Vol.18, No.
8 August 1996
Continuing Education Article
FOCAL POINT
★ Accurate diagnosis, treatment,
and prognosis of patients with
canine hip dysplasia depends on
comprehensive evaluation of
affected dogs.
KEY FACTS
■ Dogs that are affected with
hip dysplasia are genetically
predisposed to developing
a biomechanical imbalance
between muscle mass and
skeletal stresses on the hip joint.
■ The disparity between soft tissue
strength and biomechanical
forces during skeletal growth
causes a loss of congruity
between the articular surfaces of
the acetabulum and the femoral
head.
■ A comprehensive evaluation
includes signalment, history,
general physical examination,
orthopedic examination,
neurologic examination, and
radiography.
■ The goals of treatment are to
alleviate pain, to arrest secondary
degenerative changes, and to
maximize joint function.
Pathophysiology,
Diagnosis, and
Treatment of Canine
Hip Dysplasia
University of Missouri
James L. Cook, DVM
James L. Tomlinson, DVM, MVSc
Gheorghe M. Constantinescu, DVM, PhD, Drhc
C anine hip dysplasia (CHD) is a common developmental disease of the
coxofemoral joint of dogs.1–6 The disease affects 1.8% to 48.1% of dogs
of a given breed.4 Heritability indexes (which measure the percentage
of phenotypic variation attributable to genetics) also vary greatly among
breeds. Canine hip dysplasia is most frequently reported in large and giant ca-
nine breeds but can affect any breed. The disease most commonly occurs bilat-
erally; unilateral disease reportedly ranges from 3% to 30%, depending on the
breed.4
Although many causes have been proposed, a definitive cause has not been
established. A genetic predisposition involving a polygenic mode of inheritance
has been reported.1–5 Affected dogs are predisposed to developing a biomechan-
ical imbalance between muscle mass and skeletal stresses on the hip joint.2,5
The imbalance leads to laxity, subluxation, and degenerative joint disease
(DJD). Nutrition and rapid growth rate are important factors that contribute
to the disparity between muscle mass and skeletal stresses.1–3 Other proposed
causal factors include hormonal influences; collagen, muscle fiber, ligament
and nerve abnormalities; and abnormal synoviocyte ratios.1–3,6 These factors are
probable components of the polygenic basis of the disease.
The multifactorial nature of CHD can confuse client education and manage-
ment of the disease. The basic concept involved is the biomechanical imbalance
between the forces on the coxofemoral joint and the associated muscle mass; the
result is joint laxity in young, growing dogs. This laxity leads to incongruity; the
eventual result is DJD. This article considers the pathophysiology and treat-
ment options for patients with CHD and provides a framework for decision
making and prognosis for various categories of patients with the disease.
Small Animal The Compendium August 1996

PATHOPHYSIOLOGY
The coxofemoral joint is normal
at birth and begins as a congruent
unit.2,5 Genetically susceptible dogs
become dysplastic when the primary
muscle mass that supports the joint
fails to mature at the same rate as the
skeletal structures.2,5,7,8 The resultant
disparity between soft tissue strength
and biomechanical forces during
skeletal growth is manifested as a loss
of congruity between the articular
surfaces of the acetabulum and the
femoral head.2,5 This incongruity re- Figure 1—Schematic illustration of normal, increased, and decreased angles (from
sults in the instability that leads to left to right) of inclination. An increased angle results in greater stress on the cox-
DJD. ofemoral joint.
The most important time in the
development of the canine coxo-
femoral joint is the first 60 days of
life, when the periarticular soft tis-
sues are immature.2 During this peri-
od, the muscles and nerves are func-
tionally limited. If the stresses on the
hip from weight bearing and activity
exceed the strength of the supporting
soft tissue, the articular surfaces are
forced apart. If the elastic limit of the
soft tissue is exceeded, the laxity re-
sults in irreversible incongruity.2 The
incongruity in the joint results in
abnormal joint motion (instability). Figure 2—Schematic illustration of normal (left) and increased (right) angles of an-
The abnormal motion produces re- teversion. Increased anteversion results in greater stress on the coxofemoral joint.
modeling of the joint and joint effu-
sion, both of which result in further
incongruity and laxity due to articu-
lar cartilage changes and loss of hy-
drostatic pressure.2,9–17
Overloading of the hip can begin as
soon as a puppy begins to push itself
to nurse and can continue into the lat-
er developmental stages, when addi-
tional stresses exacerbate the incon-
gruity and lead to further remodeling.2
The dysplastic changes evident in
CHD apparently correlate with the
severity and duration of the biome-
chanical overloading.2,7,8 If congruity is
maintained until the soft tissue is ma-
ture or is restored before irreversible
change, nerve function and muscle
mass are sufficient to maintain con-
Figure 3—Schematic illustration of femoral head subluxation (arrows) as the result
gruity of the joint.2 When the patient
of a shallow acetabulum.
is approximately 6 months of age (i.e.,

GENETIC SUSCEPTIBILITY ■ COXOFEMORAL JOINT ■ DYSPLASTIC CHANGES

The Compendium August 1996 Small Animal

when 90% of the ossification process is complete),
changes in joint shape can only be accomplished by the
production or resorption of bone.2
BIOMECHANICS
Normal weight bearing through the coxofemoral
joint is transmitted through the shaft of the femur, the
femoral neck and head, the acetabulum, the ilium, and
the sacrum. The load placed on the coxofemoral joint
is determined by body weight, conformation, and ac-
tivity.6 When a dog is standing, 30% to 40% of the
body weight is distributed to the pelvic limbs.6,9 During
activity, however, the coxofemoral joint load may ap-
proach three times body weight.6
The amount of force placed on the joint is influ-
enced by the femoral neck–shaft angle of inclination,
the length of the femoral neck, the position of the
greater trochanter, and the distance of the femoral head
from the body’s center of gravity.6 Increased stress on
the joint occurs with an increased angle of inclination
(Figure 1), an increased angle of anteversion (Figure 2),
a relatively short femoral neck, and distal or medial dis-
placement of the greater trochanter.6 Increased stress on
the joint potentiates laxity, incongruity, and DJD. In
addition, if the craniodorsal aspect of the acetabulum
does not meet the force vector of the femoral head per-
pendicularly (because of slanting or
incomplete coverage), subluxation
results6 (Figure 3).
nized.2,10 Dogs 4 to 12 months of age often present
with a sudden onset of clinical signs.10 These dogs ex-
hibit a sudden decrease in activity in conjunction with
pain and/or lameness in the pelvic limbs.10 The cause of
the pain and lameness has been attributed to joint effu-
sion, tearing or stretching of the round ligament, syn-
ovitis, acetabular microfractures, and loss of articular
cartilage.10,18–49 Most of these patients have a positive
Ortolani sign in the affected joints and atrophy of the
associated pelvic muscle mass.7,10
In older dogs, clinical signs result from degenerative
changes in the joint.10 Signs are usually insidious but
may present suddenly as the result of acute trauma to
the abnormal tissue.10 Older dogs with CHD are often
bilaterally lame, especially after exercise; joint crepitus,
restricted range of motion (especially extension), and
muscle atrophy of the hindlimbs may be present.10 A
positive Ortolani sign is rare.7,10 In both groups of dogs,
clinical signs may include varying degrees of lameness,
so-called bunny hopping, difficult rising, and abnormal
stance or gait.
Palpation Techniques
Bardens’ method11 of coxofemoral joint palpation in
puppies at 6 to 8 weeks of age is reportedly accurate in
predicting CHD in commonly affected breeds.12 The

DIAGNOSIS
Dogs that have clinical signs at-
tributable to CHD are commonly
presented to veterinary practitioners
for evaluation. Dysplastic dogs with-
out clinically evident abnormalities
may be evaluated during routine
physical examinations. A compre-
hensive evaluation is essential for
accurate diagnosis, treatment, and
prognosis. Other causes of hindlimb
lameness (e.g., cruciate ligament rup-
ture, patellar luxation, osteochondro-
sis, and trauma) must be ruled out.
Evaluation should include signal-
ment, history, complete general
physical examination, complete or-
thopedic examination, neurologic
examination, and radiography.1,3,7

Signalment and History

Figure 4—Schematic illustration of hand placement for eliciting of the Bardens’
Two distinct groups of dogs with
sign.
CHD have been clinically recog-

NORMAL WEIGHT BEARING ■ INCREASED JOINT STRESS ■ CREPITUS

Small Animal
Figure 5— Schematic illustration of proper positioning for palpation of the tient in lateral or dorsal recumbency.
Ortolani sign.
Figure 6— Schematic illustration of the angles of reduction and subluxation greater trochanter. The left femur is
(arrows) of a dysplastic coxofemoral joint.
puppy is placed in lateral recumbency. Using one hand,
the thumb is placed on the ischiatic tuberosity, the
middle finger on the dorsal iliac spine, and the index
finger on the greater trochanter. The opposite hand is
used to attempt to pull the femoral head out of the ac-
etabulum by lifting the femur laterally (Figure 4). The
amount of laxity is estimated by the amount of move-
ment of the index finger away from the acetabulum. A
more objective measurement can be made using this
technique and a simple lever device.12 Although seda-
ANGLES OF REDUCTION AND SUBLUXATION ■ ORTOLANI SIGN
The Compendium August 1996
tion or general anesthesia may be re-
quired to facilitate palpation, we do
not routinely recommend sedation
or anesthesia of puppies in order to
perform this procedure.
The Ortolani sign was first report-
ed in human infants in 193713 and is
used in veterinary medicine to diag-
nose coxofemoral laxity. Although
the technique can be performed on
an awake patient or after sedation,
accurate interpretation of joint laxity
can be diminished. For the best re-
sults, the animal should be anes-
thetized deeply enough to cause loss
of the palpebral reflex. 7 The tech-
nique can be performed with the pa-
With the dog in dorsal recumben-
cy, the veterinarian stands behind the
animal and grasps each stifle firmly
(with the femurs perpendicular to
the surface of the examination table).
Pressure is applied down the shaft of
the femur toward the acetabulum.
Each femur is individually abducted
to its limit. In patients with CHD,
downward pressure on the femur
causes dorsal subluxation of the
femoral head. When the limb is ab-
ducted, an audible or palpable click
is elicited as the subluxated femoral
head is reduced.7
With the patient in right lateral
recumbency, the examiner stands
caudal to the dog and grasps the left
stifle with the left hand. The open
palm of the right hand is placed
against the dorsum of the pelvis,
with the thumb resting on the
positioned so that it is perpendicular
to the long axis of the pelvis and par-
allel to the table surface. Pressure is applied to the shaft
of the femur proximally toward the acetabulum while
the pelvis is supported with the right hand. The left
femur is then abducted (Figure 5). As in the previous
technique, hips that are subluxated elicit a click during
abduction.7
A palpable or audible click during this technique is
known as a positive Ortolani sign.7 False-negative re-
sults may result from positioning or technique errors,
inadequate depth of anesthesia, excessive patient size
The Compendium August 1996
(prohibiting effective palpation), gross
destruction of the dorsal acetabular rim,
a thickened fibrotic joint capsule, prolif-
eration of osteophytes, limited range of
motion, or fixed luxation of the femoral
head.7
Using the Ortolani technique, the point
of femoral head subluxation can be distin-
guished as proximal pressure is applied to
the femur. The angle of the femur from
the sagittal plane at the point of initial
femoral head subluxation is the angle of
subluxation. 10 The angle of the femur
from the sagittal plane at the point of re-
duction of the femoral head in the acetab-
ulum is the angle of reduction10 (Figure
6). These angles are useful if triple pelvic
osteotomy is considered as a treatment
option.7,10,14
Radiography
The most commonly used radiographic
grading system for CHD was established
by the Orthopedic Foundation for An-
imals (OFA). One function of the OFA
is to provide a service for the diagnosis
and registry of hip status for all canine
breeds.15 Sedation or anesthesia is recom-
mended. With the patient in dorsal
recumbency, the femurs are extended par-
allel to each other and to the film cas-
sette. The patellae are centered over the
trochlear grooves of the femurs.16 A single
ventrodorsal radiograph of the pelvis and
femurs is obtained for evaluation.16 Proper
positioning and technique are essential to
correct interpretation of the radiographic
severity of the disease.3,10,16
The coxofemoral joints are evaluated
radiographically for the following fac-
tors10,16:
■ Congruity of the femoral head and the
acetabular margin
■ Amount of coverage of the femoral
head by the acetabular rim, as defined
by the intersection of the femoral head
physeal scar with the dorsal acetabular
rim (At least 50% of the femoral head
should be covered by the acetabulum.)
■ Remodeling and flattening of the
femoral head (The femoral head
should approximate a hemicircle.)
DORSAL ACETABULAR RIM DESTRUCTION ■ DISTRACTION INDEX
Small Animal
Based on these criteria, the coxofemoral
Grading Criteria joints are given one of seven grades15 (see
for Radiography the box). In German shepherds, evaluation
of Canine of CHD by the OFA radiographic method
Coxofemoral Joints reportedly has a reliability for correct diag-
nosis of 69.9% at 12 months, 82.7% at 18
■ Excellent—nearly months, and 95.4% at 24 months.15 After
perfect conformation
radiographic evaluation by three board-
certified OFA radiologists, a dog can be
■ Good—normal registered with the OFA if it is at least 2
conformation for age years of age and the radiographs are appro-
and breed priately identified.15
■ Fair—less than ideal, Another radiographic evaluation tech-
but within normal nique for CHD is the University of Penn-
radiographic limits
sylvania Hip Improvement Program
(PennHIP). The PennHIP technique is a
■ Near normal— stress-radiographic method intended to
borderline; minor hip provide a quantitative means of determin-
abnormalities often ing laxity before the dog is 24 months of
cannot be clearly age.17 By correlating joint laxity with sub-
assessed because sequent incidence and severity of CHD,
of poor positioning
this method can provide optimum predic-
tive value.17–19
during radiographic The stress-radiographic method requires
procedures deep sedation or general anesthesia.17 The
■ Mild dysplasia— patient is positioned in dorsal recumbency,
minimal deviation with the coxofemoral joints in a neutral
from normal with flexion–extension angle to allow maxi-
slight flattening of the
mum lateral displacement of the femoral
head.17 The neutral positioning avoids spi-
femoral head and ral tensioning of the fibrous elements of
minor subluxation the joint capsule and hydrostatic influ-
■ Moderate dysplasia— ences that decrease hip laxity.17
obvious deviation A compression view and a distraction
from normal with view are obtained via the PennHIP com-
evidence of shallow
pression–distraction device. The distance
between the center of the acetabulum and
acetabulum, flattened the center of the femoral head is measured
femoral head, poor on both views via templates or gauges.
joint congruity, and This distance is divided by the radius of
(in some cases) the femoral head; a numerical value be-
subluxation with tween 0 and 1 (the distraction index) is
marked changes of the
determined.17 This index quantitates the
relative displacement of the femoral head
femoral head and neck center from the acetabular center.17 In ad-
■ Severe dysplasia— dition, the compression view delineates
complete dislocation the articular surfaces and provides in-
of the hip and severe formation concerning acetabular depth,
flattening of the thickness of articular cartilage, and the
acetabulum and
center of rotation of the joint.17
The distraction index quantitates pas-
femoral head sive joint laxity. Dogs with an index less
than 0.3 rarely develop radiographic evi-
Small Animal
dence of DJD.18 Hips with a distraction index greater
than 0.3 are considered to be susceptible to DJD.18 In
some breeds, an increase in the distraction index has
been correlated with an increased incidence of DJD as-
sociated with CHD.18,19 Not all dogs with passive laxity
(an index greater than 0.3) eventually develop DJD,
however, and results should be interpreted with cau-
tion.
The PennHIP method shows promise for detecting
susceptibility to CHD in dogs as early as 16 weeks of
age.17 The method is designed to minimize radiograph-
ic artifacts caused by positioning and to allow dog-
to-dog comparison of hip joint laxity. 17 To use the
PennHIP system in practice, a veterinarian must be
certified at a 1-day training session and must have a
compression–distraction device, a 300-mA radiograph-
ic unit, and an automatic film processor.
The dorsal acetabular rim (DAR) radiographic view
was developed to image the rim using standard radio-
graphic equipment and technique.20 The DAR tech-
nique was designed to address the failure of standard
ventrodorsal and lateral radiographic techniques to iso-
late the weight-bearing portion of the acetabulum.20
The value of DAR radiographs is in evaluating the rim
for damage and secondary osteoarthritic changes, corre-
lating palpable joint laxity with observable radiographic
findings, and displaying acetabular filling. This tech-
nique has been proposed to provide an objective, repro-
ducible method for determining whether a coxofemoral
joint is normal, dysplastic, or injured by trauma.20
The DAR view is obtained with an anesthetized pa-
tient in sternal recumbency. The pelvic limbs are pulled
cranially so that the femurs are parallel with the long
axis of the torso.20 A restraining device is placed around
the thighs and back to align the femurs close to the
body.20 The tibias are angled 120˚ to the femurs, and
the hips are internally rotated 45˚ to prevent the greater
trochanter from interfering with visualization of the
dorsal acetabular rim.20
A 2-inch spacer is placed between the calcaneal tuber
and the examination table to increase the tension in the
hamstring muscles in order to pull the ischiatic
tuberosity cranially with respect to the tuber sacrale.20
This causes the pelvis to be aligned vertically so that the
radiographic beam passes through the shaft of the ili-
um.20 After the DAR view is obtained, lines can be
drawn tangential to the point of lateral contact between
the femoral head and the dorsal acetabular rim on both
hips. In dogs with normal hips, the angle at the point
of intersection of the lines is 165˚ to 180˚.20 In dogs
with hip dysplasia, the angle is reportedly less than
165˚20; however, there is no reported correlation be-
tween this angle and the development of DJD.
ACETABULAR FILLING ■ PALPATION FINDINGS ■ STRICT CAGE REST
The Compendium August 1996
The DAR radiographic view accurately confirms pal-
pation findings of damage to the weight-bearing por-
tion of the acetabulum.20 The view is used to identify
dorsal acetabular rim osteophytes, acetabular filling,
and the lateral extent of the acetabulum and resultant
dorsal coverage of the femoral head.20,21 The DAR ra-
diographic view has been recommended as part of the
evaluation process for patients with CHD and as an aid
in determining disease, treatment options, and progno-
sis.20,21
TREATMENT
By the time of diagnosis, the pathologic changes of
CHD are often irreversible. No treatment is effective in
restoring a dysplastic joint to a completely normal cox-
ofemoral joint. The aims of treatment are alleviating
pain, arresting secondary degenerative changes, and
producing maximum joint function. Decision making
in treating a patient with CHD should be based on the
age and health of the dog, the clinical severity of the
disease, the radiographic appearance of the joint, the
intended function of the dog, and the financial con-
straints of the owner.
Medical Therapy
Medical therapy for patients with CHD involves
controlled exercise, weight control, antiinflammatory
agents, and analgesics. Medical therapy is oriented to-
ward alleviating pain and slowing the deterioration of
the coxofemoral joint. Medical therapy does not correct
the problems associated with CHD or arrest the pro-
gression of disease. Such therapy thus should be re-
served for patients with mild or intermittent clinical
signs. Medical therapy may be effective as palliative
treatment for young dogs before total hip replacement
and for geriatric patients with minimal activity levels.
Monetary considerations may prompt the client to
choose medical therapy alone.
Activity should be reduced to a level that the patient
can tolerate without signs of pain or exercise intoler-
ance.22 Exercise should initially be restricted to short
leash walks, then gradually increased to the maximum
level of function that does not cause pain or lameness.22
Non–weight-bearing activities (e.g., swimming) are an
excellent means of exercise and avoid concussive trau-
ma to the joints. Strict cage rest has been recommended
as preventive therapy for dogs predisposed to or affect-
ed by CHD.5 Severe exercise restriction can result in in-
creased exercise intolerance, loss of muscle mass and
tone, decreased range of motion, exacerbation of carti-
lage destruction, and social maladjustment.5,22
The patient’s weight must be maintained in the opti-
mum range for the age and breed. Weight loss is vital in
Small Animal
obese patients. Diet control can be accomplished via
foods specifically formulated for this purpose (reducing
diets or low-calorie diets) or via reduced portions of a
maintenance-type dog food.22 Protocols for weight con-
trol have been outlined.22,50 Conservative therapy, con-
sisting of exercise restriction and weight control, is ef-
fective in controlling pain and lameness in a significant
number of dogs with CHD.51
Antiinflammatory analgesics should be considered
for adjunctive therapy in medically managed patients.
Many protocols have been suggested.2,3,10,22–26,52,53 Oral
aspirin (10 to 25 mg/kg every 8 to 12 hours), 3,10,22
phenylbutazone (1 to 5 mg/kg divided every 8
hours),3,10,22 meclofenamic acid (1.1 mg/kg every 24
hours),3,22 and carprofen (2 mg/kg every 12 hours)52,53
are reportedly effective. Aspirin is effective in most cas-
es and is easily accessible and inexpensive. Buffered or
enteric-coated products are recommended to minimize
the gastric irritation and ulceration that can be a com-
mon side effect of these medications.22
Recent reports suggest that polysulfated glycosamino-
glycan (4.4 mg/kg every 3 to 5 days for eight intramus-
cular injections) has beneficial antiinflammatory ef-
fects, but no statistically significant results have been
reported in severe cases of CHD.23–26 Corticosteroids
can be used, but care is necessary to avoid immuno-
suppression, adrenal suppression, and exacerbation of
cartilage damage. Hyaluronate and glucosamine–
chondroitin salts have been promoted for medical man-
agement of DJD.54,55 To date, no controlled studies
have reported use of these products to treat CHD.
Pectineal Myectomy
Pectineal myectomy is a controversial treatment for
patients with CHD. The procedure, which does not
correct the disease or arrest its progression,10,27,28 was
originally proposed to relieve muscle spasm and the as-
sociated pain.28 The technique is reportedly effective in
relieving pain in some cases.2,3,10,27,28 The pain relief has
been attributed to release of muscle tension, reduced
stress on the joint capsule, and increased abduction re-
sulting in articular alterations. Myectomy is preferred
to myotomy in preventing postoperative fibrosis and
contracture.3,10 The procedure is usually performed bi-
laterally. Postoperative care should include moderate
exercise 2 to 3 days after surgery.10
Complications associated with pectineal myectomy
include postoperative hematoma formation and the
possibility of fibrous bands forming at the excision
site.3,10,27,28 Furthermore, pectineal myectomy may be
ineffective in controlling the pain associated with
CHD.3,10,27,28 The technique is no longer widely advo-
cated for treating patients with CHD.
LOW-CALORIE DIETS ■ PUBIC OSTEOTOMY ■ ACETABULAR ROTATION
The Compendium August 1996
Triple Pelvic Osteotomy
If the biomechanical imbalance in a dysplastic hip is
corrected early in the progression of CHD, the coxo-
femoral joint can return to normal function.3,29,30 Triple
pelvic osteotomy (TPO) is a surgical procedure designed
for this purpose. Ideally, correction takes place before
complete skeletal maturity and before secondary degen-
erative changes occur.56 The goals of TPO are correction
of femoral head subluxation and restoration of the coxo-
femoral weight-bearing surface area.31–35 In our opinion,
the ideal candidate for this procedure is a young dog
(<10 months of age) with clinical signs of CHD, radio-
graphic subluxation, and no secondary degenerative
changes. Selection criteria for performing the procedure
vary among surgeons, and successful outcomes have been
achieved in patients older than 10 months.
Several variations have been described for performing
pelvic osteotomy with axial acetabular rotation.27,31–35,37
The technique most often used by veterinary orthope-
dists requires three incisions to create a pubic osteoto-
my or subtotal pubic ostectomy, an ischial osteotomy,
and an ilial osteotomy.10,27,31,37 The pubis is approached
ventrally, the ischium caudally, and the ilial body later-
ally.10,27,36 The ilial osteotomy is stabilized via internal
fixation. Plates that are available for fixation include a
canine pelvic osteotomy plate, an AO/ASIF (Associa-
tion for the Study of Internal Fixation) triple osteoto-
my plate, and a standard AO/ASIF dynamic compres-
sion plate twisted to the desired angle.
The canine pelvic osteotomy plate is available for the
left or right hemipelvis, with one of three angles of ro-
tation: 20˚, 30˚, or 40˚.10,27 We prefer the 20˚ or 30˚
plates for providing accurate acetabular rotation and
stable fixation while avoiding overrotation and severe
pelvic-canal narrowing.37,56 The AO/ASIF 2.7- or 3.5-
mm triple osteotomy plate is available at a preset angle
of 45˚. The ischial osteotomy can be stabilized with
one hemicerclage orthopedic wire. No fixation is neces-
sary for the pubic ostectomy.
The degree of axial acetabular rotation is determined
by measuring the angles of subluxation and reduction,
radiographic evaluation (DAR view), and intraopera-
tive observation and palpation for Ortolani sign and
range of motion.10,27,37,56 The optimum angle of acetab-
ular rotation is approximately 5˚ to 10˚ smaller than
the angle of reduction.10 The angle of subluxation pro-
vides the value for the minimal amount of acetabular
rotation.10 The actual angle used for acetabular rotation
should be the minimum angle necessary to maintain
coxofemoral stability.35,37 Overrotation can lead to im-
pingement of the dorsal acetabular rim on the femoral
neck and abnormal coxofemoral articulation.10,27,31,35
Underrotation results in continued subluxation.
Small Animal
Postoperative management involves exercise restric-
tion until radiographically evident healing of the ilial
osteotomy, followed by a gradual return to normal
function.10,14,31 A sling can be used to provide internal
rotation and abduction and to prevent weight bearing
for 2 to 3 days after surgery if necessary.14 Triple pelvic
osteotomy can be performed in the contralateral hip at
least 2 to 6 weeks after the first surgery if surgical selec-
tion criteria are still fulfilled.3,10 Simultaneous bilateral
TPO has been recommended, especially if delaying
surgery would allow degenerative changes.57
Complications associated with TPO include narrow-
ing of the pelvic canal, constipation, urethral injury,
overrotation of the acetabulum (resulting in limited
femoral extension and abduction), implant failure,
infection, sciatic nerve palsy, persistent incongruity,
and failure to retard the progression of degenerative
changes.10,14,27,31 Proper preoperative selection and good
surgical technique should alleviate pain, arrest sec-
ondary degenerative changes, and allow normal joint
function.3,10,14,29–31,35 Long-term success, as determined
by normal weight bearing and limb function, reported-
ly ranges from 72% to 92%.14,29–31
Total Hip Replacement
In our opinion, total hip replacement (THR) is the
best treatment option for dogs that are clinically affect-
ed with DJD resulting from CHD. Total hip replace-
ment is a salvage procedure that can produce a func-
tionally normal joint, eliminate secondary degenerative
changes, and alleviate joint pain.3,10,38 Various tech-
niques have been described.38,39,58 Cemented and ce-
mentless prostheses are available. Currently, cemented
prostheses are most commonly used. Total hip replace-
ment is an option in most cases of CHD. The candi-
date should be skeletally mature (closed trochanteric
physis) and have pain and/or lameness attributable to
coxofemoral disease.3,10,38,59 Dogs must weigh at least 35
to 50 pounds to accept the prosthesis. With currently
available implants, there is no maximum size limit.
Contraindications include infection, neurologic dis-
ease that affects the hindlimbs, and concurrent ortho-
pedic problems.10,38,59 Systemic disease is a potential
contraindication.59 The procedure can be done bilater-
ally, with at least 2 to 3 months between surgeries.38,59
Unilateral THR, however, reportedly results in accept-
able function in 80% of dogs with bilateral disease.61
The surgical procedure involves a craniolateral ap-
proach to the hip, with partial tenotomy of the deep
gluteal and vastus lateralis muscles. After arthrotomy,
the femoral head and neck are excised. The acetabulum
is reamed to the medial cortex. The acetabular com-
ponent is then placed appropriately. The femoral
PELVIC CANAL NARROWING ■ POSTOPERATIVE MANAGEMENT ■ SALVAGE
The Compendium August 1996
medullary canal is then drilled, reamed, and shaped.
The femoral endoprosthesis is positioned and secured.
If a modular prosthetic system is used, an appropriately
sized femoral head is seated on the neck of the femoral
prosthesis. The size of each component is determined
by comparing templates to preoperative radiographs.
The prosthetic joint is reduced; closure, including the
joint capsule, is performed routinely.
Postoperative management is vital to successful treat-
ment. For the first week after surgery, activity is restricted
to leash walking with support of the hindlimbs.59 Activi-
ty restriction should continue for the first month, with a
gradual return to normal function 10 to 12 weeks fol-
lowing surgery.38,59 Clinical and radiographic evaluation
is recommended at 6 and 12 weeks after surgery.59
Total hip replacement is reported to have a 91% to
95.2% success rate.38 Complication rates vary widely
and decrease (6.3% or less) with increased surgical ex-
perience.60 Complications include dislocation (1% to
8.7%),61,62 osteomyelitis (1.1% to 7.7%),39,60,61 aseptic
component loosening (3.1%), 61,62 femoral fractures
(3.2%),61 and sciatic neuropraxia (2.2% to 3.1%).61,62
Infection is the most severe complication.
No cases of osteomyelitis associated with THR have
been successfully treated without implant removal.59,61
In all reported cases, sciatic neuropraxia has resolved in
3 to 15 weeks.61 In successful procedures, patients can
be expected to demonstrate full range of motion, in-
creases in pelvic muscle mass, and pain relief.3,10,38,39,59 In
light of the excellent results and minimal complications
associated with THR, expense and availability are usu-
ally the major determinants in clients’ decisions.
Femoral Head and Neck Excision Arthroplasty
Femoral head and neck excision (FHNE) arthroplasty
is a salvage procedure. Joint function and pain are elimi-
nated, and only a fibrous pseudojoint exists.40–42,46–48 The
pseudojoint is less stable than normal, and the range of
motion is reduced.3,40–42,46–48 Femoral head and neck ex-
cision arthroplasty can be performed at nearly any stage
in the progression of CHD. Most surgeons wait until
secondary degenerative changes and the associated pain
are prevalent. Severe muscle atrophy may result in a less
favorable outcome.63 For optimum results, the surgical
candidate should weigh less than 18 to 20 kg.46,47 Be-
cause most dogs treated for CHD weigh more than 20
kg, the procedure has produced less favorable outcomes
than those of other CHD treatments.42,46–48,63
The traditional technique for FHNE has been de-
scribed.40–42 Modifications of the procedure using inter-
posed muscle flaps have also been reported.43,44 No ad-
vantage in using the modified techniques has been
demonstrated.3,27,45,46 A craniolateral approach to the
The Compendium August 1996
hip is most often used because it provides adequate ex-
posure and does not require tenotomy of the gluteal
muscles.10,36,40–42 The joint capsule is incised, and the
femoral head is luxated laterally.10,40–42 Incision of the
ligament of the head of the femur (if intact) and joint
capsule attachments is necessary to facilitate complete
luxation and adequate exposure.10,40–42 The osteotomy
extends from the medial aspect of the greater tro-
chanter to a point immediately proximal to the lesser
trochanter.10,40–42 An oscillating saw or sharp osteotome
should be used for the osteotomy. Irregularities at the
osteotomy site should be smoothed with rongeurs or a
bone rasp.10,40–42
Complications associated with FHNE include short-
ening of the limb, abnormal limb motion, muscle atro-
phy, varying degrees of lameness, patellar luxation, and
compromised joint function.3,10,42,45–48 Pain can result if
excision is inadequate.3,46-48
Postoperative management involves a rapid return to
exercise (in 7 to 10 days) to promote formation of the
fibrous pseudojoint while maintaining muscle mass and
range of motion.10 Physical therapy involving active
flexion and extension exercise should begin 2 to 3 days
after surgery.10 Success rates, as determined by slight or
intermittent lameness, reportedly range from 60% to
83%.46–48
CONCLUSION
Canine hip dysplasia is a multifaceted disease that
is still not fully understood. The pathophysiology and
biomechanics of CHD are important considerations for
the veterinary practitioner and influence diagnosis,
treatment selection, and prognosis. Diagnosis of CHD
is based on signalment, history, complete physical and
orthopedic examination findings, and radiography. Ra-
diographic severity must be viewed in light of the clini-
cal severity of the disease.
Available treatment options and the associated prog-
nosis, complications, and aftercare should be thorough-
ly described to clients with dysplastic or potentially
dysplastic dogs. The choice of treatment is determined
by clinical signs; diagnostic findings; the age, health,
and intended use of the dog; the availability of treat-
ment; and the financial constraints of the client.
About the Authors
Drs. Cook and Tomlinson are affiliated with the Depart-
ment of Small Animal Surgery, and Dr. Constantinescu is
with the Department of Veterinary Biomedical Sciences,
College of Veterinary Medicine, University of Missouri,
Columbia, Missouri. Dr. Tomlinson is a Diplomate of the
American College of Veterinary Surgeons.
ADEQUATE EXPOSURE ■ ABNORMAL LIMB MOTION ■ BIOMECHANICS
Small Animal
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