CLINICAL
Canine hip dysplasia:
aetiology and treatment
With a prevalence of over 70% amongst some breeds, hip dysplasia is one of the most common developmental
orthopaedic diseases diagnosed in first opinion practice. With a multimodal approach leading to the best form of
management of the condition, this two-part article looks at the causes and treatment of the condition, and the
role that the veterinary nurse and rehabilitation can play. Part one below focuses on aetiology and treatment. 
Cheryl Corral BVMS PGCert SARehab MRCVS WVAG MIRVAP, Veterinary Surgeon, Gatehouse Veterinary Rehabilitation,
Rouken Glen Park, Glasgow, G46 7UG
Key words: canine hip dysplasia | genetic disease | conservative management
C
anine hip dysplasia is a developmental rather
than a congenital disorder. Pups are born with
normal hips, but in individuals with dysplasia,
changes in development around the femoral
head and acetabulum begin around 3 weeks of age (Kealy
et al, 1992). Around this age, subluxation or complete luxa-
tion of the femoral head from the acetabular fossa occurs,
as a result of joint and soft tissue laxity (Barrett, 2008). This
leads to incomplete coverage of the femoral head by the ac-
etabular fossa. Over time, this manifests as painful stretch-
ing of the joint capsule, and a reduced area for articulation
leading to flattening of the femoral head. Resultant contact
between the femoral head and the acetabular fossa causes
wear of the protective layer of articular cartilage, which
stimulates new bone deposition by the body and so the de-
velopment of secondary osteoarthritis (King, 2017).
Genetics, environment and prevalence
Hip dysplasia is a complex inherited disorder, whereby both
a number of different genes and environmental factors are
influential in the disease process (Kennel Club, 2018). The
condition is most prevalent amongst large or giant pure-
breds, but is also seen in smaller purebreds and crossbreed
dogs. Certain breeds including German Shepherds, Labra-
dor Retrievers and Boxers are over-represented. Many such
breeds are subject to testing prior to breeding for registered
litters under the hip scheme recommended by the Kennel
Club and British Veterinary Association (BVA) (BVA, 2014).
Radiographing potential parents to produce hip scores un-
der the scheme, and only selecting those with lower than
average scores for the breed, is likely to minimise the risk
of producing clinically affected offspring. Monitoring the
effectiveness of schemes such as this is often difficult, but
is required to ensure the efficacy of selection (Wilson et al,
2006). Gender does not appear to have an influence on the
likelihood of developing hip dysplasia (Barrett, 2008).
246
Much attention is currently being placed on environ-
mental factors including excessive nutrient intake and ex-
ercise during development. Research unsurprisingly found
a significant increase in prevalence amongst a group of ad-
lib fed labrador retrievers compared with their limit-fed co-
horts (Kealy et al, 1992). Excessive dietary consumption of
calcium and vitamin D, and energy in the form of any food
group in growing dogs is thought to lead to rapid skeletal
growth and increase representation of the condition (Fries
et al, 1995). Excessive bodyweight can be further demon-
strated to be an associated factor as neutered animals have
been shown to be 1.5 times more likely to develop hip dys-
plasia when compared with entire individuals, a statistic
which is likely to be explained by the fact that neutering
generally leads to weight gain within 6 months of the pro-
cedure (Rodrigues et al, 2011).
Controlled weight-bearing through restricted exercise
programmes for growing dogs has also been suggested as a
method of reducing prevalence as excessive loading of the
hip joints through the growing phase is thought to be an
additional environmental factor (Carver, 2016).
Discussion of both a suitable diet and exercise regimen
with puppy owners in the veterinary clinic setting during
routine appointments for vaccinations and health checks
could be initiated by the veterinary nurse to help minimise
the impact of environmental factors.
Clinical signs and diagnosis
Clinical signs in affected individuals generally develop at
around 4–12 months of age, and include some or all of the
following:
© 2018 MA Healthcare Ltd
zzLameness
zzDifficulty rising
zzA bunny-hopping gait pattern
zzReduced exercise tolerance
zzAtrophy of surrounding musculature.
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CLINICAL
Veterinary examination findings are also likely to in-
clude pain or restriction on manual extension of one or
both hip joints (Barrett, 2008).
Diagnosis is confirmed radiographically, which should
be performed under anaesthetic or heavy sedation to allow
for accurate positioning. Standard practice is to lie dogs in
dorsal recumbency with hind limbs extended, and stifles
adducted. Care should be taken to ensure the pelvis is not
rotated to allow for accurate comparison and interpreta-
tion. Radiographic changes do not always correlate with
the severity of clinical signs displayed by the patient, and
include (as shown in Figure 1) loss of femoral head coverage
by the acetabular fossa and luxation or subluxation (Ginja
et al, 2015). This is often paired with changes consistent
with secondary osteoarthritis including:
zzThe presence of osteophytes, often demonstrated at the
acetabular rim which is the main site for weight bearing
zzChanges at the femoral head including sclerosis and
flattening in shape
zzThickening and remodelling of the femoral neck, also as
a result of osteophyte formation (Barrett, 2008).
In the 1980s, The University of Pennysylvania School
of Veterinary Medicine developed the PennHIP screening
method to assess dogs from as early as 16 weeks for the
likelihood of developing hip dysplasia. The scheme, with
proven accuracy and sensitivity, assesses the degree of
laxity of the hip joints as dogs with ‘loser’ hips have been
shown to be more likely to develop dysplasia than those
with ‘tight’ hips. Specially certified veterinary surgeons
take three different radiographic views of the hip joints,
and use a specific tool to measure this degree of laxity un-
der heavy sedation or general anaesthesia. The radiographs
are submitted for assessment, which allows breeders to
Figure 1. Radiographs of a 5-year-old Cocker Spaniel
diagnosed with hip dysplasia, demonstrating luxation of
both femoral heads and remodelling including flattening
of the femoral heads and osteophyte deposition at the
acetabular rim.
248
only select and breed from low risk individuals, with the
hope of reducing prevalence of the condition (Antech Im-
aging Services, 2018).
The PennHIP screening method has not always been
available in the UK due to regulations as two out of the
three x-ray views required manual holding. A hands-free
technique has now been developed meaning manual in-
tervention is no longer necessary, and so UK veterinary
surgeons can now train for PennHIP certification (Barrett,
2008).
Treatment
Treatment of hip dysplasia is focused on management as
it is an incurable condition, options including surgical
or non-surgical techniques (Kirkby and Lewis, 2011).
Possible surgical interventions include the triple-pelvic-
osteotomy, a procedure where the pelvic bones are re-
aligned in an attempt to improve acetabular coverage of
the femoral head. Age is often the limiting factor in rec-
ommending this procedure, as it has a more successful
outcome if performed below 7 months of age, at which
point many affected dogs may be as yet undiagnosed.
Other commonly available surgical procedures include
total hip replacement, a procedure by which an artifi-
cial ball and socket joint replaces the existing joint; and
femoral head excision (Norris, 2011). These techniques
are often reserved for severe cases, or when non-surgical
management alone is not successful in the control of as-
sociated pain. The success of any of the identified pos-
sible surgical procedures, described as a complete return
to function, has been difficult to assess due to lack of fol-
low-up (Bergh and Budsberg, 2014); but the likelihood is
that there is not a ‘one size fits all’ approach, and a case
by case selection, often dictated by age of the patient at
time of presentation, is best.
Non-surgical options include the use of pharmaceuticals
such as non-steroidal anti-inflammatory drugs (NSAIDs)
and those affecting the progression of joint disease; weight
management; exercise modification; nutraceuticals and re-
habilitation therapies (Kirkby and Lewis, 2012). The veteri-
nary nurse can play a vital role in each of these, as discussed
below.
The role of the veterinary nurse in practice
Many owners are unaware of the changes in lifestyle which
may positively assist in the management of dogs diagnosed
with hip dysplasia, and the veterinary nurse can play a vital
role in raising these issues and impacting management.
Pharmaceuticals
Several analgesics exist for the management of pain as-
© 2018 MA Healthcare Ltd
sociated with hip dysplasia and secondary osteoarthritis,
including NSAIDs, paracetamol/ codeine based drugs,
opioids, gabapentin and corticosteroids (Pettitt and Ger-
man, 2015). Owners may not always be aware of the dif-
ferent presentations of pain and related behaviours in dogs.
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During weight clinics or routine appointments any behav-
ioural changes, reluctance to exercise or alterations in gait
the owners mention could first be picked up on by the vet-
erinary nurse, for prompt referral to the veterinary surgeon
for intervention with analgesics when necessary.
Nutraceuticals
Several nutraceuticals are now available which claim to as-
sist in the management of secondary osteoarthritis. These
include glucosamine sulphate and chondroitin sulphate,
hyaluronic acid, avocado/soybean unsaponifiables and
omega-3 fatty acids, many of which have anecdotally im-
proved symptoms in human management (Henrotin et al,
2005).
Exercise modification
The goal of any exercise programme is to promote the main-
tenance of muscle mass, maintain joint range of motion and
manage pain. Slow, controlled, leash walking (Figure 2) has
been shown to promote hip extension when compared with
trotting, which assists by helping to maintain as near nor-
mal range of motion within the hip joint as possible; and
can be started immediately.
Initiating an exercise programme of short walks of
15–20 minutes’ duration, two to three times daily, then pro-
gressing by adding 5 minutes to each walk per week to a
duration of 35–40 minutes can be used to promote the de-
velopment of muscle mass to support the hips and prevent
stiffness by promoting range of motion. Once this level has
been reached, this can be further progressed to include in-
cline walking to promote hip flexion, and walking up and
down stairs to promote extension.
Encouraging owners to allow their pets to warm up for
5–10 minutes before any form of exercise and cool down af-
terwards will help prevent painful flare-ups resulting from
injuries (Dycus et al, 2017), and suggesting owners walk
their dogs on more forgiving surfaces such as grass or sand
rather than concrete will minimise forces applied through
the joint.
Consideration should also be given to controlling high
impact exercises such as ball throwing and walking on un-
even terrain until it can be sure this will not result in painful
flare-ups (Millis and Levine, 2014).
Weight management
Weight modification through dietary restriction has been
demonstrated to decrease lameness score in dogs affected
by hip dysplasia, and reduce the progression and clinical
signs associated with secondary osteoarthritis in humans
(Kirkby and Lewis, 2011). As such, the importance of the
maintenance of normal body condition in management of
© 2018 MA Healthcare Ltd
canine hip dysplasia cannot be underestimated. Veterinary
nurses are often responsible for running in-house weight
management clinics and a few main considerations should
be given to methods used to enhance compliance and in-
crease success:
The Veterinary Nurse | June 2018, Volume 9 No 5
CLINICAL
Figure 2. Balance harness and leash walking allows a slow,
controlled form of exercise which enables hip extension.
zzSpending time finding out more about the patient’s
background and existing routine can lead to a more
achievable plan for weight reduction
zzRecording findings such as weight, body condition score
and waist and neck measurements provide multiple
markers for progress which can be useful owner
incentives
zzSetting realistic targets and ensuring client
understanding of necessary changes
zzRebooking the client and pet in with the same nurse
in 2–4 weeks to ensure continuity and allow for any
necessary adjustments (Jobson, 2013).
Rehabilitation
Techniques which can be performed in practice, at home
by the owner, and by the rehabilitation therapist following
referral will be discussed in detail in the next article.
Conclusion
This multimodal approach to conservative management of
the hip dysplasia patient demonstrates the importance of
communication with owner regarding a number of different
options, many of which can be incorporated into the patient’s
daily routine to positively impact quality of life. VN
Conflict of interest: none.
References
Antech Imaging Services. AIS PennHIP The key to reducing canine hip
dysplasia. 2018. www.info.antechimagingservices.com/pennhip (ac-
cessed April 2018)
Barrett E. Early radiographic detection of canine hip dysplasia. UK Vet
Companion Animal. 2008; 13(3):43-7
Bergh MS, Budsberg SC. A Systematic Review of the Literature Describ-
ing the Efficacy of Surgical Treatments for Canine Hip Dysplasia
(1948–2012). Vet Surg. 2014; 43(5):501-6
British Veterinary Association. Hip Dysplasia Scheme for Dogs. 2014. www.
bva.co.uk/canine-health-schemes/hip-scheme (accessed January 2018)
Carver D. Practical Physiotherapy for veterinary nurses. 2016. Wiley
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249
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CLINICAL

on the incidence of hip dysplasia in growing dogs. J Am Vet Med Assoc.

KEY POINTS
zzHip dysplasia is a complex inherited disorder with both genetic and
environmental components affecting the prevalence.
zzClinical signs include lameness, alterations in gait pattern and behavioural
change; and diagnosis is confirmed radiographically.
zzTreatment options include surgical and non-surgical forms of management.
Ginja M, Gaspar, AR, Ginja C. Emerging insights into the genetic basis
of canine hip dysplasia. Veterinary Medicine: Research and Reports.
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Kealy RD, Olsson SE, Monti KL et al. Effects of limited food consumption
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Kennel Club. BVA/KC health schemes. 2018. www.thekennelclub.org.uk/
health/for-breeders/complex-inherited-disorders/bvakc-health-schemes
(accessed 23rd May, 2018)
King MD. Etiopathogenesis of Canine Hip Dysplasia, Prevalence, and
Genetics. Vet Clin North Am Small Anim Pract. 2017; 47(4):753-67. doi:
10.1016/j.cvsm.2017.03.001
Kirkby KA, Lewis DD. Canine Hip Dysplasia: Reviewing the Evidence for
Nonsurgical Man-agement. Seattle Veterinary Surgery. 2011; 41(1):2-9
Millis DL, Levine D. Canine Rehabilitation and Physical Therapy. 2014.
Elusive
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Rodrigues D, Ortiz V, Vala H, Santos C, Oliveria AL. Hip Dysplasia in dogs:
control and pre-vention. The Veterinary Nurse. 2011; 2(4):199-204
Wilson B, Nicholas FP, Thomson PC. Selection against canine hip
dysplasia: Success or failure? Vet J. 2011; 189(2):160-8. doi: 10.1016/j.
tvjl.2011.06.014

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