-old

Labrador Retriever puppies with severe coxofemoral joint

laxity than those with normal joints.15 Abnormal collagen

composition is thought to contribute to reduced joint capsule

stiffness, which contributes to excess femoral head motion

and abnormal mechanical stresses on the femoral greater

trochanter and acetabular margins and cartilage.15 Over time,

the abnormal forces are thought to result in deformation of

the articulating structures and an incongruous joint.18

Despite almost a century of work, many aspects of the

development and progression of joint changes and OA associ-

ated with CHD remain elusive. This makes establishment of a

gold standard for treatment a challenge. The lack of a single,

predictable pattern of joint degeneration is likely a reﬂection

of natural variability, including individual responses to exter-

nal environmental inﬂuences. However, ambiguity in disease

progression may also reﬂect distinct disease processes that

have yet to be recognized. Continued efforts to identify and

characterize patterns in joint changes may lead to identiﬁcation

of CHD phenotypes, which will, in turn, contribute to earlier

disease identiﬁcation and more effective targeted treatments.

Diagnosis

Despite some recognized patterns of joint degeneration

characteristic of CHD, there is signiﬁcant variability in the

progression and ultimate severity of the disease as well as

inconsistent relationships between gross and radiographic

joint changes and clinical signs.21 There are, however, two

general behaviors often attributed to CHD, including lame-

ness in young dogs (under 1 year), that increases with activity

or trauma, and gait abnormalities and hind limb muscle atro-

phy in older dogs.27 Notably, hind limb lameness can be due

to reasons other than CHD joint changes, including pelvic,

distal hind limb, and neurological pathologies, metabolic

bone disease, ligament rupture, patellar luxation, and spine

disorders.27 Hence, a thorough, comprehensive assessment is

paramount to identiﬁcation of the source of discomfort.

Subjective laxity examinations

The Ortolani test is a subjective evaluation of coxofemoral joint

laxity originally designed for diagnosis of human congenital

hip dislocation in the 1930s.28,29 The test is also used as a CHD

screening test.28 Dogs are placed in lateral recumbency; one

hand of the examiner is used to apply force along the length of

the femur from the stiﬂe toward the pelvis as the other braces

the back just above the sacrum (Figure 2).27 This maneuver is

intended to displace the femoral head. The stiﬂe is then slowly

abducted to reduce the joint.29 An audible or palpable pop as the

femur slips back into the acetabulum is considered a positive

Ortolani sign indicative of joint laxity. Lack of an Ortolani

sign does not necessarily mean that the hip is normal. Joint

changes associated with dysplasia, like thickening of the joint

capsule and joint tissue, may interfere with the displacement

required for a positive sign.28,30 Bardens’ test,31 an examination

technique designed to evaluate the hips of babies (aged younger

than 6 months), is thought to be more sensitive for detecting

coxofemoral joint laxity and/or shallow acetabula in puppies

6–8 weeks of age.29 With the dog in lateral recumbency, the

proximal femur is elevated laterally from the body. With the

femur elevated, the index ﬁnger of the other hand is used to

push the femur away from the joint in a dorsal direction with

pressure on the greater trochanter. More than 2 mm of displace-

ment is considered a positive sign.31 In general, these and other

palpation techniques may be used as part of a comprehensive

examination on puppies or dogs suspected to have excessive

joint laxity characteristic of CHD. However, the tests alone are

not sufﬁcient for diagnosis of CHD.

Radiography

Radiography has long been the gold standard to assess

and quantify joint changes associated with CHD joint

remodeling.32,33 Worldwide, there are ﬁve popular, standard-

ized evaluation systems with distinct metrics that are used to

grade canine radiographic coxofemoral joint conformation

and degenerative changes.

Orthopedic Foundation for Animals

The Orthopedic Foundation for Animals evaluation is

performed on hip-extended radiographs performed under

heavy sedation or general anesthesia by three independent

board-certiﬁed radiologists.10 Based on subjective assess-

ment of nine joint parameters (Figure 3A), conformation

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Schachner and Lopez

is categorized as excellent, good, fair, borderline, mild,

moderate, or severe. The ﬁrst three categories are considered

to be normal while the last three are dysplastic.10 Metrics

are largely subjective assessments of hip conformation and

evidence of degenerative joint disease.

British Veterinary Association/Kennel Club

The British Veterinary Association/Kennel Club maintains a

“pass/fail” evaluation system that was instituted in 1965 and

updated in 1984.34 For scoring, dogs must be at least 1 year

of age, microchipped (or tattooed), and, if registered with the

Kennel Club, the registration number must be included on the

radiograph.35 Each dog has one opportunity to be scored by the

system. Joints are individually scored on nine criteria from 0 to

5 or from 0 to 6 on hip-extended radiographs by two qualiﬁed

radiologists on a British Veterinary Association/ Kennel Club

panel, with 0 being the best score and 106 the worst (53 possible

points for each hip).34 The nine criteria ( Figure 3B) include the

Norberg angle (Figure 3C) and subjective assessments includ-

ing subluxation, dorsal acetabular edge, cranial acetabular

edge, cranial effective acetabular rim, acetabular fossa, femoral

head recontouring, and femoral head and neck exostosis.34,35

An average score for each individual dog breed is published,

ie, the breed mean score, and it is recommended that only

animals with total scores well below the breed mean be used

for breeding purposes.35

Fédération Cynologique Internationale

The Fédération Cynologique Internationale (FCI)36 is one

of the largest canine organizations in the world and includes

kennel clubs from across Europe, Asia, Africa, and South

America. Extended hip and abducted hind limb radiographs

performed at 1 year of age (18 months for large breed dogs)

are scored according to the ofﬁcial FCI system by radiologists

approved by breed-speciﬁc kennel clubs.36 Scoring includes

the Norberg angle, formed by a horizontal line connecting

the centers of the right and left femoral heads and a line con-

necting each center to the cranial margin of the corresponding

acetabulum (Figure 3C)37 as well as subjective hip conforma-

tion parameters. Each joint is assigned a grade of A–E, with

A representing healthy and E representing severe dysplasia.

The more dysplastic of the two joint scores is considered the

Acetabulum

Ligamentum

teres

Cartilaginous labrum

Femoral head

Joint capsule

Figure 2 Schematic illustration of the Ortolani test.

Notes: Image demonstrates the coxofemoral joint prior to distraction (A), while force is applied from the stie toward the hip along the axis of the femur to displace the

femoral head (B), during abduction of the femur to reduce the joint (C), and with the femoral head snapping back into place with an audible click, ie, the Ortolani sign (D).

Arrows indicate the direction of the applied force. Adapted from Chalman JA, Butler HC. Coxofemoral joint laxity and the Ortolani sign. Journal of American Animal Hospital

Association. 1985;21:671–676.28

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Canine hip dysplasia

ﬁnal score for the individual dog. The same grading scale can

also be applied to computed tomography (CT) scans.

Pennsylvania Hip Improvement Program

University of Pennsylvania researchers developed a quantita-

tive method to evaluate canine hip conformation38–40 that was

implemented in 1994.41 The primary distinction of the Penn-

sylvania Hip Improvement Program (PennHIP) method is that

passive hip joint laxity is measured in addition to subjective

radiographic conformation.38–40 Three radiographic views

are evaluated by PennHIP-certiﬁed radiologists: a standard

hip-extended view for evidence of degenerative joint disease;

a compression view for congruity between the femoral head

and acetabulum; and a distraction view, for joint laxity. The

distraction index is the ratio of the distance between the

centers of the femoral head and acetabulum (d) and the radius

of the femoral head (r), as shown in Figure 3D. The closer the

score is to 0, the better the ﬁt, ie, minimal femoral distrac-

tion, but a score of 1 indicates severe laxity and associated

femoral distraction.41 Recently, the PennHIP distraction index

and OA scores were found to have strong correlations with

microstructural changes in the articular cartilage,42 potentially

indicating a relationship between joint laxity measured by

this technique and articular surface degeneration.

Dorsolateral subluxation

Dorsolateral subluxation is used to quantify joint laxity in

a position to simulate weight-bearing (Figure 3E). During

Figure 3 Representations of anatomical landmarks and evaluation mechanisms to assess canine hip dysplasia.

Notes: Coxofemoral joint anatomical characteristics considered by the Orthopedic Foundation for Animals (A): craniolateral acetabular rim (1), cranial acetabular margin

(2), femoral head (3), fovea capitis (4), acetabular notch (5), caudal acetabular margin (6), dorsal acetabular margin (7), junction of femoral head and neck (8), and trochanteric

fossa (9). (B) British Veterinary Association/Kennel Club canine coxofemoral joint characteristics scored during evaluation.10,34 Schematic superimposed on a hip-extended

radiograph demonstrating the Norberg angle (C, arrow). Illustration of the Pennsylvania Hip Improvement Program (distraction index, the distance between the centers of

the femoral head and acetabulum during distraction (D) divided by the radius (r) of the femoral head (d).41 Depiction of the dorsolateral subluxation score (E) calculated as

100 multiplied by the percentage of femoral head medial to the cranial acetabular rim (d) divided by the femoral head diameter (θ), d/θ ×100%).

Abbreviations: AF, acetabular fossa; An, acetabular notch; CaAE, caudal acetabular edge; CrAE, cranial acetabular edge; CrEAR, cranial effective acetabular rim; DAE, dorsal

acetabular edge; Fh, femoral head; Fv, foveal defect.

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186

Schachner and Lopez

general anesthesia, pressure is applied to the femur at the level

of the stiﬂe while imaging the dog in ventral recumbency.43

Joints with less than 45% coverage of the femoral head

by the lateral aspect of the cranial acetabular rim have an

increased chance of developing joint changes and OA over

time compared with those with a higher percentage (.55%)

of coverage.43

Subjective radiographic evaluations are limited by

the inherent variability associated with examiners, image

quality, and differences between animals including periar-

ticular soft tissue changes and muscle atrophy. Variation in

the degree of muscle relaxation associated with sedation

or anesthesia during imaging can inﬂuence the ability to

identify joint abnormalities by as much as 50%.44 Further,

each evaluation system is distinct, so results are based on

slightly different criteria. Recently, the Orthopedic Founda-

tion for Animals score was reported to underestimate the

likelihood of developing coxofemoral joint OA compared

to the PennHIP distraction index.45 Reporting mechanisms

also vary widely in public access to individual scores for

reproduction decisions. As with any measure, radiographic

hip scores should not be used in isolation to evaluate and

predict current and future joint structure and function. It

is possible that the presence of OA at a young age may be

indicative of rapidly progressive joint disease, and, given

recognition of the genetic basis for the disease, consider-

ation of the presence and extent of CHD signs in related

individuals is likely warranted. Based on this information,

it is clear that continued efforts to identify mechanisms for

early and accurate CHD diagnosis are of utmost importance.

Adaptation of knowledge from decades of research to emerg-

ing imaging modalities will, no doubt, continue to improve

upon current standards.

Computed tomography

CT technology for pelvic imaging has improved consider-

ably over the past few decades. While radiographs remain

the primary method used to image canine coxofemoral

joints, CT is becoming increasingly popular. Using three-

dimensional CT models, a recent longitudinal study showed

that volumetric changes in the acetabulum and proximal

femur occurred in a predictable manner during skeletal

growth in a colony of dogs with coxofemoral joint laxity.46

Another study demonstrated that two-dimensional CT images

and three-dimensional models created from CT images

can be used to predict the presence of joint OA at matu-

rity.47 Two-dimensional CT measures included the percent

femoral head coverage, acetabular index, and the following

angles: acetabular anteversion, ventral, dorsal, and horizontal

acetabular sector, center edge, and horizontal toit externe

(Figure 4). Measures on three-dimensional models included

femoral head and neck volumes, femoral head and neck radii

and femoral neck angle (Figure 4). The 16-week distraction

index and center edge angle combination was the best pre-

dictor of mature OA, whereas the 32-week dorsal acetabular

sector angle and Norberg angle combination was the most

effective predictor of the presence of OA at maturity. Hence,

combined measures were the best mechanism for predicting

development of OA, and the combinations varied with age.

In a separate study, numerous measures were performed on

pelvic CT scans of beagles and mixed breed dogs at various

time points between the ages of 2 months and 1 year to assess

the relationship of the measures with joint laxity.17 The dorsal

acetabular rim angle and center distance index (the distance

between the femoral head and the center of the acetabulum,

divided by the radius of the femoral head, or the PennHIP41

distraction index) were found to be good indicators of joint

laxity and dysplastic changes.17 Magnetic resonance imag-

ing is used to evaluate the three-dimensional structure of

human articular soft tissues, and relatively recently, canine

articular soft tissues,48 but CT is best for bone structure,49

and the cost of magnetic resonance imaging for screening

may be prohibitive. As technology advances, and CT and

magnetic resonance imaging become more readily available

and affordable, use of three-dimensional imaging method-

ologies will likely become an integral part of diagnosis and

assessment of CHD.

Therapeutic management

and intervention

Conservative management

There are numerous descriptions of multifactorial systems,

with numeric, visual analog, and descriptive scales to repro-

ducibly evaluate joint pain associated with CHD.50 Many of

the assessments within the systems are subjective evalua-

tions of individual behavior or responses, and there is no

single gold standard with which to quantify hip pain in the

dog.50 While efforts continue to establish a uniform, standard

evaluation system for canine hip joint pain, those systems

that include multiple subjective and objective assessments

by individuals who are not aware of speciﬁc treatments or

conditions, are often informative.

Conservative management of CHD generally consists

of a combination of mechanisms to reduce progression of

joint damage and alleviate discomfort.51 Nonsteroidal anti-

inﬂammatory drugs are commonly used for pain associated

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Canine hip dysplasia

Figure 4 Measurements and three-dimensional models for evaluating the dysplastic canine hip.

Notes: (A) Volume rendered model of the canine pelvis generated from two-dimensional computed tomography images (B and C). The blue line in (A) indicates the level

of the cross-sectional image in (B) and (C). (B) and (C) Representative measures performed on two-dimensional computed tomographic images of the canine coxofemoral

joint. Acetabular index is the ratio between the width and the depth of the acetabulum; d/w ×100. For further information see Lopez et al42 and Andronescu et al.47 For

details on these measures see Lopez et al.42

Abbreviations: AAA, acetabular anteversion angle; AI, acetabular index; CEA, center edge angle; CPC, percentage of femoral head coverage; DASA, dorsal acetabular

sector angle (dorsal coverage of the femoral head); HASA, horizontal acetabular sector angle (total acetabular coverage of the femoral head); HTEA, horizontal toit externe

angle (orientation of the acetabulum); VASA, ventral acetabular sector angle (ventral coverage of the femoral head).

with severely arthritic joints in dogs.52 Numerous studies

indicate that achieving and maintaining a healthy body

weight contributes to delayed onset and reduced clinical signs

associated with hip joint pain.4,5,53 Various food supplements

reported to alleviate signs of coxofemoral joint pain from OA

range from green-lipped mussels (Perna canaliculus)54 to

ﬁsh oil.55 Polysulfated glycosaminoglycan supplements and

injections have been recommended for prevention and treat-

ment of OA in dogs and other mammals.56–59 Intramuscular57

and intra-articular administration has also been reported,56

but responses vary.51 Alternative methods that have also been

investigated for the treatment of painful CHD joints include

acupuncture and gold bead implantation, among others. The

implantation of gold beads at acupuncture points was devel-

oped in the USA in the 1970s and implemented to a limited

degree in veterinary medicine in the 1990s for degenerative

joint disease pain.60,61 Results are mixed, with some studies

showing clinical improvement61,62 and others showing no

discernible effect.63

Maintenance of optimum body weight has long been

considered one of the most effective methods for reducing the

signs associated with dysplasia and OA.4 A lifelong dietary

restriction of 25% delayed the appearance of OA as well as the

intensity of clinical signs in Labrador Retrievers compared

with feeding ad libitum.53 Weight loss in conjunction with

physiotherapy that included transcutaneous electrical nerve

stimulation improved the clinical outcome for obese dogs

with radiographic signs of OA.64 Recently, intra-articular

botulinum toxin A was reported to reduce the pain associated

with OA based on improvements in limb use (ie, gait pat-

terns) measured with a force platform.65 At present, there are

few reports of long-term studies concerning the efﬁcacy of

nonsurgical or conservative treatment of CHD joint changes.

These studies can be limited by the challenges of consistent

monitoring and reporting by multiple and individual owners,

as well as a wide range of disease severity and canine per-

sonalities.66 However, a recent retrospective report indicates

that conservative and nonsurgical management (ie, weight

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Schachner and Lopez

control, reduced exercise, and analgesics) of 74 dogs over the

span of 13 years did not improve quality of life as anticipated

from previous reports.66

There is signiﬁcant interest in the use of regenerative

medicine to treat signs of CHD and OA; however, much of

the information reported is subjective in nature. Currently,

numerous controlled, preclinical and clinical trials are under-

way that may provide some perspective on the value of this

emerging technology. Intra-articular injection of adipose-

derived stem cells has been found to be a safe therapeutic

approach for the treatment of symptoms associated with

OA.67 Preliminary studies show that injection of adipose-

derived stem cells into affected joints may reduce clinical

signs of hip pain (ie, lameness) based on subjective clinical

evaluations67 and force platform gait analysis.68,69 A random-

ized comparison between a single intra-articular injection of

adipose-derived stem cells or plasma rich in growth factors

showed that both treatments reduced behavior associated with

pain, but that the adipose-derived stem cells appeared to be

more effective for up to 6 months post-treatment based upon

owner assessments.70 This information clearly demonstrates

that there is more work to be done on the efﬁcacy of conserva-

tive and alternative methods to manage signs of CHD.

Surgery

Despite the prevalence of CHD, a gold standard surgical pro-

cedure has yet to be identiﬁed.71 As such, there are numerous

surgeries to prevent progression of degenerative joint changes

or alleviate pain and restore joint function.

Some surgical procedures designed to prevent onset of OA

in hips identiﬁed as being predisposed to development of OA72

include double and triple pelvic osteotomy, acetabular shelf

and excision arthroplasty, femoral osteotomy, and juvenile

pubic symphysiodesis.73 Both juvenile pubic symphysiodesis

and triple pelvic osteotomy are designed to increase femoral

head coverage by ventrolateral rotation of the acetabulum. The

juvenile pubic symphysiodesis procedure involves premature

closure of the pubic symphysis.72,74 Resulting reduction in

the pelvic inlet width causes ventrolateral rotation of the

acetabulum during pelvic growth, and is thought to result in

a 40%–46% improvement in acetabular and dorsal acetabu-

lar rim angles compared to no treatment.73–75 Juvenile pubic

symphysiodesis appears to have the best outcomes when per-

formed in puppies that are 12–16 weeks old.73 Triple pelvic

osteotomy is a much more extensive procedure, and involves

osteotomies of the ilium, pubis, and ischium to allow manual

rotation of the acetabulum for better femoral head coverage.76

The ilial osteotomy is stabilized with bone plates customized

to accommodate the rotation.77 This procedure is generally

recommended for young dogs without irreversible (or with

mild) degeneration of the coxofemoral joint.77,78 Information

about long-term outcomes of the various surgical treatments

is limited. Preliminary reports indicate that juvenile pubic

symphysiodesis and triple pelvic osteotomy minimally affect

laxity and femoral head coverage when performed at 5 months

or older72 compared with earlier reports indicating that the

procedure performed slightly earlier (15 weeks) improved

acetabular coverage of the femur.75 Mechanisms to reduce the

OA characteristic of CHD will undoubtedly improve quality of

life for affected dogs. Long-term outcomes will help identify

treatments toward this end.

Total hip replacement (Figure 5) is often applied in

advanced cases of joint degeneration and is considered a

salvage procedure.79 There are no clear guidelines for the

best time to implement total hip replacement, but the aver-

age time between onset of signs and surgery is 10 months.80

Total hip replacement procedures in dogs began in the 1970s,

and a modular system was introduced in the mid 1990s that

coupled a ﬁxed monobloc cobalt-chromium alloy femoral

implant with an acetabular cup for cemented ﬁxation.81

Further reﬁnements to total hip replacement implants have

contributed to a high clinical recovery rate, with loosening of

the acetabular cup and cup wear reported as some of the most

common complications.81 More recently, cementless ﬁxation

has been developed, and is reported to have positive results.79

As the name implies, femoral and acetabular implants are

cemented to bone for cemented total hip replacement. In

contrast, cementless ﬁxation or uncemented implants are

designed so that the bone grows into or onto the prosthesis

without the need for cement at the bone–implant interface.

Implant loosening is reported to be less than for cemented

implants.79,82 A primary concern associated with total hip

replacement is the potential for an inﬂammatory response

Figure 5 Radiograph illustrating a bilateral total hip replacement.

Notes: Blue line indicates femoral implant, pink line indicates acetabular implant.

Image courtesy of Dr Jeffrey D Brourman.

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189

Canine hip dysplasia

to implant particulate wear debris from aseptic implant

loosening.83 Another consideration is that the persistence

of joint laxity may inﬂuence the outcomes of total hip

replacement.84 Efforts continue to improve upon available

total hip replacement implants for dogs. A hybrid system of

a cementless acetabular cup and a cemented femoral implant

has been successfully applied in dogs relatively recently.85

Hip resurfacing to replace only joint surfaces versus the

entire joint86 in dogs is under development, but clinical

trials have yet to be reported.81 Unfortunately, large-scale,

prospective randomized studies have yet to be conducted

for comparison of long-term outcomes for various surgical

procedures and nonsurgical management. Hence, individu-

alized care remains largely based on clinician preference

and experience.71

Genetics

While diagnosis and treatment of CHD are central to indi-

vidual patient care, prevention by selective breeding will help

obviate the presence of a debilitating condition in canine

companions. With this in mind, there has been signiﬁcant

effort focused on identifying speciﬁc genes, genetic muta-

tions, and quantitative trait loci (regions of chromosomes

containing DNA for a speciﬁc trait), to use in conjunction

with standard imaging methods for identiﬁcation of CHD

carriers.87,88 Genetic screening programs are complicated

by the polygenic nature of CHD and related OA, as well as

environmental inﬂuences on phenotypic expression. A few

promising quantitative trait loci for OA associated with

CHD89 and the CHD phenotype in German shepherds90

have been identiﬁed relatively recently. Additionally, several

chromosomal markers for CHD have been reported for a

population of cross-bred Labrador Retriever–Greyhounds.91

Notably, several speciﬁc single nucleotide polymorphisms

and positional candidate genes in dogs with CHD have been

found to correlate with genes associated with the expression

of OA and developmental dysplasia of the hip in humans.87

While the genomic underpinnings of CHD remain largely

elusive, signiﬁcant progress has been made and will continue,

with expanding knowledge of the canine genome and interac-

tions among genes that inﬂuence their expression.

Future directions

Despite almost a century of research, the complex etiology

and optimal treatment paradigm for CHD remain elusive.

As originally proposed by Schnelle at a meeting of the

Veterinary Medical Society of New York City in the 1930s,92

CHD is not likely a single afﬂiction but an array of heritable

and environmentally induced degenerative disorders that

differentially affect the morphology and function of the

canine hip. The variable phenotypic expression of CHD

makes development and implementation of standard iden-

tiﬁcation procedures difﬁcult. It may be possible to identify

speciﬁc phenotypes within the broad spectrum of CHD

similar to those of the human hip, like acetabular rim syn-

drome, acetabular retroversion, and femoral head necrosis.

The relationship between articular damage in the human

hip with morphology suggests a need to evaluate similar

relationships in the dog.93 Identiﬁcation and characteriza-

tion of CHD phenotypes at the genetic, microstructural, and

macrostructural levels will likely contribute to early detec-

tion and informed breeding decisions. Another area that will

continue to promote progress in both imaging and treatment

is development of novel measures on images obtained with

contemporary imaging modalities like CT and magnetic

resonance imaging. As evidence-based assessments of CHD

prevention and treatment strategies become available, their

selection and implementation will improve and facilitate

the development of novel clinical approaches and surgical

procedures. Incremental advances in the diagnosis, treat-

ment, and prevention of the joint degeneration and pain

associated with CHD through focused research and clinical

evidence will continue to progress toward diminishing and

eradicating CHD from our canine companions.

Disclosure

The authors report no conﬂicts of interest in this work.

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Jan 2024

This study assessed the efficacy of an intra-articular injection of allogeneic adipose tissue-derived from mesenchymal stem cells (AD-MSCs) for the treatment of hip dysplasia in dogs. The study group included 12 otherwise healthy dogs of different breeds, ages, weights, and degrees of hip dysplasia diagnosed using radiography. An orthopedic assessment was performed on all dogs before and at 30, 60, and 90 days after infusion of AD-MSCs(2 × 106cells). On the same days, each dog’s owner answered a questionnaire based on theHelsinkiChronic Pain Index. The data were converted to ordinal data based on the score for each variable, and the Friedman test for multiple comparisons was used to verify the results. Compared with the corresponding values on day 0, orthopedic and gait assessments and owners’ reported pain indexes improved over the 90-day observation period. These results suggested that treatment with allogeneic AD-MSCs significantly reduced the clinical signs associated with hip dysplasia during the study period. However, long-term studies are needed to determine the optimal therapeutic protocol for routine clinical use of AD-MSCs in hip dysplasia.

Femoral Neck Thickness Index as an Indicator of Proximal Femur Bone Modeling

Article

Full-text available

May 2023

The alteration in the shape of the femoral neck is an important radiographic sign for scoring canine hip dysplasia (CHD). Previous studies have reported that the femoral neck thickness (FNT) is greater in dogs with hip joint dysplasia, becoming progressively thicker with disease severity. The main objective of this work was to describe a femoral neck thickness index (FNTi) to quantify FNT and to study its association with the degree of CHD using the Fédération Cynologique Internationale (FCI) scheme. A total of 53 dogs (106 hips) were randomly selected for this study. Two examiners performed FNTi estimation to study intra- and inter-examiner reliability and agreement. The paired t-test, the Bland-Altman plots, and the intraclass correlation coefficient showed excellent agreement and reliability between the measurements of the two examiners and the examiners’ sessions. All joints were scored in five categories by an experienced examiner according to FCI criteria. The results from examiner 1 were compared between FCI categories. Hips that were assigned an FCI grade of A (n = 19), B (n = 23), C (n = 24), D (n = 24), and E (n = 16) had a mean ± standard deviation FNTi of 0.809 ± 0.024, 0.835 ± 0.044, 0.868 ± 0.022, 0.903 ± 0.033, and 0.923 ± 0.068, respectively (ANOVA, p < 0.05). Therefore, these results show that FNTi is a parameter capable of evaluating proximal femur bone modeling and that it has the potential to enrich conventional CHD scoring criteria if incorporated into a computer-aided diagnosis capable of detecting CHD.

B-mode ultrasonography and ARFI elastography of articular and peri-articular structures of the hip joint in non-dysplastic and dysplastic dogs as confirmed by radiographic examination

Article

Full-text available

Oct 2023
BMC Vet Res

Background Canine hip dysplasia is a common orthopedic disease in veterinary practice. The diagnosis is made by radiographic examinations that evaluate bone alterations associated with hip dysplasia. Although radiographic examination is the gold standard for diagnosis, it does not allow a detailed evaluation of soft tissues such as the joint capsule and periarticular muscles. This study aimed to evaluate the accuracy of B-mode ultrasonography and acoustic radiation force impulse (ARFI) elastography in assessing the joint capsule and periarticular muscles of dogs using the Orthopedic Foundation of Animals (OFA) classification and the distraction index (DI) in the early and late diagnosis of hip dysplasia. This study sought to propose a protocol for the ultrasonographic evaluation of the structures involved in canine hip dysplasia. Methods Radiographic and ultrasonographic evaluations were performed on 108 hip joints of 54 dogs. Thirty dogs were older than 2 years and 24 were aged between 4 and 10 months. Results It was verified that an increase in pectineus muscle stiffness (cutoff value > 2.77 m/s) by elastography in some dysplastic dogs and an increase in the thickness of the joint capsule (cutoff value > 0.9 mm) in B-mode ultrasonography, were associated with a distraction index > 0.5, with both having a positive correlation. In B-mode ultrasonographic evaluation, the presence of signs of degenerative joint disease, such as irregularities of the cranial edge of the acetabulum and femoral head, were associated with a distraction index > 0.5 in canines, with a specificity of 94%. In adult dogs, the findings of degenerative joint disease on ultrasound were associated with a diseased OFA classification (P < 0.05). Measurement of the joint capsule > 1.10 mm was diagnostic for dysplasia in unhealthy dogs by OFA. Conclusions ARFI elastography has shown that the pectineus muscle may experience changes in stiffness in dysplastic animals. Additionally, changes in joint capsule thickness can be identified in B-mode in young and adult dogs with dysplastic joints, which contributes to the diagnosis of hip dysplasia.

Breed-specific evaluation of serum biochemical markers in canine hip dysplasia observed in a Tornjak dog population

Article

Full-text available

Sep 2023

OBJECTIVE Canine hip dysplasia (CHD) is a global disease and an improved diagnostic approach to this orthopedic condition is needed, with an emphasis on inexpensive and minimally invasive techniques. This research aimed to determine the differentiating potential of selected biochemical markers in serum between healthy dogs and dogs with hip dysplasia in a breed-specific study that involved the Tornjak dog population. ANIMALS 99 Tornjak dogs radiographically categorized (Federation Cynologique Internationale procedure and scoring scheme) between December 2019 and April 2021, as having no sign of hip dysplasia or near normal hip joints (nondysplastic group; n = 51) vs mild, moderate, or severe hip dysplasia (dysplastic group; 48). METHODS Serum concentrations and enzyme activity of the biochemical markers hyaluronic acid (HA), procollagen II C-terminal propeptide (PIICP), and metalloproteinase 9 (MMP9) were compared among adult dogs with or without radiographic hip dysplasia. Statistical tests used to examine the differentiating potential of biochemical markers in Tornjak dog groups were assessed using the Mann–Whitney U test, logistic regression, and receiving operating characteristics (ROC) analysis. RESULTS Tornjak dogs with radiographic CHD had significantly lower serum concentrations of HA and higher concentrations of PIICP and MMP9 activity compared to dogs with radiographically normal hips ( P < .05). Selected biochemical markers could distinguish dogs with radiographic CHD from those without CHD with high sensitivity and specificity. CLINICAL RELEVANCE These data suggest that the diagnostic technique of measuring serum concentrations of HA, PIICP, and MMP9 activity has a selective ability to distinguish dogs with dysplastic from dogs with normal hips.

Therapeutic efficacy and pharmacokinetics of liposomal-cannabidiol injection: a pilot clinical study in dogs with naturally-occurring osteoarthritis

Article

Full-text available

Aug 2023

Introduction Osteoarthritis is a common disease in dogs resulting in chronic pain and decreased wellbeing. Common analgesics such as non-steroidal anti-inflammatories may fail to control pain and can produce major adverse effects. Study objectives were to evaluate pharmacokinetics, therapeutic efficacy, and safety of subcutaneous liposomal-cannabidiol (CBD) as an additional analgesic therapy in dogs suffering from naturally-occurring osteoarthritis. Methods Six such dogs were recruited following ethics approval and owner consent. Dogs were administered a single subcutaneous injection of 5 mg/kg liposomal-CBD. Plasma concentrations of CBD, blood work, activity monitoring collar data, wellbeing questionnaire (owners) and pain scoring (veterinarian) were performed at baseline and monitored up to six weeks following intervention. Data overtime were compared with baseline using linear-regression mixed-effects. P -value was set at 0.05. Results CBD plasma concentrations were observed for 6 weeks; median (range) peak plasma concentration (C max ) was 45.2 (17.8–72.5) ng/mL, time to C max was 4 (2–14) days and half-life was 12.4 (7.7–42.6) days. Median (range) collar activity score was significantly increased on weeks 5–6; from 29 (17–34) to 34 (21–38). Scores of wellbeing and pain evaluations were significantly improved at 2–3 weeks; from 69 (52–78) to 53.5 (41–68), and from 7.5 (6–8) to 5.5 (5–7), respectively. The main adverse effect was minor local swelling for several days in 5/6 dogs. Conclusion Liposomal-CBD administered subcutaneously produced detectable CBD plasma concentrations for 6 weeks with minimal side effects and demonstrated reduced pain and increased wellbeing as part of multimodal pain management in dogs suffering from osteoarthritis. Further placebo-controlled studies are of interest.

Serum Hyaluronic Acid- An Effective Biomarker for Early Detection of Osteoarthritis in Young Dogs with Canine Hip Dysplasia

Article

Jul 2023

Background: Most of the biomarkers used in joint disease are articular cartilage components such as chondroitin sulphate (CS), keratan sulphate (KS), hyaluronic acid (HA), or type II collagen. Some of these biomarkers, alone or together, could have the potential to provide clinically useful indices of the effects of isolated joint injury, the progression of joint changes and/or the response to therapy. Serum concentration of HA were elevated in human patients with osteoarthritis which increase is considered a reliable biomarker reflective of cartilage damage and synovitis in these patients. Methods: Blood samples were collected from all the dogs and serum concentration of hyaluronic acid was determined by Canine Hyaluronic Acid Elisa kit (catalogue No.ITE070452), SIZE -96T, Reactivity: Canine, Range: 2 ng/ml -700ng/ml and sensitivity: 1.04 ng/ml, supplied by G Biosciences. Result: Serum concentration of HA were lower in dogs aged between 0 to 12 months with CHD when compared to dogs of similar age with healthy hip joints and that this significant decrease in serum HA in dogs can be considered a reliable biomarker reflective of CHD and serum HA levels can be used as an effective biomarker for osteoarthritis in dogs with CHD.

Aspects of the innervation mode of the adjacent anatomical formations of the coxofemoral joint in dogs

Article

Jan 2023

A. Dumitriu

Full spectrum medical cannabis (Vijaya) oil as a veterinary treatment for osteoarthritis, hip dysplasia and musculoskeletal disorders: A case series

Article

May 2023

In veterinary medicine, Osteoarthritis, Hip Dysplasia and pain disorders are commonly diagnosed conditions, and it presents significant difficulties for the well-being of canines. The aim of this case series is to report the use of full spectrum medical cannabis (vijaya) for treating symptoms such as pain, inflammation, impaired mobility. Four Labrador breed patients between 6 years to 8 years, suffering from acute mobility issues were diagnosed with OA and HD. All patients were administered 4 drops of the full spectrum oil, orally, twice daily. After one month of the treatment, there was significant change in the pain markers with improved mobility. The recommended dose is 0.16 mg/kg/body wt for management of OA and HD related pain and inflammation. A boost in appetite and quality of life was also observed. In the future it is important to incorporate new treatment options in the medical practice and further research needs to be conducted on its use for other illnesses and animal species.

PROFILE IDENTIFICATION OF CANICROSS PRACTITIONERS AND THEIR DOGS IN BRAZIL

Article

Full-text available

May 2023

The study analyzed the profile of Canicross practitioners in Brazil. A semi-structured questionnaire consisting of 33 questions was used: seven related to the handler and 26 to the dogs. Results: Of the total handlers, 53.3% are women, 64% have practiced the sport for at least 5 years and 52.3% trained with a personal trainer. Of the dogs, 62.6% were females, 60% were between one and four years old and the Mixed Breeds were the majority with 34.6%; as for the health of the animals, 80% of the handlers stated that they did not carry out veterinary monitoring aiming at the Canicross. 6.6% of the animals had sports-related injuries and 80% of these cases received veterinary treatment. It was clear that handlers know strategies to prevent and / or treat injuries caused by the sport, however this is not reflected in dogs. The unprecedented nature of the work will help handlers, veterinarians and sports lovers to draw up protocols so that dogs can practice Canicross safely. IDENTIFICAÇÃO DO PERFIL DOS PRATICANTES DE CANICROSS E SEUS CÃES NO BRASIL RESUMO: O estudo analisou o perfil dos praticantes de Canicross no Brasil. Foi utili-zado um questionário semiestruturado composto por 33 questões, sendo sete relacionadas ao condutor e 26 aos cães. Resultados: Do total de manipuladores, 53,3% são mulheres, 64% praticam o esporte há pelo menos 5 anos e 52,3% treinam com personal trainer. Dos cães, 62,6% eram fêmeas, 60% tinham entre um e quatro anos e os sem raça definida eram a maioria com 34,6%; quanto à saúde dos animais, 80% dos tratadores afirmaram não realizar acompanhamento veterinário visando o Canicross. 6,6% dos animais tiveram lesões esportivas e 80% desses casos receberam tratamento veterinário. Ficou claro que os tratadores conhecem estratégias para prevenir e/ou tratar lesões causadas pelo esporte, porém isso não se reflete nos cães. O caráter inédito do trabalho ajudará tratadores, veterinários e esportistas a traçarem protocolos para que os cães possam praticar Cani-cross com segurança. PALAVRAS-CHAVE: Lesão; Corrida; Handler; Esporte. IDENTIFICACIÓN DEL PERFIL DE LOS PRACTICANTES DE CANICROSS Y SUS PERROS EN BRASIL RESUMEN: El estudio analizó el perfil de los practicantes de Canicross en Brasil. Se utilizó un cuestionario semiestructurado compuesto por 33 preguntas, siendo siete relaci-onadas con el conductor y 26 con los perros. Resultados: Del total de manejadores, 53,3% son mu-lheres, 64% practican el deporte hace por lo menos 5 años y 52,3% entrenan con trainer personal. De los perros, 62,6% eran hembras, 60% tenían entre uno y cuatro años y los sin raza definida eran la mayoría con 34,6%; en cuanto a la salud de los animales, 80% de los manejadores afirmaron no realizar acompañamiento veterinario con vistas al Canicross. El 6,6% de los animales presentaron lesiones deportivas y el 80% de estos casos recibieron tratamiento veterinario. Quedó claro que los cuidadores conocen estra-tegias para prevenir y/o tratar lesiones causadas por el deporte, sin embargo esto no se refleja en los perros. El carácter inédito del trabajo aju-dará a cuidadores, veterinarios y deportistas a trazar protocolos para que los perros puedan practicar Canicross con segu-ridad.

Environmental factors associated with incidence of developmental dysplasia of the hip

Preprint

Full-text available

Jul 2023

Background Established risk factors for DDH include female sex, breech presentation, family history, congenital malformations, oligohydramnios, and maternal hyperthyroidism. However, evidence for environmental factors that may contribute to DDH is limited and inconsistent. Methods A review of medical literature from 1956 to 2023 was conducted to collect data on environmental factors, including latitude, longitude, average yearly precipitation, average yearly temperature, minimum monthly temperature, and maximum monthly temperature, from all institutions that published articles on DDH. Univariate linear regression analysis was used to examine the correlation between environmental factors and DDH incidence, while multiple regression analysis was conducted to identify significant risk factors for DDH incidence. Results Data from a total of 93 unique manuscripts were analyzed, revealing a significant negative correlation between DDH incidence and temperature, including average yearly temperature (r = -0.27, p = 0.008), minimum monthly temperature (r = -0.28, p = 0.006), and maximum monthly temperature (r = -0.23, p = 0.029). Additionally, there was a significant positive correlation between DDH incidence and latitude (r = 0.27, p = 0.009), and a significant negative correlation between DDH incidence and average yearly precipitation (r = -0.29, p = 0.004). In the final multiple regression analysis, temperature, including average yearly temperature, minimum monthly temperature, and maximum monthly temperature, were identified as significant risk factors for DDH incidence. Conclusion The study findings suggest that temperature is the most significant predictor of DDH incidence, highlighting the potential impact of colder weather on DDH development in infants.

Acupoint Injection of Autologous Stromal Vascular Fraction and Allogeneic Adipose-Derived Stem Cells to Treat Hip Dysplasia in Dogs

Article

Full-text available

Aug 2014

Stem cells isolated from adipose tissue show great therapeutic potential in veterinary medicine, but some points such as the use of fresh or cultured cells and route of administration need better knowledge. This study aimed to evaluate the effect of autologous stromal vascular fraction (SVF, n = 4 ) or allogeneic cultured adipose-derived stem cells (ASCs, n = 5 ) injected into acupuncture points in dogs with hip dysplasia and weak response to drug therapy. Canine ASCs have proliferation and differentiation potential similar to ASCs from other species. After the first week of treatment, clinical evaluation showed marked improvement compared with baseline results in all patients treated with autologous SVF and three of the dogs treated with allogeneic ASCs. On days 15 and 30, all dogs showed improvement in range of motion, lameness at trot, and pain on manipulation of the joints, except for one ASC-treated patient. Positive results were more clearly seen in the SVF-treated group. These results show that autologous SVF or allogeneic ASCs can be safely used in acupoint injection for treating hip dysplasia in dogs and represent an important therapeutic alternative for this type of pathology. Further studies are necessary to assess a possible advantage of SVF cells in treating joint diseases.

Hip Osteoarthritis in Dogs: A Randomized Study Using Mesenchymal Stem Cells from Adipose Tissue and Plasma Rich in Growth Factors

Article

Full-text available

Aug 2014

Purpose: The aim of this study was to compare the efficacy and safety of a single intra-articular injection of adipose mesenchymal stem cells (aMSCs) versus plasma rich in growth factors (PRGF) as a treatment for reducing symptoms in dogs with hip osteoarthritis (OA). Methods: This was a randomized, multicenter, blinded, parallel group. Thirty-nine dogs with symptomatic hip OA were assigned to one of the two groups, to receive aMSCs or PRGF. The primary outcome measures were pain and function subscales, including radiologic assessment, functional limitation and joint mobility. The secondary outcome measures were owners' satisfaction questionnaire, rescue analgesic requirement and overall safety. Data was collected at baseline, then, 1, 3 and 6 months post-treatment. Results: OA degree did not vary within groups. Functional limitation, range of motion (ROM), owner's and veterinary investigator visual analogue scale (VAS), and patient's quality of life improved from the first month up to six months. The aMSCs group obtained better results at 6 months. There were no adverse effects during the study. Our findings show that aMSCs and PRGF are safe and effective in the functional analysis at 1, 3 and 6 months; provide a significant improvement, reducing dog's pain, and improving physical function. With respect to basal levels for every parameter in patients with hip OA, aMSCs showed better results at 6 months.

Assessment of the effect of intraarticular injection of autologous adipose-derived mesenchymal stem cells in osteoarthritic dogs using a double blinded force platform analysis

Article

Full-text available

Jul 2014
BMC Vet Res

Background Regenerative medicine using Mesenchymal Stem Cells (MSC) alone or combined with Plasma Rich in Growth Factors (PRGF) is a rapidly growing area of clinical research and is currently also being used to treat osteoarthritis (OA). Force platform analysis has been consistently used to verify and quantify the efficacy of different therapeutic strategies for the treatment of OA in dogs including MSC associated to PRGF, but never with AD-MSC alone. The aim of this study was to use a force platform to measure the efficacy of intraarticular ADMSC administration for limb function improvement in dogs with severe OA. Results Ten lame dogs with severe hip OA and a control group of 5 sound dogs were used for this study. Results were statistically analyzed to detect a significant increase in peak vertical force (PVF) and vertical impulse (VI) in treated dogs. Mean values of PVF and VI were significantly improved within the first three months post-treatment in the OA group, increasing 9% and 2.5% body weight, respectively, at day 30. After this, the effect seems to decrease reaching initial values. Conclusion Intraarticular ADMSC therapy objectively improved limb function in dogs with hip OA. The duration of maximal effect was less than 3 months.

Clinical evaluation of firocoxib and carprofen for the treatment of dogs with osteoarthritis

Article

Oct 2006

A double-blind, randomised, controlled, multicentre field study was conducted to compare the safety and efficacy of firocoxib chewable tablets and carprofen tablets in 218 dogs with osteoarthritis. Firocoxib is a non-steroidal anti-inflammatory drug with more than 350-fold selectivity in dogs for the inducible isoform of the enzyme cyclo-oxygenase-2. The efficacy, tolerance and ease of administration of firocoxib (5 mg/kg/day) and carprofen (4 mg/kg/day) were assessed by the owners and the attending veterinarians during 30 days of treatment. The efficacy was assessed in terms of the dogs' overall scores at the end of the treatment, based on the veterinarians' assessment of lameness, pain on manipulation/palpation, range of motion, and joint swelling; 92.5 per cent of the dogs treated with firocoxib and 92.4 per cent of the dogs treated with carprofen had improved. The reduction in lameness in the dogs treated with firocoxib was significantly greater than in the dogs treated with carprofen. The owners' evaluations were that 96.2 per cent of the dogs treated with firocoxib and 92.4 per cent of the dogs treated with carprofen had improved, and this difference was statistically significant.

The dysplastic hip joint: Radiologic and histologic development

Article

Jan 1975

W.H. Riser

Gait analysis of dogs with hip dysplasia treated with gold bead implantation acupuncture

Article

Jan 2002

A “double blinded” prospective study was undertaken to determine whether gold bead implantation acupuncture alleviates lameness and pain in dogs, affected by moderate to severe hip dysplasia. Nineteen large-breed adult dogs, of various breeds with clinical and radiographic evidence of hip dysplasia, were randomly assigned to the acupuncture or the placebo group. The acupuncture treatment with gold bead implantation was performed by a licensed acupuncturist. Objective data were acquired, in the gait analysis laboratory, using kinetic and kinematic parameters before and at one and three months after treatment. In the acupuncture group there was a decrease in vertical and peak vertical impulse formation at one month, which indicated an increase in lameness, without any significant difference between groups at three months post-treatment. Subjective data were gathered by radiographs as well as serial complete physical examinations by an experienced clinician and an owner questionnaire, before and at one and three months after treatment. Subjective grading of hip dysplasia radiographs did not show any difference in severity between the two groups. According to the physical examination, one dog in the acupuncture group improved, five stayed the same and three worsened. In the placebo group two dogs improved, four stayed the same and three worsened. According to the questionnaire, three dogs in the acupuncture group improved, four stayed the same and two worsened. In the placebo group three dogs improved and six stayed the same. Serial blood analyses were performed and the results were within normal limits at all times.

Coxofemoral joint laxity and the Ortolani sign

Article

Jan 1985

Interpretation and use of BVA/KC hip scores in dogs

Article

Apr 2012

Ruth Dennis

Hip dysplasia is a potentially debilitating orthopaedic disease in which laxity of the coxofemoral joint often leads to secondary osteoarthritis, a reduction in joint function and pain. It has been recognised for many years as being of particular importance in pedigree dogs, especially in larger breeds, and is known to be partly governed by genetic factors. In order to try to control canine hip dysplasia and to reduce its incidence, a number of radiographic screening programmes have been developed worldwide. In 1983, a scheme was established by the British Veterinary Association and supported by the Kennel Club to examine radiographs of dogs' hips by assessing different anatomical features and giving them a numerical score. This article describes the process of scoring in this scheme, explains how to interpret the score and gives advice on the use of hip scores in the selection of breeding animals.

Associations between early radiographic and computed tomographic measures and canine hip joint osteoarthritis at maturity

Article

Jan 2015
AM J VET RES

Objective: To evaluate associations of measures assessed by radiography, 2-D CT, and 3-D CT of the hip joints of immature dogs with osteoarthritis in the same joints at maturity. Animals: 46 hound-type dogs from a colony predisposed to osteoarthritis. Procedures: Images of hip joints (1/dog) were obtained at 16, 32, and 104 weeks of age. Radiographic measures included Norberg angle, distraction index, and osteoarthritis score. Two-dimensional CT measures included acetabular index, percentage of femoral head coverage, and center edge, horizontal toit externe, acetabular anteversion, and ventral, dorsal, and horizontal acetabular sector angles. Three-dimensional CT measures were femoral head and neck volume, femoral neck angle, and femoral head and neck radius. Differences among measures at 16 and 32 weeks in dogs with different osteoarthritis scores at later time points, relationships among variables at each time point, and relationships of single and combined measures with the presence of osteoarthritis at 104 weeks were evaluated. Results: The 16- and 32-week distraction index, center edge angle, dorsal acetabular sector angle, horizontal acetabular sector angle, percentage of femoral head coverage, acetabular index, and Norberg angle and the 32-week femoral neck angle varied significantly with osteoarthritis severity at 104 weeks. Presence of osteoarthritis in mature dogs was most strongly associated with 16-week combined measures of distraction index and center edge angle and 32-week combined measures of dorsal acetabular sector angle and Norberg angle. Conclusions and clinical relevance: Changes in hip joint morphology associated with radiographic signs of osteoarthritis were detectable as early as 16 weeks of age and varied with osteoarthritis severity in adult dogs. The use of combined hip joint measures may improve early identification of dogs predisposed to hip joint osteoarthritis.

Hip morphology influences the pattern of articular cartilage damage

Article

Sep 2014

Purpose The aim of this study was to obtain data on chondral damage and compare the damage patterns of various hip disorders. Methods Data were collected at 100 consecutive arthroscopies, and chondral lesions were recorded on anatomic articular maps divided into different anatomical zones. This geographic zone method made it possible to analyze the ICRS grade and location in relation to the hip morphology. Results The distribution and degree of the chondral defects showed a hip morphology-specific pattern. On the acetabular side, there were high incidences of full-thickness defects in the anterior–superior zone and the middle superior zone in patients with femoroacetabular impingement (FAI) (zone 2: 25.4 % grade 3, 35.5 % grade 4; zone 3: 20.3 % grade 3, 37.2 % grade 4) and borderline dysplasia (zone 2: 31.2 % grade 3, 12.5 % grade 4; zone 3: 18.7 % grade 3, 25 % grade 4). However, in patients with joint laxity, partial-thickness defects were dominant (zone 2: 50 % grade 1, 15 % grade 2; zone 3: 40 % grade 1). In patients with acetabular dysplasia, full-thickness defects extended even to the posterior superior zone (zone 4: 80 % grade 4). On the femoral head side, the incidence of full-thickness cartilage injuries was high in patients with FAI and borderline dysplasia compared to those with joint laxity and acetabular dysplasia. Conclusion Evaluation of chondral damage using the geographic zone method showed that the pattern of cartilage damage was influenced by hip morphology. Understanding of hip disorder-specific chondral damage patterns may be useful for the development of arthroscopic classification of hip disorders and may lead to the establishment of treatment guidelines. Level of evidence Diagnostic study, Level III.

Diagnosis, prevention, and management of canine hip dysplasia: a review

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