Front Matter

Chapter 14 Disorders of the Pelvic Limb: Diagnosis and Treatment 363

assessment of joint conformation, laxity, and
degenerative changes in dogs at least 2 years
of age. Lastly, submission of radiographs to the
OFA by breeders and veterinarians is optional;
consequently, underestimation of the prevalence
of HD is likely (Powers et al., 2010; Gatineau
et al., 2012; Verhoeven et al., 2012).
Other radiographic views have been devel­
oped to objectively diagnose HD earlier in the
disease process (Powers et al., 2010; Gatineau
et  al., 2012; Verhoeven et al., 2012). PennHIP®
measures joint congruity by calculating the
relative displacement of the femoral head from
the acetabulum during coxofemoral distrac­
tion, thus accounting for passive joint laxity
(Powers et al., 2010). The calculated distraction
index (DI) predicts the likelihood of developing
OA compared with other dogs of the same
breed (Runge et al., 2010). PennHIP® has been
validated as a reliable screening tool in dogs
as young as 6 months (Powers et al., 2010).
When compared directly, the OFA underesti­
mates the susceptibility to OA compared with
PennHIP® (Powers et al., 2010). The Norberg
angle, dorsal acetabular slope, and dorsolat­
eral subluxation view are other objective
methods of evaluating HD (Gatineau et al.,
2012; Verhoeven et al., 2012).

Nonsurgical management

Nonsurgical management involves a multimodal
approach including activity modification, reha­
bilitation, and pain management, maintenance
of a lean body condition, pharmacological
modulation of joint disease, and regenerative
and complementary medicine.
A systematic review of the veterinary litera­
ture regarding nonsurgical management of
HD found high levels of evidence in support
of weight management through dietary restric­
tion, parenteral administration of polysulfated
glycosaminoglycans (PSGAGs), and adipose‐
derived stem cell therapy (Kirkby & Lewis,
2012). Additional techniques that have been
shown to be effective include acupuncture,
extracorporeal shock wave therapy (ESWT),
and omega‐3 fatty acid supplementation (Roush
et al., 2010).
At the time of this publication, scientific
evaluation of physical rehabilitation, including

therapeutic exercise and hydrotherapy, for the

management of HD and OA in dogs has not

been investigated. However, considering the

role of passive joint laxity in the pathogenesis of

HD, it is practical to assume that strengthening

of the soft tissue support structures of the hip

would be beneficial. In fact, German Shepherd

Dogs are more likely to develop hip OA at a

lower distraction index (less passive laxity) than

more well‐muscled breeds such as Rottweilers

(Gatineau et al., 2012). Initiation of a comprehen­

sive rehabilitation program for a dog with HD

will likely prove successful either alone or com­

plementary to surgical intervention.

Surgical management

Joint preservation procedures

Greater degrees of hip laxity correlate with an

increased likelihood of secondary OA, but not

necessarily clinical disability. There are two

surgical procedures that aim to improve the

clinical signs associated with coxofemoral lax­

ity in skeletally immature dogs.

Juvenile pubic symphysiodesis

Juvenile pubic symphysiodesis (JPS) causes pre­

mature closure of the pubic symphysis. This

procedure results in ventral rotation of the

dorsal acetabular rim as the remaining growth

plates continue to grow. The technique reduces

the risk of progression of HD in cases of mild to

moderate hip laxity, but is significantly less

effective in addressing more severe laxity. In

puppies with more severe laxity, the progressive

correction of acetabular orientation would fail

to capture the femoral head. JPS should be per­

formed before 16 weeks of age to improve hip

stability (Patricelli et al., 2002; Bernarde, 2010).

Consequently, JPS is recommended in dogs that

are unlikely to have any contemporary disabil­

ity from HD. Dynamic imaging of the hips to

demonstrate laxity (e.g., hip distraction with

PennHIP®) should guide selection or exclusion

of the individual dog as a candidate for JPS.

Triple or double pelvic osteotomy

Triple or double pelvic osteotomy (TPO or

DPO) aims to increase dorsal acetabular rim