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Diagnosis, prevention, and management of

canine hip dysplasia: a review

Article · May 2015

DOI: 10.2147/VMRR.S53266

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Diagnosis, prevention, and management

of canine hip dysplasia: a review

This article was published in the following Dove Press journal:

Veterinary Medicine: Research and Reports
19 May 2015
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Emma R Schachner Abstract: Canine hip dysplasia (CHD) is a polygenic and multifactorial developmental disorder
Mandi J Lopez characterized by coxofemoral (hip) joint laxity, degeneration, and osteoarthritis (OA). Current
Department of Veterinary Clinical
diagnostic techniques are largely subjective measures of joint conformation performed at dif-
Sciences, School of Veterinary ferent stages of development. Recently, measures on three-dimensional images generated from
Medicine, Louisiana State computed tomography scans predicted the development of OA associated with CHD. Continued
University, Baton Rouge, LA, USA
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
Correspondence: Mandi J Lopez and brachycephalic dogs as well as those with high body length to height ratios.10,11
Department of Veterinary Clinical
Sciences, School of Veterinary Medicine,
The periodic appearance of OA in joints other than the coxofemoral joint12,13 has led
Louisiana State University, Skip Bertman some to propose systemic contributions to CHD expression.1 These complexities,
Drive, Baton Rouge, LA 70803, USA
Tel +1 225 578 9918
among others, complicate attempts to manage the CHD by selective breeding despite
Email [email protected] strict reporting and guidelines.14

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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 fibrillated (H, arrow) articular cartilage.

There are many theories to explain CHD joint degenera- variation in the process of endochondral ossification may play
tion, but joint laxity and irregular or delayed endochondral a role in the development of CHD, the exact relationships
ossification are among the most popular. The conditions are between ossification patterns, abnormal joint structure, and
not mutually exclusive, and their phenotypic expression is development of OA remain unclear.20
variable within and among breeds.15 Partially ossified hip Affected joints usually develop varying degrees
structures may become distorted during development due of synovial inflammation, articular cartilage damage
to mechanical stresses in joints with delayed endochondral ­(Figure 1), osteophytes, and subchondral bone sclerosis and
ossification.8,16 Joint components may be more vulnerable to remodeling.21–23 While there is no single, overarching descrip-
deformation and damage from normal joint kinetics before tion of the sequence of events in the process, there are changes
they are fully ossified.8,9,17 Abnormal and delayed endochon- that occur in many forms of dysplasia. Recently, the dorsal
dral ossification in the coxofemoral joint has been identified acetabular rim angle (a measure of the dorsal slope [angle] of
in 15-day-old dogs that developed CHD by the time they were the subchondral articular acetabular surface relative to hori-
12 months old,8,9,18 and in Great Danes with experimentally zontal) was reported to be significantly larger (less femoral
induced hip dysplasia.19 In contrast, comparably earlier joint head coverage by the acetabulum) in dogs with coxofemoral
ossification appears to occur in Greyhounds, a breed with joint laxity versus normal dogs as early as 1 week of age.17
one of the lowest incidences of CHD. While it is clear that Subluxation of the femoral head and delays in ossification

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Dovepress Canine hip dysplasia

of the craniodorsal acetabular margin are often visible by bone disease, ligament rupture, patellar luxation, and spine
8  weeks, and, in many cases, subluxation of the femoral disorders.27 Hence, a thorough, comprehensive assessment is
head increases by around 12 weeks of age.18 Degeneration paramount to identification of the source of discomfort.
and microfractures of the articular cartilage, and thickening,
inflammation, and deterioration of the joint capsule, tendi- Subjective laxity examinations
nous insertions, and ligaments are often apparent by 5 months The Ortolani test is a subjective evaluation of coxofemoral joint
of age.18 Despite the presence of these degenerative traits in laxity originally designed for diagnosis of human congenital
many dogs with degenerative coxofemoral joint changes, hip dislocation in the 1930s.28,29 The test is also used as a CHD
clinical signs are variable.21 screening test.28 Dogs are placed in lateral ­recumbency; one
A direct relationship between joint capsular collagen hand of the examiner is used to apply force along the length of
composition and mechanical properties was proposed over the femur from the stifle toward the pelvis as the other braces
30 years ago.24 Altered capsular collagen composition has the back just above the sacrum (Figure 2).27 This maneuver is
been identified in children with congenitally dislocated intended to displace the femoral head. The stifle is then slowly
hips25 and dogs with hip joint laxity.26 Joint capsular collagen abducted to reduce the joint.29 An audible or palpable pop as the
fibrils were found to be more heterogeneous in 8-month-old femur slips back into the acetabulum is considered a positive
Labrador Retriever puppies with severe coxofemoral joint Ortolani sign indicative of joint laxity. Lack of an Ortolani
laxity than those with normal joints.15 ­Abnormal collagen sign does not necessarily mean that the hip is normal. Joint
composition is thought to contribute to reduced joint capsule changes associated with dysplasia, like thickening of the joint
stiffness, which contributes to excess femoral head motion capsule and joint tissue, may interfere with the displacement
and abnormal mechanical stresses on the femoral greater required for a positive sign.28,30 Bardens’ test,31 an examination
trochanter and acetabular margins and ­cartilage.15 Over time, technique designed to evaluate the hips of babies (aged younger
the abnormal forces are thought to result in deformation of than 6 months), is thought to be more sensitive for detecting
the articulating structures and an incongruous joint.18 coxofemoral joint laxity and/or shallow acetabula in puppies
Despite almost a century of work, many aspects of the 6–8 weeks of age.29 With the dog in lateral recumbency, the
development and progression of joint changes and OA associ- proximal femur is elevated laterally from the body. With the
ated with CHD remain elusive. This makes establishment of a femur elevated, the index finger of the other hand is used to
gold standard for treatment a challenge. The lack of a single, push the femur away from the joint in a dorsal direction with
predictable pattern of joint degeneration is likely a reflection pressure on the greater trochanter. More than 2 mm of displace-
of natural variability, including individual responses to exter- ment is considered a positive sign.31 In general, these and other
nal environmental influences. However, ambiguity in disease palpation techniques may be used as part of a comprehensive
progression may also reflect distinct disease processes that examination on puppies or dogs suspected to have excessive
have yet to be recognized. Continued efforts to identify and joint laxity characteristic of CHD. However, the tests alone are
characterize patterns in joint changes may lead to identification not sufficient for diagnosis of CHD.
of CHD phenotypes, which will, in turn, contribute to earlier
disease identification and more effective targeted treatments. Radiography
Radiography has long been the gold standard to assess
Diagnosis and quantify joint changes associated with CHD joint
Despite some recognized patterns of joint degeneration remodeling.32,33 Worldwide, there are five popular, standard-
characteristic of CHD, there is significant variability in the ized evaluation systems with distinct metrics that are used to
progression and ultimate severity of the disease as well as grade canine radiographic coxofemoral joint conformation
inconsistent relationships between gross and radiographic and degenerative changes.
joint changes and clinical signs.21 There are, however, two
general behaviors often attributed to CHD, including lame- Orthopedic Foundation for Animals
ness in young dogs (under 1 year), that increases with activity The Orthopedic Foundation for Animals evaluation is
or trauma, and gait abnormalities and hind limb muscle atro- performed on hip-extended radiographs performed under
phy in older dogs.27 Notably, hind limb lameness can be due heavy sedation or general anesthesia by three independent
to reasons other than CHD joint changes, including pelvic, board-certified radiologists.10 Based on subjective assess-
distal hind limb, and neurological pathologies, metabolic ment of nine joint parameters (Figure 3A), conformation

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A B

Acetabulum

Ligamentum
teres Femoral head
Cartilaginous labrum
Joint capsule
C D

Figure 2 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

is ­categorized as excellent, good, fair, borderline, mild, head recontouring, and femoral head and neck exostosis.34,35
moderate, or severe. The first three categories are considered An average score for each individual dog breed is published,
to be normal while the last three are dysplastic.10 Metrics ie, the breed mean score, and it is recommended that only
are largely subjective assessments of hip conformation and animals with total scores well below the breed mean be used
evidence of degenerative joint disease. for breeding purposes.35

British Veterinary Association/Kennel Club Fédération Cynologique Internationale

The British Veterinary Association/Kennel Club maintains a The Fédération Cynologique Internationale (FCI)36 is one
“pass/fail” evaluation system that was instituted in 1965 and of the largest canine organizations in the world and includes
updated in 1984.34 For scoring, dogs must be at least 1 year kennel clubs from across Europe, Asia, Africa, and South
of age, microchipped (or tattooed), and, if registered with the America. Extended hip and abducted hind limb radiographs
Kennel Club, the registration number must be included on the performed at 1 year of age (18 months for large breed dogs)
radiograph.35 Each dog has one opportunity to be scored by the are scored according to the official FCI system by radiologists
system. Joints are individually scored on nine criteria from 0 to approved by breed-specific kennel clubs.36 ­Scoring includes
5 or from 0 to 6 on hip-extended radiographs by two qualified the Norberg angle, formed by a horizontal line connecting
radiologists on a British ­Veterinary ­Association/­Kennel Club the centers of the right and left femoral heads and a line con-
panel, with 0 being the best score and 106 the worst (53 ­possible necting each center to the cranial margin of the corresponding
points for each hip).34 The nine criteria (­Figure 3B) include the acetabulum (Figure 3C)37 as well as subjective hip conforma-
Norberg angle (Figure 3C) and ­subjective ­assessments includ- tion parameters. Each joint is assigned a grade of A–E, with
ing subluxation, dorsal ­acetabular edge, cranial acetabular A representing healthy and E representing severe dysplasia.
edge, cranial effective acetabular rim, acetabular fossa, femoral The more dysplastic of the two joint scores is considered the

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Dovepress Canine hip dysplasia

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.

final score for the individual dog. The same grading scale can distraction index is the ratio of the distance between the
also be applied to computed tomography (CT) scans. ­centers of the femoral head and acetabulum (d) and the radius
of the femoral head (r), as shown in Figure 3D. The closer the
Pennsylvania Hip Improvement Program score is to 0, the better the fit, ie, minimal femoral distrac-
University of Pennsylvania researchers developed a quantita- tion, but a score of 1 indicates severe laxity and associated
tive method to evaluate canine hip conformation38–40 that was femoral distraction.41 Recently, the PennHIP distraction index
implemented in 1994.41 The primary distinction of the Penn- and OA scores were found to have strong correlations with
sylvania Hip Improvement Program (PennHIP) method is that microstructural changes in the articular cartilage,42 potentially
passive hip joint laxity is measured in addition to subjective indicating a relationship between joint laxity measured by
radiographic conformation.38–40 Three radiographic views this technique and articular surface degeneration.
are evaluated by PennHIP-certified radiologists: a standard
hip-extended view for evidence of degenerative joint disease; Dorsolateral subluxation
a compression view for congruity between the femoral head Dorsolateral subluxation is used to quantify joint laxity in
and acetabulum; and a distraction view, for joint laxity. The a position to simulate weight-bearing (Figure 3E). During

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Schachner and Lopez Dovepress

general anesthesia, pressure is applied to the femur at the level angles: ­acetabular anteversion, ventral, dorsal, and horizontal
of the stifle while imaging the dog in ventral ­recumbency.43 acetabular sector, center edge, and horizontal toit externe
Joints with less than 45% coverage of the femoral head (Figure 4). Measures on three-dimensional models included
by the lateral aspect of the cranial acetabular rim have an femoral head and neck volumes, femoral head and neck radii
increased chance of developing joint changes and OA over and femoral neck angle (Figure 4). The 16-week distraction
time compared with those with a higher percentage (.55%) index and center edge angle combination was the best pre-
of coverage.43 dictor of mature OA, whereas the 32-week dorsal acetabular
Subjective radiographic evaluations are limited by sector angle and Norberg angle combination was the most
the inherent variability associated with examiners, image effective predictor of the presence of OA at maturity. Hence,
quality, and differences between animals including periar- combined measures were the best mechanism for predicting
ticular soft tissue changes and muscle atrophy. Variation in development of OA, and the combinations varied with age.
the degree of muscle relaxation associated with sedation In a separate study, numerous measures were performed on
or anesthesia during imaging can influence the ability to pelvic CT scans of beagles and mixed breed dogs at various
identify joint abnormalities by as much as 50%.44 Further, time points between the ages of 2 months and 1 year to assess
each evaluation system is distinct, so results are based on the relationship of the measures with joint laxity.17 The dorsal
slightly different ­criteria. Recently, the Orthopedic Founda- acetabular rim angle and center distance index (the distance
tion for Animals score was reported to underestimate the between the femoral head and the center of the acetabulum,
likelihood of developing coxofemoral joint OA compared divided by the radius of the femoral head, or the PennHIP41
to the PennHIP distraction index.45 Reporting mechanisms distraction index) were found to be good indicators of joint
also vary widely in public access to individual scores for laxity and dysplastic changes.17 Magnetic resonance imag-
reproduction decisions. As with any measure, radiographic ing is used to evaluate the three-dimensional structure of
hip scores should not be used in isolation to evaluate and human articular soft tissues, and relatively recently, canine
predict current and future joint structure and function. It articular soft tissues,48 but CT is best for bone structure,49
is possible that the presence of OA at a young age may be and the cost of magnetic resonance imaging for screening
indicative of rapidly progressive joint disease, and, given may be prohibitive. As technology advances, and CT and
recognition of the genetic basis for the disease, consider- magnetic resonance imaging become more readily available
ation of the presence and extent of CHD signs in related and affordable, use of three-dimensional imaging method-
individuals is likely warranted. Based on this information, ologies will likely become an integral part of diagnosis and
it is clear that continued efforts to identify mechanisms for assessment of CHD.
early and accurate CHD diagnosis are of utmost importance.
­Adaptation of knowledge from decades of research to emerg- Therapeutic management
ing imaging modalities will, no doubt, continue to improve and intervention
upon current standards. Conservative management
There are numerous descriptions of multifactorial systems,
Computed tomography with numeric, visual analog, and descriptive scales to repro-
CT technology for pelvic imaging has improved consider- ducibly evaluate joint pain associated with CHD.50 Many of
ably over the past few decades. While radiographs remain the assessments within the systems are subjective evalua-
the primary method used to image canine coxofemoral tions of individual behavior or responses, and there is no
joints, CT is becoming increasingly popular. Using three- single gold standard with which to quantify hip pain in the
dimensional CT models, a recent longitudinal study showed dog.50 While efforts continue to establish a uniform, standard
that volumetric changes in the acetabulum and proximal evaluation system for canine hip joint pain, those systems
femur occurred in a predictable manner during skeletal that include multiple subjective and objective assessments
growth in a colony of dogs with coxofemoral joint laxity.46 by individuals who are not aware of specific treatments or
Another study demonstrated that two-dimensional CT images conditions, are often informative.
and three-dimensional models created from CT images Conservative management of CHD generally consists
can be used to predict the presence of joint OA at matu- of a combination of mechanisms to reduce progression of
rity.47 Two-dimensional CT measures included the percent joint damage and alleviate discomfort.51 Nonsteroidal anti-
femoral head coverage, acetabular index, and the following inflammatory drugs are commonly used for pain associated

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Dovepress 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 Maintenance of optimum body weight has long been
indicate that achieving and maintaining a healthy body considered one of the most effective methods for reducing the
weight contributes to delayed onset and reduced clinical signs signs associated with dysplasia and OA.4 A lifelong dietary
associated with hip joint pain.4,5,53 Various food supplements restriction of 25% delayed the appearance of OA as well as the
reported to alleviate signs of coxofemoral joint pain from OA intensity of clinical signs in Labrador Retrievers compared
range from green-lipped mussels (Perna canaliculus)54 to with feeding ad libitum.53 Weight loss in conjunction with
fish oil.55 Polysulfated glycosaminoglycan supplements and physiotherapy that included transcutaneous electrical nerve
injections have been recommended for prevention and treat- stimulation improved the clinical outcome for obese dogs
ment of OA in dogs and other mammals.56–59 Intramuscular57 with radiographic signs of OA.64 Recently, intra-articular
and intra-articular administration has also been reported,56 botulinum toxin A was reported to reduce the pain associated
but responses vary.51 Alternative methods that have also been with OA based on improvements in limb use (ie, gait pat-
investigated for the treatment of painful CHD joints include terns) measured with a force platform.65 At present, there are
acupuncture and gold bead implantation, among others. The few reports of long-term studies concerning the efficacy of
implantation of gold beads at acupuncture points was devel- nonsurgical or conservative treatment of CHD joint changes.
oped in the USA in the 1970s and implemented to a limited These studies can be limited by the challenges of consistent
degree in veterinary medicine in the 1990s for degenerative monitoring and reporting by multiple and individual owners,
joint disease pain.60,61 Results are mixed, with some studies as well as a wide range of disease severity and canine per-
showing clinical improvement61,62 and others showing no sonalities.66 However, a recent retrospective report indicates
discernible effect.63 that conservative and nonsurgical ­management (ie, weight

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Schachner and Lopez Dovepress

control, reduced exercise, and analgesics) of 74 dogs over the recommended for young dogs without irreversible (or with
span of 13 years did not improve quality of life as anticipated mild) degeneration of the coxofemoral joint.77,78 Information
from previous reports.66 about long-term outcomes of the various surgical treatments
There is significant interest in the use of regenerative is limited. Preliminary reports indicate that juvenile pubic
medicine to treat signs of CHD and OA; however, much of symphysiodesis and triple pelvic osteotomy minimally affect
the information reported is subjective in nature. Currently, laxity and femoral head coverage when performed at 5 months
numerous controlled, preclinical and clinical trials are under- or older72 compared with earlier reports indicating that the
way that may provide some perspective on the value of this procedure performed slightly earlier (15 weeks) improved
emerging technology. Intra-articular injection of adipose- acetabular coverage of the femur.75 Mechanisms to reduce the
derived stem cells has been found to be a safe therapeutic OA characteristic of CHD will undoubtedly improve quality of
approach for the treatment of symptoms associated with life for affected dogs. Long-term outcomes will help identify
OA.67 Preliminary studies show that injection of adipose- treatments toward this end.
derived stem cells into affected joints may reduce clinical Total hip replacement (Figure 5) is often applied in
signs of hip pain (ie, lameness) based on subjective clinical advanced cases of joint degeneration and is considered a
evaluations67 and force platform gait analysis.68,69 A random- salvage procedure.79 There are no clear guidelines for the
ized comparison between a single intra-articular injection of best time to implement total hip replacement, but the aver-
adipose-derived stem cells or plasma rich in growth factors age time between onset of signs and surgery is 10 months.80
showed that both treatments reduced behavior associated with Total hip replacement procedures in dogs began in the 1970s,
pain, but that the adipose-derived stem cells appeared to be and a modular system was introduced in the mid 1990s that
more effective for up to 6 months post-treatment based upon coupled a fixed monobloc cobalt-chromium alloy femoral
owner assessments.70 This information clearly demonstrates implant with an acetabular cup for cemented fixation. 81
that there is more work to be done on the efficacy of conserva- Further refinements to total hip replacement implants have
tive and alternative methods to manage signs of CHD. contributed to a high clinical recovery rate, with loosening of
the acetabular cup and cup wear reported as some of the most
Surgery common complications.81 More recently, cementless fixation
Despite the prevalence of CHD, a gold standard surgical pro- has been developed, and is reported to have positive results.79
cedure has yet to be identified.71 As such, there are numerous As the name implies, femoral and acetabular implants are
surgeries to prevent progression of degenerative joint changes cemented to bone for cemented total hip replacement. In
or alleviate pain and restore joint function. contrast, cementless fixation or uncemented implants are
Some surgical procedures designed to prevent onset of OA designed so that the bone grows into or onto the prosthesis
in hips identified as being predisposed to development of OA72 without the need for cement at the bone–implant interface.
include double and triple pelvic osteotomy, acetabular shelf Implant loosening is reported to be less than for cemented
and excision arthroplasty, femoral osteotomy, and juvenile implants.79,82 A primary concern associated with total hip
pubic symphysiodesis.73 Both juvenile pubic symphysiodesis replacement is the potential for an inflammatory response
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
Figure 5 Radiograph illustrating a bilateral total hip replacement.
The ilial osteotomy is stabilized with bone plates customized
Notes: Blue line indicates femoral implant, pink line indicates acetabular implant.
to accommodate the rotation.77 This procedure is generally Image courtesy of Dr Jeffrey D Brourman.

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Dovepress Canine hip dysplasia

to implant particulate wear debris from aseptic implant differentially affect the morphology and function of the
loosening.83 Another consideration is that the persistence canine hip. The variable phenotypic expression of CHD
of joint laxity may influence the outcomes of total hip makes development and implementation of standard iden-
replacement.84 Efforts continue to improve upon available tification procedures difficult. It may be possible to identify
total hip replacement implants for dogs. A hybrid system of specific phenotypes within the broad spectrum of CHD
a cementless acetabular cup and a cemented femoral implant similar to those of the human hip, like acetabular rim syn-
has been successfully applied in dogs relatively recently.85 drome, acetabular retroversion, and femoral head ­necrosis.
Hip resurfacing to replace only joint surfaces versus the The relationship between articular damage in the human
entire joint86 in dogs is under development, but clinical hip with morphology suggests a need to evaluate similar
trials have yet to be reported.81 Unfortunately, large-scale, relationships in the dog.93 Identification and characteriza-
prospective randomized studies have yet to be conducted tion of CHD phenotypes at the genetic, microstructural, and
for comparison of long-term outcomes for various surgical macrostructural levels will likely contribute to early detec-
procedures and nonsurgical management. Hence, individu- tion and informed breeding decisions. Another area that will
alized care remains largely based on clinician preference continue to promote progress in both imaging and treatment
and experience.71 is development of novel measures on images obtained with
contemporary imaging modalities like CT and magnetic
Genetics resonance imaging. As evidence-based assessments of CHD
While diagnosis and treatment of CHD are central to indi- prevention and treatment strategies become available, their
vidual patient care, prevention by selective breeding will help selection and implementation will improve and facilitate
obviate the presence of a debilitating condition in canine the development of novel clinical approaches and surgical
companions. With this in mind, there has been significant procedures. Incremental advances in the diagnosis, treat-
effort focused on identifying specific genes, genetic muta- ment, and prevention of the joint degeneration and pain
tions, and quantitative trait loci (regions of chromosomes associated with CHD through focused research and clinical
containing DNA for a specific trait), to use in conjunction evidence will continue to progress toward diminishing and
with standard imaging methods for identification of CHD eradicating CHD from our canine companions.
carriers.87,88 Genetic screening programs are complicated
by the polygenic nature of CHD and related OA, as well as Disclosure
environmental influences on phenotypic expression. A few The authors report no conflicts of interest in this work.
promising quantitative trait loci for OA associated with
CHD89 and the CHD phenotype in German shepherds90
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