Diagnosis of HD at 3 month pup check

Re: Diagnosis of HD at 3 month pup check

Malcolm Ness — Sat, 27 Sep 2014 08:49:27 GMT

Even with radiographs, it is a very brave clinician who pronounces on HD at that very young age.

To some extent, it depends on what you mean by hip dysplasia. HD literally means an abnormal development of the hip so it is really a catch-all term and while most clinicians use HD to refer to the syndrome commonly seen in labradors, GSDs Newfoundlands etc etc. There is a so-called congenital luxation seen commonly in bulldogs but also in many other breeds that presents obviously and early and has been mentioned earlier in this thread. Most orthopods would distinguish that from HD.

While there are a papers out there that look at early diagnosis of HD and show that detection of statistically significant abnormality is possible a very early age (Bardens and Ortalani tests are less poor but radiography shows some differences even at 6-10 weeks). However, critical appraisal of that evidence shows that the correlation of these abnormalities with subsequent clinically significant problems is poor and that there are a lot of false negatives so this is probably not clinically useful information on an individual patient basis.

The interest in early diagnosis of HD was driven to some extent by the development of a novel treatment, juvenile pubic symphydesis JPS. That procedure has not found widespread favour as though it seems to be effective in modifying radiographic appearance of the hips when done on very young dogs, its potential to produce any clinically obvious and useful benefit to the patient has not been convincingly demonstrated.

In practice, most dogs with typical clinically significant HD will present with clinical problems much later at 5-9 months of age.

Re: Diagnosis of HD at 3 month pup check

Nicola Lawlor — Fri, 26 Sep 2014 19:45:16 GMT

I can think of one puppy, a bulldog, where I suspected HD at such a young age, presented for vaccines, though the dog was lame and clearly not right on the hind legs. I got a mouthful of abuse from the breeder for my concerns and she took the puppy off the new owner and took it to her own vet to prove a point to me. Her own vet rang me to explain that he was pretty sure the pup had hip dysplasia based on his exam of it too. I felt vindicated. I do not however usually check hips that closely at that age for obvious reasons and I think that the vast majority of puppies it would not be easy to tell even if we did do detailed checks at such a young age.

Re: Diagnosis of HD at 3 month pup check

John Flynn — Fri, 26 Sep 2014 19:16:27 GMT

[quote user="Anthony Todd"]Yeah, but I reckon the pup will walk real funny, if at all.[/quote]

For clarity:

Evidence of joint laxity can be present radiographically in pups; there is reasonable correlation between this and clinical problems of the hip joint at an older age.

I was only responding to the query as to what could be seen on a radiograph of a pup.

On the point of whether or not to do this, it is not totally wacky to radigraph pups with reasonable index of suspicion of incraesed risk for hip dysplasia or palpable joint laxity with a view to doing a JPS. It is most certianly not well proven approach, but that does not make it totally wacky.

"In a prospective study of 217 puppies 14 to 22 weeks of age treated with juvenile pubic symphysiodesis or no surgery, juvenile pubic symphysiodesis increased the odds of limiting the progression of hip dysplasia in puppies with mild to moderate laxity... The procedure is indicated primarily for puppies 12 to 20 weeks of age with palpable hip joint laxity... Juvenile pubic symphysiodesis is more effective if done in younger puppies, particularly in puppies younger than 18 weeks of age..." Gail Smith et al., p851 of Tobias&Johnston Volume1

Re: Diagnosis of HD at 3 month pup check

ruths — Fri, 26 Sep 2014 19:12:29 GMT

The pup I saw bunny hopped, had next to no muscle over its HQs and cried when lying down and getting up. The grating and clunking with just gentle rocking was really remarkable. I don't remember about the X-rays but in the end I did a bilateral FHE and at least there was no more pain. The dog got rehomed to one of the nurses and did really well. The crying stopped about two days post surgery.( before you all get stressed- I did the surgery after I'd spoken to two lecturers in orthopaedics prior to the surgery - it was before TPOs etc)

Re: Diagnosis of HD at 3 month pup check

Anthony Todd — Fri, 26 Sep 2014 18:41:31 GMT

[quote user="John Flynn"]"The first radiographic signs of canine hip dysplasia, seen as early as 7 weekjs of age, are subluxation of the femoral head and underdevelopment of the craniodorsal acetabular rim" Gail Smith et al., p824 of Tobias&Johnston volume 1[/quote]

Yeah, but I reckon the pup will walk real funny, if at all.

Re: Diagnosis of HD at 3 month pup check

John Flynn — Fri, 26 Sep 2014 18:12:15 GMT

[quote user="Robin Grimmer"]You can't diagnose HD in a pup of this age. All pups are born with normal hips. It's only as they grow that joint laxity develops, hence the requirement to be over a year old to have hip X rays for the scheme[/quote]

"The first radiographic signs of canine hip dysplasia, seen as early as 7 weekjs of age, are subluxation of the femoral head and underdevelopment of the craniodorsal acetabular rim" Gail Smith et al., p824 of Tobias&Johnston volume 1

Re: Diagnosis of HD at 3 month pup check

Anthony Todd — Fri, 26 Sep 2014 17:41:48 GMT

[quote user="Richard Carter"]If/when they start bunny hopping gait, struggle to rise, have sub luxation, crepitus in hip joints on MILD manipulation, then possibly.[/quote]

Yes, that's what I was meaning, ie it is possible to detect gross abnormality at 10 weeks or probably earlier.

Sorry, no aspersions cast, probably the "other vet" didn't even give an opinion; the new owner didn't want the pup!

Ironically, even if one does find really gross abnormalities of any sort most new owners, having owned the pup for only a couple of days, are very very reluctant to return them. I could never understand that.

Re: Diagnosis of HD at 3 month pup check

Richard Carter — Fri, 26 Sep 2014 17:19:13 GMT

This is a toddler pup with normal gait, no lameness. Some pups I have seen have such loose ligaments that if you want to then you could subluxate a joint - any joint. Doesn't make a diagnosis of HD. If/when they start bunny hopping gait, struggle to rise, have sub luxation, crepitus in hip joints on MILD manipulation, then possibly.

Re: Diagnosis of HD at 3 month pup check

Anthony Todd — Fri, 26 Sep 2014 17:12:47 GMT

I reckon extreme gross hip joint pathology could be suspected at 8-10 weeks and HD would then be mentioned.

If the pup objected to hip joint lateral movement then I'd be rather cautious and probably say "return it to the breeder".

Re: Diagnosis of HD at 3 month pup check

Bob Russell — Fri, 26 Sep 2014 17:05:46 GMT

[quote user="Richard Carter"]

would like to think so but I am the one being accused of missing HD at 8-10 weeks age!!

[/quote]

Clearly we are all likely to be just as guilty! I have seen many puppies over the years that have gone on to develope HD. I have missed 100% of them at 8-10 weeks old. I am likely to have discussed the fact that some may be high risk candidates.

Re: Diagnosis of HD at 3 month pup check

Martin Atkinson — Fri, 26 Sep 2014 17:04:08 GMT

[quote user="Richard Carter"]

would like to think so but I am the one being accused of missing HD at 8-10 weeks age!!

[/quote]Tell them that if they want you will make an appointment for them to see a specialist and if you're wrong you will pay the fee. I think your money will be pretty safe.

Alternatively tell them to take a hike and find another vet as breeders are all the pits. That was my choice a long time ago!

Re: Diagnosis of HD at 3 month pup check

Richard Carter — Fri, 26 Sep 2014 17:01:01 GMT

would like to think so but I am the one being accused of missing HD at 8-10 weeks age!!

Re: Diagnosis of HD at 3 month pup check

Robin Grimmer — Fri, 26 Sep 2014 12:46:54 GMT

You can't diagnose HD in a pup of this age. All pups are born with normal hips. It's only as they grow that joint laxity develops, hence the requirement to be over a year old to have hip X rays for the scheme. So more than likely breeder bs.

Re: Diagnosis of HD at 3 month pup check

Matt Hilary — Fri, 26 Sep 2014 12:41:24 GMT

[quote user="Clive Ansell"]

Have you obtained the clinical notes from the colleague in question, and if so have they made a diagnosis of HD? not that I'm cynical or anything, but I tend to disbelieve anything that comes from the mouth of a breeder until proven otherwise.

[/quote]

This. I think some miscommunication here is very likely.

Re: Diagnosis of HD at 3 month pup check

ruths — Fri, 26 Sep 2014 12:28:28 GMT

I had a puppy that young who could t walk properly I made a provisional dx by swaying it from side to side with the palms of my hands on the greater trochanters. The grating and clunking was almost audible. I suspect that was the most extreme- it was a gsd

Re: Diagnosis of HD at 3 month pup check

Clive Ansell — Fri, 26 Sep 2014 10:47:04 GMT

Re: Diagnosis of HD at 3 month pup check

Francisco Gomez — Fri, 26 Sep 2014 10:30:57 GMT

[quote user="Bob Russell"]

Must be a hell of a clinician to diagnose HD confidently enough to recommend returning a puppy.

Of course this may only be half the story!!

[/quote]

Re: Diagnosis of HD at 3 month pup check

Bob Russell — Fri, 26 Sep 2014 10:25:07 GMT

But this puppy has not had X-rays. The diagnosis seems to have been made on clinical examination.

Penn HIP from 16 weeks.

Must be a hell of a clinician to diagnose HD confidently enough to recommend returning a puppy.

Of course this may only be half the story!!

Re: Diagnosis of HD at 3 month pup check

John Flynn — Fri, 26 Sep 2014 09:57:16 GMT

[quote user="Richard Carter"]How would one diagnose HD in a pup on x-ray where most of the skeleton is still cartilage??[/quote]

A distracted view to assess distraction index (of course you have to believe in JPS to make this worhtwhile)