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Hip dysplasia in dogs (part 2): The real cost of diagnosis

Posted Oct 27 2008 12:10pm

Now that we’ve discussed some of the politics of hip dysplasia in dogs (in last week’s post on the same subject) it’s time to count the nuts and bolts involved in its diagnosis.

Every dog is potentially at risk of suffering hip dysplasia—no matter his or her breed. This post is intended to help those of you who take on new dogs (whether it’s a purebred pup or older mix) learn more of the ins and outs of how vets come to this diagnosis so you can be more proactive in your dog’s long term orthopedic health.

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As mentioned in the previous discussion, the treatment for hip dysplasia in dogs tends to depend on the age at which the condition presents itself and the severity of disease once it’s diagnosed. As with any disease, the sooner it’s diagnosed the more options that can be made available for its treatment.

So how does an owner come to realize that their dog has hip dysplasia? Unless a pet limps, has an abnormal gait or shows some other sign of discomfort, most owners don’t worry unduly about hip disease.

Enlightened owners and breeders who understand their breed’s predisposition to hip disease, however, are likely to understand that poor hip conformation can lurk beneath the surface for many years before outward signs become obvious. And with a proactive veterinarian as partner, even the most inexperienced owner is given the choice to have their pet diagnosed early.

For me it starts at the first puppy visit…and continues at each successive physical examination.

Pups can be unusually willing to have their joints manipulated. This opportunity means that even the tiniest babies can often receive a tentative diagnosis for at-risk hips. Pups with “crepitance” (a grinding sensation) in one or both hips on manipulation can be flagged as requiring follow-up attention in the form of X-rays as early as four to six months of age.

With basic X-ray techniques pioneered by the Orthopedic Foundation for Animals (OFA), a certifying organization for canine hips, even pups at this young age can be identified as having dysplastic hips—which means they can potentially receive treatment (surgical or otherwise) at this time.

A basic set of X-rays of this type will run anywhere from $150 to $500 in most general practice settings. The cost depends on whether sedation is deemed necessary (usually it is if you want the best set of X-rays available) and whether a consultation with a radiologist or surgeon is in order—if there’s any doubt, consultation with a specialist is always the right approach.

This is how we position dogs for OFA hip X-rays:



Though OFA will not “certify” an animal for good hip conformation until two years of age (when hips in most breeds no longer change their basic joint structure), X-rays of this type will often prove sufficiently diagnostic for younger pets who are moderately to severely affected.

Here's what "excellent" OFA hips look like in a beagle:



Here's an example of mild hip dysplasia in a similar dog (see how the ball of the hip joint isn't as well-set into the socket?:



Here are poor hips (see how the ball part of the hip joints are barely in the sockets?):



Certification (which is strongly recommended for breeding animals) can, however, be achieved earlier through an alternate method:

PennHIP is another diagnostic approach that requires deep sedation or anesthesia (due to the specific position they must be placed in for the X-rays). Pioneered by one of my profs at the University of Pennsylvania, it’s considered a more sensitive test than the OFA method. That's because it's considered a more objective measurement of hip conformation. As such, it can be applied as early as four months of age to predict even geriatric changes to the hips.

This is how we position dogs for PennHIP X-rays:



And here's what the PennHIP X-rays look like:



Unfortunately, the PennHIP method is not frequently applied, mostly because vets need to take a course before they can certify animals with it. Though most specialists consider it a superior predictor of disease than the OFA version, adoption of the PennHIP method is hampered by its perceived complexity (we take measurements of the hips from the X-rays) and the need for veterinary certification.

The cost for PennHIP X-rays consequently runs a bit higher ($300-$600, on average).

Of course, not all dogs are subjected to X-rays at this young age. The expense (and risk of sedation, even if minor) often precludes these diagnostic procedures. Much though I’d like to screen ALL my canine patients by six months, I realize that the cost of this approach can seem prohibitive given the relatively low risk of requiring early intervention-type care for hip disease.

That’s why the vast majority of my patients are X-rayed as older dogs, once signs of probable hip disease become evident.

If an inexpensive genetic (blood) test were available, it would certainly improve our ability to treat these dogs and, furthermore, to prevent even mildly affected animals from breeding and passing on the trait.

But for now, asking your vet about hip disease and concerning yourself with the long-term orthopedic health of your dog (especially if he’s a large or giant breed) is possible through these early tests.

If you have a large breed dog, especially if she’s a high risk breed (shepherd, Lab, golden, Rottweiler, etc.), think seriously about spending the extra cash early on. In fact, why not ask your vet to snap off some X-rays when he/she’s under anesthesia for castration/spay? After all, it only costs an extra hundred (or two, at the most) if the pet is already anesthetized for another procedure.

If every dog owner were so cautious and considerate of their pet’s orthopedic future by investing their hip wellness through early diagnosis, we’d surely prevent a tremendous amount of suffering in the form of early treatment. After all, the real cost of diagnosis is minimal if it means preventing much larger expenses later in life.

Stay tuned for more on this in next week’s post.
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