When it comes to arthritis and hip dysplasia, we fortunately have a considerable number of options to alleviate pain, while hopefully slowing the progression of the disease, or even restoring the body to a more normal anatomy. In many cases, we must use a combination of modalities to treat this common condition that affects all types of pets including dogs, cats, and even exotics. Many of the currently used options are described below.
Nutrition
Weight Reduction – In many overweight dogs, weight management is the single most effective way to reduce pain, increase activity, and increase quality of life. Prescription diets may be appropriate for some pets to help them lose weight. A weight reduction plan can be tailored by our staff to find the approach that will best fit your pet.
Cosequin® (glucosamine and chondroitin sulfate)/Dasuquin® – This nutritional supplement has been shown to reduce inflammation in arthritic joints. Some pets get significant benefits from these supplements. Dasuquin is a more recent product with glucosamine & chondroitin but it ALSO contains avocado extract. This has been shown to significantly improve most pet’s response to glucosamine and is what we carry in our pharmacy as we believe it to be the most effective. There is a version with MSM (methylsulfonylmethane) that may help as an analgesic & we can special order this for you.
Omega 3 Fatty Acids – Omega 3 fatty acids, in appropriate ratios with omega 6 fatty acids, has shown to improve activity level and have anti-inflammatory effects in dogs with arthritis.
Antioxidants – Research in humans and animals has shown that high levels of antioxidants (vitamins C and E) have reduced the symptoms and slowed progression of the arthritic changes.
Therapeutic Foods – A few companies have started formulating diets to provide dogs with many of the supplements recommended. Hill’s J/D® and Purina’s JM® are two such prescription diets. Best Friends Animal Hospital carries Purina’s JM® diet. JM has omega 3 fatty acids, antioxidants and glucosamine. Purina may have some discounts available for new customers. Please ask our staff for details.
CAUTION: The biggest problem with many over-the-counter supplements is the inconsistency in the quality of the products. Research has found that many of these products don’t actually have the amounts of active ingredients in the pills that are claimed on the bottle. The industry is poorly regulated so use extreme caution when buying a brand that hasn’t been recommended to you. The Nutramax brand (Dasuquin) is an example of a very reputable brand.
Exercise and Physical Therapies
Walking, Swimming - Exercise is important for patients with arthritis, but how much they get is a very important consideration that needs to be adjusted to each patient. Exercise helps maintain muscle development and the range of motion in the joints. It also reduces pain and helps with weight control. Too much exercise in the arthritic patient can actually make things worse, because the exercise causes more inflammation. Walking and swimming are ideal exercises to start with. Short periods of exercise should be used initially (15-20 minutes) and then monitor your pets for signs of being more painful afterwards. If the exercise causes pain, you need to reduce the exercise amount by 50% and evaluate again.
For more details, please ask one of our doctors. You should never start a new exercise program without consulting your veterinarian first, because other medical problems could exist.
Therapeutic Laser - We’re excited to offer laser therapy as an adjunct to treatment for our arthritic patients! This modality is increasing in popularity as more professional sports teams & veterinarians realize the tremendous impact it has on the majority of the patients it’s used on. In addition it’s extremely safe, non-invasive & drug-free. We have a separate handout on laser therapy for more information. It’s one of the most exciting therapies in recent years by far.
Massage Therapy – Massaging the muscles can help increase the blood flow to the area, help reduce inflammation, and reduce pain. Stretching of the joints helps to reduce scar tissue, increases the range of motion, and promotes better use of the joint.
Professional Physical Therapy – We can refer some patients for further professional physical therapy. The physical therapist has treatment options which include extracorporeal shock wave therapy, neuromuscular electrical stimulation, acupuncture, swimming, treadmill therapies, and more. Our doctors can recommend where these services might be performed.
Pharmaceutical Options
Adequan® (polysulfated glycosaminoglycan) – Adequan® is a drug that is given as an injection. The drug binds to cartilage and helps protect against further breakdown of the cartilage. It also has been shown to help repair cartilage. Many patients respond very well to this drug. We start with injections twice weekly for 4 weeks. If we see good results we start to decrease how often the injections occur. Long term, some dogs get a single injection every 4-6 weeks or less.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – A wide variety of great new anti-inflammatory medications exist for the treatment of dogs with arthritis. These products are great at removing pain and can help reduce inflammation in the joints. They aren’t capable of healing cartilage, but can help slow damage to the cartilage and, therefore, slow the progressive changes of arthritis. Metacam™, Deramaxx™, Etogesic™, and Rimadyl™ are all examples of these newer non-steroidal anti-inflammatory drugs. (Most of these are labeled for dogs and extreme caution must be taken with other species such as cats. Please never give a medication to your cat that was prescribed for your dog!)
Analgesics - Rather than reducing inflammation which ultimately causes pain, analgesics act directly on the nervous system to reduce pain. There are several analgesics available and they are oftentimes used in addition to NSAIDs.
Steroids – Corticosteroids are great at reducing inflammation. This can indirectly reduce pain and lessen damage to the cartilage. The primary problem with these drugs is that they have a wide array of side effects when used long-term. Since the condition is life-long, treatment is life-long and these drugs can create problems. We try to avoid this class of drugs in nearly all arthritic patients.
Surgical Options
Hip surgeries are the most common type of surgery performed for arthritis. Back surgeries and others exist, but will not be covered in this discussion. If you would like more details about other surgical options please ask our doctors for more information. The surgeries are divided into two general categories. The first category is preventative surgeries. These procedures are used for young animals that have poor anatomical design that place them at high risk for quickly developing arthritic changes in the joints. The therapeutic surgeries are for pets that already have arthritic changes. The surgery is designed to relieve pain and return the joint to a more normal function.
Preventative Procedures:
TPO – Triple pelvic osteotomy – Used to treat hip dysplasia in dogs with excess hip joint laxity. This technique moves the hip socket over the top of the ball of the thigh bone. This makes the ball go into the socket when the dog puts weight on the leg rather than partially dislocating the way it did before surgery. This can be done at any age as long as arthritis doesn’t exist.
JPS – Juvenile pelvic symphodesis – This surgery results in the same effect as the TPO, but is done only in dogs less than 5 months old. Ideally, puppies are treated at 3-4 months of age. A growth plate on the pelvis is damaged which causes the pelvis to change its normal growth pattern. There needs to be enough growth potential left in the pelvis for this procedure to work well, which is why the procedure has to be done when the puppy is young. By the time most pets that this procedure could benefit actually slow signs of arthritis, they are too old for the surgery. We recommend that breeds considered to be at high risk for developing hip dysplasia be screened for hip dysplasia. Screening can be done when a neuter or spay is done (about 4 months old). If problems are detected the great thing is that this technique is inexpensive compared to the other surgical options (~20% the cost of a TPO). Because it is so cost effective and beneficial, screening at-risk breeds early can save a great deal of money and pain over the long term.
Therapeutic Surgeries:
Total hip replacement – An orthopedic surgeon can perform a hip replacement on larger breed dogs. The results are typically very good but proper patient selection is important. If you would like details about where this can be done please speak to our staff.
FHO – Femoral head and neck ostectomy – This is a salvage procedure done on dogs with severe arthritis or dysplasia with poor prognosis with medical therapy. The technique removes the ball from the hip joint. This helps by removing the bone on bone grinding in the hip joint, therefore, providing pain relief. The muscles and joint capsule will scar post operatively and create a functioning hip joint. This technique works well with small dogs and cats. Large dogs have a more unpredictable outcome. Post-operative physical therapy is important to improve long term function of the limb. Our surgeons perform this technique.
As you can see there are many considerations in treating an arthritic pet. In all cases, the goal is to alleviate pain and slow disease progression with minimal side effects. Obviously, arthritis can never be cured, but most pets will achieve a good level of comfort with one or more of these therapies. Please talk to your veterinarian about what options would be best for your pet.