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Hip Dysplasia

Hip Dysplasia - A Common Maltese Hip Problem

Overview

This is a genetic skeletal disease in which there is a malformation of the hip joint and socket. Many toy breeds, including the Maltese, are prone to this. 

What this Is

There are two basic portions of the hip: the ball and the socket. 

When the hip is functioning normally, the ball and socket match up without issue, ligaments hold them firmly in place, connective tissue helps add further support, and a cushion of shock-absorbing cartilage is present where the bones connect. All of these parts play a role in allowing a dog to have free and smooth range of motion.  

Hip dysplasia is a condition in which the hip joint (ball) and socket do not properly align due to a bone malformation, and sometimes with additional issues of weak ligaments.This leads to the hip joint moving out of the socket. It can move partially or fully and can affect one or both hips. 

Since this is a congenial disease, it is present at birth and early onset may begin at the young age of 3 to 4 months. However, for some Maltese, clinical signs may not show until much later.  

Symptoms

If your Maltese has hip problems, this will usually be very clear to you. One, some, or all of the following are signs of hip dysplasia:
  • A quick yelp at the moment of the separation. It is not uncommon for a dog to let out a loud yelp at the very moment the hip joint slides out of the socket, but then appear to be fine. If so, it may only be hours or even a day or so later when swelling sets in, that other signs appear. 
  • Weakness in the rear legs. This is usually more noticeable after exercising. The dog's hind legs will become shaky, unstable, and the dog may have a hard time balancing while trying to maintain a standing position
  • Difficulty getting up from a laying position
  • Limping– Walking may be difficult and the dog may compensate by favoring one or more limbs
  • Rising using front legs only and dragging rear end
  • A very short gait with the rear legs taking very tiny steps
  • A 'bunny hop' in which a dog brings up both hind legs at the same time
  • Unwillingness to jump, run, climb stairs or walk uphill 

Diagnosis

The veterinarian will perform a complete physical exam on your dog and run tests. This will include:
  • X-rays - These are crucial for visualizing the signs of hip dysplasia. This is also done to rule out other possible conditions including degenerative disease of the spinal cord, lumbar vertebral instability, bilateral stifle disease, and other bone diseases.
  • Blood chemical profile
  • Complete blood count
  • Electrolyte panel
  • Urinalysis
The veterinarian will also ask you questions to have good understanding of your Maltese's history. 

This includes any hip issues seen with the sire and dam, past health issues, and any possible instances in which the puppy or dog may have injured or caused trauma to the hips (this includes jumping from heights). 

Treatment

In all but the most serious cases, non-surgical, at-home treatment is tried first. Age plays a factor as well; senior dogs that would have a hard time with anesthesia are rarely operated on. Therefore, in many cases surgery is a last resort.

Treatment at home usually involves a combination of rest, medication, and then later special exercises to help build up surrounding muscles. This includes:
  • Initial bed rest for several days to a week. This is often accomplished by keeping a Maltese in a small crate. 
  • Corticosteroids to reduce swelling. Typically, this is injected directly into a dog’s hip joint.
  • Acetaminophen can help with pain and swelling; however, careful dosing must be done since liver damage can occur with too much use.
  • NSAIDs (Aspirin or buffered types of Rimadyl, Carprofen, Metacam or Meloxiam) may be given to help reduce swelling, tenderness, and inflexibility. 
  • Special injections, called Visco-supplementation can be helpful. This gel type material is injected straight into a dog’s hip joint. It lubricates the socket and joint; therefore helping with pain. This supplement can help to increase mobility; However, this only works temporarily.
  • Once swelling has gone down, physical therapy may be prescribed. Physiotherapy (passive joint motion) can decrease joint stiffness and help maintain muscle integrity. In addition, swimming is a good form of physical therapy, as this allows a dog to practice full range of motion without putting undue stress on the area. 
Surgery may be performed if a Maltese does not respond to at-home treatment or if the hip degenerates further. The exact type of procedure will depend on a dog's age and the severity of the dysplasia. 

1. If detected early on when a Maltese is still a puppy and if the joint and sockets are still mostly intact:
  • A surgical procedure can be carried out in which the pelvis is divided into 3 separate parts. These are then re-positioned to fit correctly. Typical recovery time is 8 weeks. 
2. For dogs with serious deterioration of the hip or if the joint is fully out of place:
  • The pelvic joint may need to be removed. This sounds serious and it is; however many dogs actually do much better afterward. Many dogs compensate very well for the missing joint and have a much higher quality of life than with an abnormal hip that causes pain and does not allow for proper movement. 
Recovery time is about 8 weeks, followed by rehab to improve walking mobility.
  • Total hip replacement surgery is an option. This is considered to be a major surgical operation. A cobalt chrome stainless-steel implant is positioned to serve as the 'ball' portion of the hip, and a socket is created out of high-tech plastic to be used in place of the socket. 
In many cases, this will allow a dog to resume an entirely active life. Typical recovery time is 8 to 10 weeks, followed by physical therapy to help a dog practice walking and become mobile again. 
Other Articles of Interest:

Maltese Collapsed Trachea - A serious condition involving rings of cartilage surrounding the windpipe. 
White Dog Shaker Syndrome Affecting Maltese - Signs, diagnosis, and treatment options. 
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