From physical therapy to acupuncture, an integrative multimodal approach is an effective way to manage canine hip dysplasia and the osteoarthritis that often arises from it.
Canine hip dysplasia is the most common congenital joint condition in dogs. It affects several breeds, with a higher prevalence in the larger ones.1 Some dogs with dysplastic hips will never show signs of disease, while others may be debilitated by severe osteoarthritis as a result of the condition. In either scenario, managing hip dysplasia is a lifelong endeavor. This article discusses an integrative multimodal approach to managing hip dysplasia, including the management of osteoarthritis.
TREATMENT AND MANAGEMENT
Four surgical procedures are used for treating dogs with hip dysplasia. Two are complete salvage procedures used when medical management has failed; these include total hip replacement and femoral head/neck osteotomy (FHO).
- Total hip replacements can be performed on dogs only after the growth plate of the greater trochanter has closed. Cemented and uncemented implants are available and may be used in combination. Total hip replacements may be financially inaccessible for many guardians.
- FHO may be preferred if the dysplasia is unilateral, and is a more affordable surgery that can be successfully performed by many general practitioners.2
The other two surgeries for correcting hip dysplasia include triple pelvic osteotomies (TPO) and juvenile pubic symphysiodesis (JPS).
- Triple pelvic osteotomies are performed in dogs who are diagnosed with hip dysplasia and are less than 20 weeks of age, with the aim of reducing the future development of osteoarthritis. The goal of this surgery is to increase the coverage of the femoral head by the acetabulum and decrease ligamentous laxity in the joint.3
- Juvenile pubic symphysiodesis (JPS) is also performed on young puppies by using electrocautery to fuse the pubic symphyseal growth plate. Like TPO, this causes more of the femoral head to be covered by the acetabulum.4
2. Physical therapy
Physical therapy is an underutilized tool in veterinary medicine for supporting canine patients with hip dysplasia and osteoarthritis. It aims to relieve pain by strengthening the tendons and muscles around a joint, increasing circulation and mobility, and decreasing pain caused by compensatory movement. Hydrotherapy, such as underwater treadmills and current pools, create resistance while providing buoyancy. Fascial release can relieve adhesions from the compensatory movement patterns that cause pain. Massage done both by a practitioner and guardian can help improve mobility and circulation, while decreasing pain. Exercises done regularly at home can help improve stability of the coxofemoral joint. This may also help reduce the onset and severity of arthritis; however, more studies are needed.
Research that investigates the efficacy of acupuncture to treat hip dysplasia in dogs is lacking, but an abundance of anecdotal evidence from general practitioners supports its use.
For the practitioner who uses acupuncture in private practice, hip dysplasia and osteoarthritis are often the most rewarding cases to treat. Most patients start with acupuncture once to twice weekly and decrease to every other week or monthly, depending on how long symptom relief is experienced. Three points are commonly used to treat hip dysplasia: GB 29, GB 30 and BL 54.
These are often the same points practitioners use to implant gold beads in an effort to permanently stimulate the points. The small and limited studies that have investigated gold bead implants yielded mixed results.
4. Chiropractic care
Adjustments of the spine and other joints may provide relief from pain in other areas of the body caused by compensatory movement. Dogs with hip dysplasia anecdotally have an increase in SI joint dysfunction and paraspinal lumbar pain. Regular chiropractic adjustments may improve the health of surrounding structures as well as alleviate pain.
While this modality will likely not decrease osteoarthritis in the coxofemoral joint, it may reduce overall pain and improve quality of life for patients with mild to moderate hip dysplasia and osteoarthritis.
While most supplements have mixed data to support their use, they can be part of an integrative plan to help dogs with dysplastic hips. Most of these supplements do not have published dosing, leaving practitioners guessing and using medical grade products in hopes of reaching a therapeutic dose.
- Glucosamine, chondroitin sulfate and MSM can all support joint integrity and may reduce inflammation. These supplements are thought to be more effective when started at a young age. Starting high-risk breeds on joint-supportive blends containing glucosamine, chondroitin sulfate and MSM may help delay or reduce the severity of osteoarthritis. More studies are needed to determine their efficacy in dogs with hip dysplasia, as well as therapeutic dosing regimens.
- There is some evidence to support the use of Omega fatty acids in dogs with hip dysplasia and osteoarthritis. One study of 77 dogs with osteoarthritis showed a small improvement over several scores of assessment for the dogs supplemented with fish oil. These improvements did not reach significance, but were enough to encourage the use of fish oil in dogs with osteoarthritis as a part of a multimodal approach to management.5
- Another study investigating a diet Enriched with green lipped mussel (GLM) fed to 30 dogs found a significant improvement in clinical signs of hip dysplasia as compared to dogs fed a control diet.6 This study also investigated the plasma levels of the different components of GLM.
For many practitioners, this class of drug is a first line choice to provide relief for the pain associated with inflammation and joint degeneration resulting from hip dysplasia. These medications can be helpful for keeping dogs active and moving to maintain strength and weight control. They are also effective for controlling pain to improve quality of life.
Some dogs may not tolerate their deleterious effects on the gastrointestinal lining, while others may have concurrent conditions such as kidney or liver disease that limit the long term use of NSAIDs. In these cases, other therapies outlined in this article should be considered.
Cannabis extract may be included in a multimodal approach to decreasing inflammation and controlling pain in dogs with osteoarthritis from hip dysplasia. One study showed a significant improvement in dogs with osteoarthritis when treated with 2 mg/kg of CBD twice daily.7
Practitioners should counsel clients on product selection to ensure they are purchasing hemp extracts instead of marijuana. Hemp extracts have less than 0.3% THC and will not cause a “high” like marijuana extracts do. Hemp products may help lessen the amount and frequency of other pain medications such as tramadol and NSAIDs. CBD-rich hemp extracts are also reported to have anxiolytic effects that may benefit many dogs.
8. Weight management
This is perhaps the most critical and impactful aspect of managing the clinical signs associated with the osteoarthritis arising from hip dysplasia. Lifelong caloric restriction has been demonstrated to delay the onset and prevalence of hip osteoarthritis in Labrador Retrievers.8
This emphasizes the importance of educating guardians of medium to large-breed dogs during puppy visits, and supporting lean weights throughout life. The use of calorie calculators, diet management, regular weight checks and body condition charts becomes critical for the health and longevity of patients that are more susceptible to osteoarthritis.
9. Regenerative medicine
Therapies focused on regenerating joint cartilage and decreasing inflammation have gained popularity. Two primary types of regenerative therapy are available in veterinary medicine: stem cell therapy and platelet rich plasma therapy.
- Stem cell therapy utilizes mesenchymal cells from adipose tissue or bone marrow either from the patient or a donor. These are then administered by intra-articular injection, either once or in a series. This therapy helps regenerate cartilage and modulate inflammation in the joint.9
- Platelet rich plasma is less expensive and less invasive than stem cell therapy. Growth factors associated with the platelets decrease inflammation and promote healing.10
A recent study that compared the effectiveness of platelet rich plasma and adipose derived stem cells found that both were significantly effective at reducing pain. The stem cell therapy was slightly more effective.11
Another study published in 2020 demonstrated that the addition of physical therapy prolonged the positive effects of platelet rich plasma therapy in dogs with osteoarthritis resulting from hip dysplasia.12
Using an integrative approach when managing canine patients with hip dysplasia and osteoarthritis can be rewarding. Each patient requires an individually tailored treatment plan, as there is great variation in disease severity, lifestyle, athletic goals, personality and genetic expression. The guardian’s financial, emotional and time resources must also be considered when creating a plan for the dog.