Hip dysplasia in dogs (and elbow dysplasia): how do I recognise it and what comes next?

Your seven-month-old German Shepherd chases the ball with his back legs tucked together, hopping like a rabbit. Or your year-old Labrador is slow to get up after a nap, sits with one leg sticking out to the side and has stopped jumping into the car. Or someone in the park has told you your adult dog "has bad hips, you can see it in the way he walks". Hip and elbow dysplasia are the most common inherited orthopaedic conditions in large dogs. They do not go away on their own. Even so, a dysplastic dog can have a long, active life if you catch it early and work with your own vet. This page covers the signs to watch for, what to write down and what happens at the surgery.

When should you ring the vet today?

Dysplasia develops slowly, over months and years. A few situations still need a call the same day:

• he will not put the leg down at all, or yelps when you touch his hip or elbow;
• he cannot get up on his own, or his back legs suddenly give way;
• a large-breed puppy has been lame for more than two or three days, however cheerful he seems otherwise;
• the lameness comes with a temperature, a hot swollen joint, or he has gone off his food;
• weak back legs, a drunken wobble, toes scuffing along the ground, leaking urine. That looks more like a spinal problem and is an emergency.

One more thing. In a dog already known to be dysplastic, pain that appears out of nowhere can have another cause: a torn ligament, a sprain, the spine. Do not blame the hips by reflex.

What can you watch for at home?

The vet makes the diagnosis from X-rays. You, though, see him every day on the tiles, on the stairs and at play, and what you notice matters at the appointment.

Hips

• runs with both back legs together, "bunny hopping";
• is slow to get up, especially in the morning or after a busy day;
• sits crookedly with one leg out to the side instead of tucked under;
• hesitates at the stairs, at jumping into the car or onto the sofa;
• sways his hips as he walks, with short steps behind;
• has thin thighs, while his shoulders look much stronger than his back end;
• gives up on play sooner than other dogs his age.

Elbows

• limps on a front leg, usually between 5 and 12 months, worse after rest or a long walk;
• holds the elbow slightly out with the paw turned;
• does not like you stretching that front leg;
• sometimes the limp moves from one front leg to the other, because both elbows are affected.

Get your phone out and film him. From behind as he walks away from you, from the side at a trot, and as he gets up after a sleep. A minute of video tells your vet more than any description you could give.

What else to write down

If your puppy came from a breeder, ask whether the parents were officially X-rayed and what their results were. Good results in the parents guarantee nothing, but they shorten the odds.

What will the vet check?

1. History. Age, breed, when you first noticed, how things are now, your videos.
2. Orthopaedic exam. The vet watches him walk and trot, then feels each joint, checks how far it bends and straightens, looks for the sore spot and compares the muscles left and right.
3. Laxity tests. In puppies the vet may check how loosely the hip sits in its socket. This is usually done under sedation, because an awake dog tenses his muscles and hides the looseness.
4. X-rays. Hips and elbows are X-rayed in precise positions, nearly always under sedation or anaesthetic, otherwise the pictures are not accurate. They show the shape of the joint, how well the head of the thigh bone sits in the socket and whether arthritis has started, meaning wear of the cartilage with new bone growing round the edges.
5. Further tests for elbows. Sometimes a CT scan or arthroscopy (a small camera put into the joint) is needed, because some elbow lesions do not show up well on X-rays.
6. Official scores. Breeding dogs can have X-rays officially graded: for hips, A (normal) to E (severe dysplasia) under FCI rules, from at least a year old; for elbows, grades 0 to 3. If you want to breed from your dog, ask about them.
7. The plan. It depends on his age, how bad it is and how much it hurts:
   • keeping his weight down, the most powerful thing you can do at home; lean dogs get arthritis later and more mildly;
   • controlled exercise: regular on-lead walks on soft ground instead of long runs and jumping;
   • physiotherapy and hydrotherapy (underwater treadmill, swimming), to build the muscles that hold the joint;
   • pain relief, chosen by the vet, in courses or long term;
   • surgery, for some dogs. In very young puppies there are procedures that change how the pelvis grows, in young dogs without arthritis procedures that reorient the pelvis, and in adults in a lot of pain a total hip replacement or removal of the head of the thigh bone. For elbows, arthroscopy takes out the bone fragments. What suits your dog is for a vet with orthopaedic experience to decide, often after a second opinion.

Ask what he can still do, too: which sports, what sort of walks. Plenty of owners stop everything out of fear, and the dog loses exactly the muscle that keeps him on his feet.

What should you not do at home?

• Never give him human painkillers. Many are toxic to dogs and cause ulcers or kidney damage even in small amounts. Pain relief is the vet's call.
• Do not shut him away for months "to rest". Without exercise the muscle melts away and the joint loses its support. Regular gentle exercise is part of the treatment.
• Do not let him get fat. Every extra kilo presses on joints that are already working at the wrong angle. In a dysplastic dog you should feel his ribs easily under your palm.
• No running beside the bike and no repeated jumping for frisbees or balls thrown a long way, especially while he is a puppy. Sprinting, slamming on the brakes and landing are the hardest moments for hips and elbows.
• Do not leave bare tiles on his routes round the house. A puppy who slips dozens of times a day is loading his joints at exactly the age they are forming. Put rugs down.
• Do not buy "joint" supplements at random instead of seeing the vet. Some have weak evidence behind them; if you want to try one, ask your vet which and when.
• Do not breed from a dysplastic dog. It is inherited and turns up in the puppies even when the parent "isn't lame".

Exercise that does him good

Long walks at a steady pace on grass or earth, gentle slopes, swimming and nose games are kind to the joints. In our mantrailing sessions we see dogs with operated or well-managed dysplasia working a trail with real enthusiasm. They go at their own pace with their nose down, no sprints and no jumps, and at the end their head is tired while their hips have barely noticed. Before taking up a new sport, ask your vet what pace and how long suit him.

With puppies, the best prevention is in how they grow. Keep him lean, feed a large-breed food in the right amount with no added calcium on top of a complete diet, and let him move freely on varied ground rather than taking him on long forced walks. Inherited dysplasia cannot be prevented completely, but it can end up a lot milder.