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Hip Dysplasia

Hip Dysplasia with the Shih Tzu Breed

Overview- This is a common issue seen with the Shih Tzu and for this reason, owners should be aware of the symptoms and available treatment. Also, since this is genetic, awareness of this with testing can greatly reduce the number of Shih Tzu puppies and dogs that suffer from this condition.

What is Hip Dysplasia? 

This a degenerative joint disease seen in certain breeds, the Shih Tzu included. The hip joint forms the attachment of the hind leg to the body and is a ball and socket joint. 
The ball portion is the head of the femur while the socket is located on the pelvis. 

In a normal joint the ball rotates freely within the socket. To facilitate movement, the bones are shaped to perfectly match each other, with the socket surrounding the ball. The area where the bones touch each other is called the articular surface. It is smooth and cushioned with a layer of spongy cartilage. 

Normally, all of these factors work together to cause the joint to function smoothly and with stability. Hip dysplasia refers to the condition of abnormal development of the hip joint in a dog or if the dog is prone to this and it slips out of place. 
Most dogs with hip dysplasia are born with normal hips but due to genetic and possibly other factors, the soft tissues that surround the joint start to develop abnormally as the puppy grows. The abnormal growth affects how the bones are held together; instead of staying in place, they move apart. The joint capsule and the ligament between the two bones stretch, adding additional unsteadiness. As this happens, the planes of the two bones lose contact with each other. 

When the two bones have separation within a joint is referred to as subluxation, and this is the cause of the issues. This may happen to both hips in the same way, both hips but with one worse than the other or seemingly in just one hip (if it is moderate and the other is very minor). 

In some cases, a puppy as young as 4 or 5 months can be diagnosed with this. However, since it is a degenerative disease, clear signs often do not show until a Shih Tzu is in his later adult years, 4 to 6 years old. In some cases, as late as 8, 9 or 10. 
Shih Tzu wearing sunglasses
Zeus, at 1 year and 4 months 
Photo courtesy of Alex and Troy
The Symptoms

A bunny hop - The dog will use both back legs simultaneously when walking fast or playing around. 
A wobbly gait - A dog may wobble or ‘walk funny’, putting pressure down on one side more than the other. 
Trouble rising - Some dogs will struggle to rise up from a sitting position. 
Trouble with mobility - A dog may avoid going up steps. A dog may also squat much lower when having a bowel movement.
A narrow stance - Some dogs will stand with the hind legs much closer together than normal.
Intermittent stiffness - A dog may show signs of stiffness at all times, however there may only be signs of stiffness when the dog first wakes from sleep or first begins to walk. As he moves more, the area will ‘warm up’ and signs may go away. If the dog moves too much (a walk or exercise session), discomfort and stiffness may reappear. 
Loss of muscle tone -Due to the decrease in mobility, if the condition progresses without treatment, dogs will lose muscle tone. This will result in even more loss of mobility; the dog may not be able to rise on his own, etc.
Why This Happens

• Genetics- This is considered to be a genetic condition. If a parent has hip dysplasia, then the puppies are at greater risk for developing hip dysplasia. If you breed two dysplastic dogs, the resulting litter are much more likely to develop the disease but will not all have the same level of symptoms; some may have very minor cases in which symptoms are not apparent. Once those dogs mature, if they were to have litters, they too would be able to pass down the gene that causes this, and the cycle continues on. 

Contributing factors include:

Nutrition - Overweight dogs are more prone to this. Carrying around extra weight will put stress on the hips, which can trigger the condition. 
Rapid Growth - Another factor that may increase the incidence is rapid growth in a puppy during the ages from three to ten months. 
Excess Exercise - Dogs that are genetically susceptible to this may be at higher risk if they are over-exercised at a young age. This does not include normal walks and such, but rather refers to a pup being pushed to him limits. 
How This is Diagnosed - Diagnosis of hip dysplasia is usually made through the combination of a physical exam and x-rays.

OFA- The method used by the Orthopedic Foundation for Animals (OFA) has been the standard for many years as in the one recognized by the AKC. X-rays are taken under specific guidelines (any licensed veterinarian can take OFA radiographs) and are then submitted to OFA for evaluation of hip dysplasia and certification of hip status.

Being able to make a clear diagnosis is more difficult before the age of 2 years old. For this reason, puppies are not evaluated by OFA, though preliminary evaluations can be done. In addition, this is not performed on females that are experiencing a heat cycle; the test may be given 1 month before or after a heat cycle.

Because it is important for a dog’s body to be very still during this evaluation and for muscles to be relaxed, OFA recommends that the dog be under anesthesia, though this is not required. Most dogs will receive medication to relax the muscles. The x-rays are reviewed by 3 radiologists and a consensus score is given based on the dog’s hip conformation in comparison to other dogs of the same breed and age group. Using a 7 point scoring system, hips are scored as normal (excellent, good, fair), borderline dysplastic, or dysplastic (mild, moderate, severe). Dogs with hips scored as borderline or dysplastic are not able to be cleared through OFA for breeding. This is why, if you are getting a Shih Tzu puppy, you should ask to see proof that both dam and sire were OFA tested. 

Once the forms are sent in to OFA, the average time that it takes to receive the results is 2 weeks. If a dog passes, he will receive an OFA certificate, which clears him of this genetic condition. As of this writing, the cost for this test is $35 + x-ray and veterinarian fees.
PennHIP- The diagnostic method used by the University of Pennsylvania Hip Improvement Program (PennHIP) uses distraction/compression x-ray views to identify and measure joint laxity. This test is not recognized by the AKC. For the same reasons as OFA, X-rays of the hip joints are taken with the dog under sedation; this aspect is a requirement. Two views are obtained with the hind limbs in neutral position to maximize joint laxity. The amount of luxation will be given a number from 0 to 1. A 0 indicates a very tight joint. A 1 indicates complete luxation with little or no coverage of the femoral head. As of this writing, the cost for this test is $200-$400. 
shaved shih tzu
Petey, at 10 months old
Photo courtesy of Evelyn Cabral 
Which test is better? OFA does not require anesthesia and is able to have very accurate evaluations based on fewer radiograph views (1 compared to 3). In addition, it is the one recognized by the AKC. The cost is lower, as well. For these reasons, it is considered the better choice of the two. 

Treatment - While this cannot be cured without surgery, it can be treated and in all but the most severe cases these steps will be implemented first. This includes at-home care including:

Weight management - Even a loss of a couple of pounds can make a difference, as there will be less strain on the body. Your vet will be able to tell you if your Shih Tzu needs to lose weight. 

Controlled exercise – Dogs recovering from hip dysplasia do need to exercise, but not too much. It takes some time to find the ‘perfect’ pace and duration. This begins by taking a Shih Tzu for a short walk and gradually increasing the duration. (Start with 10 minutes, if the dog seems okay, the next day increase to 12 minutes and the next 15 and so on. When you find the time that causes signs of discomfort, your ideal duration will be 5 minutes less than that time. 
In this way, appropriate walks can be given which helps to maintain muscle tone, strengthens the area around the hip joint, increases range of motion and eases stiffness without causing pain or making things worse. 
Warmth - This comes into play in several ways:

1) Make sure there are no cool drafts where your Shih Tzu rests (either cold from windows, etc. in the winter or from AC’s in the summer). 

2) Provide a well-padded, warm canine bed. Placing baby blankets around the bed can allow a Shih Tzu to really nestle deep and stay warm. A self-warming pad can be of great help; this is a non-electrical canine bed mat that self-radiates heat back into a dog’s body. 

3) Applying a warm (not hot) dry heating pad for about 20 minutes twice per day can help relieve pain and stiffness. 

An orthopedic bed - The right high-quality orthopedic canine bed will relieve pressure on aching joints.
Non-Steroid Medication - Most veterinarians will prescribe a non-steroidal anti-inflammatory/pain medication. These are NSAIDs and the most common ones prescribed for dogs are Deramaxx, Etogesic, Previcox, Metacam, Zubrin or Rimadyl. This will allow symptoms to subside and may reduce the inflammation, but this will not strengthen or correct the knee. 

Supplements - There are 4 supplements that may help. Your vet will decide which ones should be used and the proper dosing for your Shih Tzu. These include:

Omega 3 - As with many issues that involve joint problems, Omega 3 supplements help control inflammation and also block enzymes that break down cartilage.
Microlactin - This is a milk protein extracted from the milk of cows that inhibits inflammation. If this works for your Shih Tzu, NSAID medications may be weaned down and replaced with this.
 
Glucosamine/Chondroitin - Glucosamine provides the building blocks to manufacture new cartilage. And Chondroitin blocks destructive enzymes that break down cartilage in the joint. Together, these two supplements can work very well; though they seem to work best in adult and senior Shih Tzu than younger ones. 

ASU - (avocado and soybean unsaponifiables) - This is an extract from avocado and soybean oils. It works by reducing inflammation involved in cartilage degeneration and has been shown to have a positive effect.
Surgery 

If the non-surgical treatment options do not resolve pain issues, surgery may be recommended. There 3 main surgical procedures available depending on the age and the severity of the joint degeneration. 
cute shih tzu with teddy bear
Ciara Lolita Moran
Photo courtesy of Alina Moran
Triple Pelvic Osteotomy (TPO): TPO is a procedure used in young dogs usually less than 10 months of age that have x-rays that show severe hip laxity, but have not developed joint damage. The bones will be realigned. This is a major surgery and is very expensive, but the surgery has been very successful on dogs that meet the requirements.

Total Hip Replacement: While this is a good choice for many dogs, this is rarely done with toy breed dogs like the Shih Tzu. 

Femoral Head and Neck Excision: This is a procedure in which the head of the femur is surgically removed and a new joint forms as the dog’s body naturally repairs itself. It is used in cases where degenerative joint disease has occurred and total hip replacement is not able to be done. This surgery has the best outcome with small to medium breed dogs.
Things to do Now:
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Browse though the Shih Tzu Supplies page; this is a great summary of essential items for optimal care. 
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