GiGi is a 10 year old female spayed French bulldog mix. She presented to the Carroll County Animal Hospital because her owner noticed that she was not acting normally. Recently, she has playfully wrestled with another dog in the household and has been reluctant to climb up and down the stairs. Her owner was very vigilant in caring for her pets, she thought that Gigi probably hurt her back. Gigi was also due for annual vaccines, fecal exam, and heartworm test.Physical Exam
Gigi was bright and responsive on physical exam. Her ears had mild debris and wax present. Eyes and nose were normal with no discharge. Gigi had mild plaque and tartar accumulation on her canine teeth and molars. Her capillary refill time was normal - less than 2 seconds. Her mucous membranes were pink and moist. Gigi’s lymph nodes were normal. On thoracic auscultation, Gigi’s heart auscultated normally with no murmurs or arrhythmias; Her lungs were clear bilaterally with no crackles or wheezing. Gigi’s skin was smooth with no signs of parasites, hair loss, or masses. On musculoskeletal exam, Gigi had normal non painful range of motion on both her front limbs and neck. She was quite stiff on spinal exam through her thoracic vertebra; also, she was mildly sensitive to lateral movement in the lower lumbar and sacral vertebra. When Gigi’s hips and hind limbs were evaluated, she showed increased signs of pain. Although her ankle and knees had no pain on exam through full range of motion, her right hip showed significant signs of pain when flexed and extended. She had moderate crepitus present on her right coxofemoral joint (hip joint). Gigi’s left hip was normal and had good range of pain free motion.Laboratory
Gigi’s owner opted for our senior wellness package which included full blood work: a complete blood count and a diagnostic chemistry panel. As our pets get older, it is very important to have routine lab work performed in order to catch potential disease processes earlier rather than later. Gigi’s laboratory results were normal.Diagnostic Imaging
Since Gigi had pain through her range of motion on her right hip, it was important to take a closer look by obtaining X Rays. Since Gigi had Xrays taken of her pelvis, since that where she seemed painful, and Xrays of her spine. The X Ray is pictured below.Diagnosis and Assessment
After reviewing Gigi’s case, it is clear that she has a degenerative arthritic process occurring in her Right Hip. She has Hip Dysplasia. In addition to the findings on physical exam, the X Ray image allows visualization of the changes between each coxofemoral joint. This is a very painful process that occurs in many different dog breeds, both large and small. This condition usually occurs in mature/senior pets, but it can also manifest in young growing highly active dogs that are genetically predisposed. Spinal x rays were normal.Treatment
Gigi’s owners elected to manage Gigi’s Hip dysplasia medically with a short course of nonsteroidal anti-inflammatory drugs, long term pain medications, and Polysulfated glycosaminoglycans. The latter medication is a joint fluid modifier. Although this drug therapy program will not reverse the damage that has occurred in Gigi’s hip joint, the anti-inflammatory and pain medication will alleviate discomfort associated with this condition. The joint modifier will help slow the progression of this disease and more importantly, help prevent the onset of other degenerative joint diseases.Next level Treatment
There are surgical option for treating hip dysplasia for select candidates. The 2 most popular surgical options are Total Hip Replacement and Femoral Head and Neck Osteotomy.
Total Hip replacement - This procedure removed the damaged hip joint entirely and a prosthetic joint is surgically placed to eliminate previous bone on bone contact that was causing pain.
Femoral head Osteotomy- This is a salvage orthopedic procedure for those patients who are not candidates for total hip replacement. Femoral Head osteotomy is a permanent removal of the hip joint by removal the femoral head and neck. This will form a pseudoarthrosis. This procedure eliminates bone on bone contact as well and the large muscle group surrounding the area provides support. Smaller breed dogs tend to do better with this procedure than larger breed dogs.Conclusion
Gigi was diagnosed with hip dysplasia 3 months ago. Although she occasionally has days worse than others, her owners report that she has improved significantly as she is still on her oral and injectable medications.