“Should My Dog Have Hip Surgery?”
[ VIDEO TRANSCRIPT BELOW ]
Dr. Wooten: Hi everybody! I am Dr. Sarah Wooten, and I am here with Dr. Dycus, and he is going to talk to us today a little bit about hip dysplasia. I want to talk a little bit about his letters that he has. Because, he has lots of letters, so you should really listen in. Okay?
Dr. Wooten: So, you’re a DVM.
Dr. Dycus: That’s correct.
Dr. Wooten: Doctor of Veterinary Medicine.
Dr. Dycus: That’s correct.
Dr. Wooten: You have a Master’s in Veterinary Science.
Dr. Dycus: I do.
Dr. Wooten: You are a CCRP. What is that?
Dr. Dycus: Yeah. So, that’s a Certified Canine Rehabilitation Practitioner which basically means I’ve had some additional training in the area of physical rehabilitation.
Dr. Wooten: That’s awesome. Then, you are a DACVS.
Dr. Dycus: Yeah, so that means I am a Diplomat of the American College of Veterinary Surgeons. When I finish veterinary school, instead of being smart like some of my classmates and going out practice, and getting a job, I decided to put my student loans on hold and do an internship at a residency so that I could become a boarded surgeon.
Dr. Wooten: So, you do orthopedic surgery?
Dr. Dycus: You got it. I focus strictly in the area of orthopedics of dogs and cats.
Dr. Wooten: Okay. Our audience really wants to know everything you have to say about dysplasia for pet parents. Let’s talk about it as if I was coming to see you.
Dr. Dycus: Sure.
Dr. Wooten: I was suspicious that my dog might have hip dysplasia.
Dr. Dycus: Got ya.
Dr. Wooten: So, what would that look like?
Dr. Dycus: Well, one of the more common complaints that people come in with, especially with younger dogs, is the so-called bunny hopping when they’re running or when they’re trying to go up and down stairs or that sort of thing. While we associate bunny hopping with the dysplasia, it can really be due to any kind of hind limb issue. So, bunny hopping in and of itself can be a sign of hip dysplasia, it doesn’t mean your dog has hip dysplasia.
Dr. Dycus: Other things that you could interpret as being painful could be that we have a puppy that maybe they’re in the middle of playing and they like to just sit down, or the self-limit. You know? You can tell they really want to grab the ball and play but they would rather just lie there. Or, you take them on walks and they start to sit down or they can’t finish their walk. Or, the best thing that we sometimes like to see is what we call a hip sway. So, think about Marilyn Monroe, or think about any type of model walking down a runway where they have a nice hip sway. Ultimately, dogs will have a hip sway that we like to think is very cute in a puppy, but it’s not normal for them to have a hip sway. A lot of them come to me with some of these complaints, and then we could start the process of trying to figure out if a dog truly has hip dysplasia or not.
Dr. Wooten: What would be the first step?
Dr. Dycus: The first step is going to be me watching them walk or observe them walking. Observe them running or trotting. Then, it’s going to involve an examination. In a young dog, there’s a few things that we can pick up on in examination that might suggest something’s going on. For example, if a dog is painful when we extend their hips, or we try to go hip extension, that can indicate signs of discomfort. But, there is a test for lax. It was derived from the human arena. What they would do in babies. That’s checking for hip lax. It’s a test called an ortolani where we basically mimic what’s happening clinically because the whole basis behind hip dysplasia is that we have abnormal formation of the ball and socket.
(There’s a dog bed expertly calibrated to help dogs with hip dysplasia and other painful joint conditions)
Dr. Dycus: Instead of having a nice fit of the ball and socket, we have laxity. So, what’s happening is when their foot is in the air during the gate, the hip will sublexi a little bit, then when the foot strikes the ground, it’ll snap back into the ball and into the cup. We can mimic that clinically to tell us if the dog has hip laxity or not. Those are a few things we can use on an examination to tell us if we think a dog has hip dysplasia, but the problems is, is we can’t diagnose hip dysplasia based on examination alone. We actually have to take x-rays or radiographs. Radiographs are going to be sort of our mainstay when it comes to diagnosing hip dysplasia.
Dr. Dycus: There are a couple of views that we can use to take to see if a dog has hip laxity or ultimately, the end result of hip dysplasia is arthritis. We can see if a dog has arthritic changes. Now, a puppy probably shouldn’t have arthritic changes. If they do, that’s a major red flag that something’s going on. There’s also another type of radiograph. It’s a very special type of radiograph we can take called a PennHIP distraction x-ray where basically, we are going to force the ball out of the cup with a little device and we can use a mathematical calculation to determine what’s called the distraction index or how much laxity a dog has. That can give us an idea that underlying dysplasia is present.
Dr. Wooten: If I brought like say, my puppy is 14 weeks of age. Not probably going to see any arthritis at that point. Can you take an x-ray at that point and diagnose hip dysplasia?
Dr. Dycus: Yeah. A fourteen-week old puppy is going to be a pretty young dog to try to pick up good changes on hip extension. You know, many of them, they’re going to be squirmy. They’re not going to show a lot of pain when using their hips. It may be hard to actually get laxity or ortolani, but you can take x-rays and you can see if the dog maybe has some changes that might mean that we’re going to have some issues we need to pay attention to. We can see the earliest changes on x-rays at 30 days of age where we can see a little bit of underdevelopment of the cup. We might even start to see a little bit of laxity.
Dr. Wooten: Thirty days?
Dr. Dycus: Yep. Thirty days. Very rarely, are we ever going to x-ray a puppy at 30 days. The earliest we can do a PennHIP x-ray is 16 weeks.
Dr. Wooten: Okay.
Dr. Dycus: So, I do think it’s wise if we have a dog that is coming in for their vaccinations if we are a dog that is a breed considered at risk. Some of our medium to large breed dogs that we have your veterinarian palpate the hips and start to-
Dr. Wooten: What does palpate mean?
Dr. Dycus: Palpate means we’re going to feel. We’re basically going to examine them. We’re going to extend the hips. We’re going to see if we get laxity, and if we are an at-risk breed, or if we come from a line … let’s say we purchase a puppy from that, uh-oh, they’ve had hip dysplasia in that line or we know, then it would be wise. Around that 16 weeks of age, to get a PennHIP evaluation where we check to see how much laxity they have and that way, that gives us the ability, if we need to intervene at a very young age, we can.
Dr. Wooten: If it came back and it was positive for hip dysplasia, what would be your recommendations to this owner?
Dr. Dycus: Right. Well, if we were able to get a PennHIP evaluation, and the PennHIP number, the distraction index number is high, which indicates that there is laxity.
Dr. Wooten: And, that’s bad?
Dr. Dycus: And, that’s bad. We want a score of zero. A score of one is bad. Then, we have anywhere from a zero to a 0.3, which is considered pretty good. It means there’s … the hip’s pretty tight. 0.3 to 0.7 is what we call the gray zone. The, a 0.7 means the hips are pretty lax. You know, a one would be the ball’s way out in left field. Not even close to the cup. But, there is a procedure that’s called a JPS. That stands for Juvenile Pubic Symphysiodesis. Big long word, so just remember JPS. It’s easier that way.
Dr. Dycus: Ultimately, what we do, is we make just a little incision right over the pubis, and we’ll take a little electrocautery. It’s a little device that heats up the tissue a little bit, and we’ll actually prematurely close one of the growth plates. What happens is as they’re developing, a lot of these dogs for example, the cup’s here and the ball’s here, as they’re developing, it allows the cup to deviate such that it improves the coverage of the ball in the socket.
Dr. Dycus: That is one of the things that we have to have done very early. I mean, between the ages of about 16 to 18 weeks. If we wait much after 18 weeks, we’re not going to get a lot of success with trying to do that procedure, so that’s why it’s very important that we start thinking about the concept of hip dysplasia and doing the right things to diagnose hip dysplasia in some of these really young animals.
Dr. Dycus: The problem is, a lot of the animals aren’t 14 or 16 or 18 weeks old when they come in having clinical signs. So, we have to start thinking about other avenues from a treatment standpoint, which can involve sometimes, conservative management where we really focus on weight control, daily exercise, and promoting hip extension. We can train owners how to extend the hips and stretch them or do various exercises to promote hip extension. The biggest and most important thing is keeping dogs fit and trim. Not letting them get overweight. Then, from a surgical standpoint, there are various surgical procedures that can be done at various time frames along when we might start to have clinical signs.
Dr. Wooten: What are the dog breeds that you see as most at risk to hip dysplasia?
Dr. Dycus: Well, we see breeds such as Rottweilers, German Shepherds, Golden Retrievers, Labrador Retrievers, a lot of our medium to large breed dogs. We don’t tend to see, interestingly enough, a lot of our mixed breed dogs come in with hip dysplasia. But, we do see also, Bernese Mountain Dogs, Greater Swiss Mountain Dogs, those dogs are kind of poster children for hip dysplasia and even elbow issues, by the way. I think we always would say, “well, Labradors are quite popular” and we see a lot of hip dysplasia in Labradors, but I think it’s because so many people have Labradors. It’s such a popular breed. To truly say whether Labradors have a higher increase or incidence in having hip dysplasia is a bit undetermined at the moment. Certainly, Rottweilers, German Shepherds, and our Bernese Mountain Dogs are some big top players.
Dr. Wooten: If you were to think about the most exciting development in the treatment or diagnosis of hip dysplasia that pet owners should know about, what stands out to you?
Dr. Dycus: The ability to detect hip dysplasia early. Meaning with hip PennHIP, we can detect hip dysplasia or laxity as young as 16 weeks of age, which is a little different than OFA. And, OFA stands for the Orthopedic Foundation for Animals, which is what most people are familiar with. Unfortunately, we can’t detect that a dog has issues until they’re two years of age, which is a pretty long time, unfortunately. So, I like to think of PennHIP as picking up the issue on the train before it leaves the station versus OFA, which is looking for the problem after the train’s long left the station.
Dr. Wooten: Yeah.
Dr. Dycus: The ability to detect hip dysplasia earlier. Also, the ability to address some of the issues with the JPS earlier is certainly something that has come around in the last several years that’s been proven to be beneficial. The other thing, because I’m a surgeon, is the process or technology or advancement of total hip replacements has far surpassed where we were five/ten years ago.
Dr. Wooten: Really?
Dr. Dycus: We can put hip replacements in dogs as young as 10-12 months of age. They can have a completely normal functioning hip. Have a beautiful, fantastic, great quality of life with a low complication rate. The great thing is, dogs don’t outlive their implants. So, we can put them in younger dogs and we don’t have to come back at 10 years or 15 years or 20 years and replace it again. So, when we put them in a younger dog, then they can have that same prosthetic or the hip replacement for a while.
Dr. Wooten: That’s amazing because it used to be, you would have to wait because-
Dr. Dycus: You got it.
Dr. Wooten: The implants-
Dr. Dycus: You got it. Yeah.
Dr. Wooten: Didn’t last very long.
Dr. Dycus: Five/Six years ago, the average age was like between eight and ten.
Dr. Wooten: Yeah.
Dr. Dycus: Because we made dogs kind of go through all these hoops and it wasn’t until the owners came in with their bag full of medications and they had been through physical therapy, they had been through all of these things, and their dog’s quality of life was suffering. Then, we would say, “Let’s do a hip replacement.” We would do a hip replacement, and guess what? At recovery, and once they were fully recovered and back to getting to their normal self, they would start chasing the ball again. They would start to go on hikes, they would start to go running. The owners would say, “Wow! They’re doing all these things that the last several years, they haven’t been able to do!” So, we kind of did a 180 and thought, “Well, why do we make them go through all these hoops to wait on having a hip replacement when we can simply just do it earlier and let them have all those years? We don’t lose all those years with pain and discomfort and suffering.”
Dr. Wooten: Yeah. If an owner wanted to get the PennHIP diagnostic done, how would they find somebody who would do it?
Dr. Dycus: Yeah. To do PennHIP x-rays, it takes an individual that is certified through PennHIP, and I would imagine that you could probably get online if you Google PennHIP, there’s going to be a registry that you can do to find a veterinarian in your area that does it. There are many veterinarians just in everyday general practice. It doesn’t have to be a specialist of any kind to do a PennHIP evaluation. It just needs to be somebody that’s taken the course that has the appropriate equipment and they have the ability to send the x-rays to the radiologist room to evaluate and do the calculations.
Dr. Wooten: Dr. Dycus is not only an orthopedic surgeon, but he is also a pet parent.
Dr. Dycus: I am! Absolutely.
Dr. Wooten: Tell us about your furry friend?
Dr. Dycus: I currently have one geriatric, he’s 13, Cocker Spaniel. Interestingly enough, he actually tore both of his cruciate ligaments or his ACL ligaments in his knees. I always told myself I would never do surgery on my own dogs, but then when he tore his ACL ligaments, I thought to myself, “Well, who’s better to do the surgery than me, since I do orthopedic surgery.” So, I did surgery on both of his knees and he’s done phenomenal since then. I gave him back the opportunity to be able to go up and down the stairs, and go on walks and be a little more active. Granted, he’s slowed down a little bit because of her age.
Dr. Wooten: Was that stressful? Like were stressful or did you just detach from that?
Dr. Dycus: Well, I was a bit stressful. My wife made sure that I was … knew who I was operating on. But, in surgery, I kind of phased it and it became just another surgery. Of course, then came the postoperative care and I had to be the best owner there, which veterinarians are usually the worst owners when it comes to pets, sometimes. So, I had to follow the rules of the exercise restrictions during the healing period.
Dr. Wooten: Does your Cocker, does he sleep on a Big Barker bed?
Dr. Dycus: He does! He does. He has a nice big, Big Barker orthopedic bed. It’s got the little pillow, kind of, aspect to it. It sits right underneath the window in our bedroom. Of course, he’s lost his hearing over time, he usually doesn’t know when we’re coming in the door, but we come up to the bedroom and he’s usually crashed out and asleep in there. Then, over time, he’s lost the ability to jump up in and on the bed, so that’s his bed now. He sleeps there at night, and-
Dr. Wooten: And he likes it?
Dr. Dycus: Oh, he loves it. Yep. That’s his. We usually find a toy or two in there that he takes up there with him, but yeah, he thoroughly enjoys it and he curls up and passes right out on it.
(This is the special bed that Dr. Dycus is recommending to help dogs with hip dysplasia)
Dr. Wooten: Do you think those mattresses would help dogs that have sore joints?
Dr. Dycus: I do. I do, I think what’s happening is, because of how thick it is and the memory foam in it and how soft it is, obviously what we’re doing is taking that pressure off of the skin. Off of some of the bony prominences when they’re laying on the floor themselves, but also, some of the other beds where they’re not very cushiony. They lay down. Essentially, it’s like a small little layer above the floor that they’re laying on, because it compresses down so much. But, with the Big Barker bed, it really keeps them elevated off the ground. Therefore, we don’t have the wear and tear of pressure sores and bony prominences pushing on the ground and that sort of thing.
Dr. Wooten: Well, that’s awesome.
Dr. Dycus: Yeah.
Dr. Wooten: Well, thank you so much.
Dr. Dycus: I think so. Absolutely. Happy to be here.