Hip Dysplasia and Juvenile Pubic Symphysiodesis

Last Updated September 2021

What is Hip Dysplasia?

The hip joint is a ‘ball and socket’. The head of the femur (thigh bone) is the ball which sits in a socket in the pelvis. Hip dysplasia is a condition where the socket does not adequately cover the ball portion of the joint. In severe cases, an affected joint can be so loose that it is prone to subluxation (partial dislocation). The result of this is instability, varying degrees of osteoarthritis, pain and lameness.

The breeds of dog most at risk for hip dysplasia are dominated by large and giant breeds, but a few smaller breeds are also frequently affected. These breeds include Labrador and Golden Retrievers, German Shepherds, Rottweilers, Great Danes, Mastiffs, Newfoundlands, British, French and Australian Bulldogs, Poodle X breeds, Pugs and Cavalier King Charles Spaniels.

Hip dysplasia arises primarily as a heritable condition, however nutrition and physical activity during growth and development also play a role. Purchasing a pup bred from parents that have undergone X-ray screening and are known to have good “hip scores” will reduce the chance of hip dysplasia, but regardless it may still occur.

Hip dysplasia may be suspected at a young age if joint instability is obvious, or your puppy shows certain early signs. These may include a “bunny-hopping” or “wobbly” hindlimb gait, reluctance to use stairs or jump up, tiring quickly on walks, and wanting to sit frequently, to name a few. However, it is important to emphasize that the majority of affected puppies will show no signs of hip dysplasia until much later in life when osteoarthritis has developed. X-rays of the pelvis with your puppy under anaesthesia are needed to properly check for hip dysplasia. There are many options for the management of hip dysplasia. \What is most suitable will depend on the age of the dog, the severity, and whether or not osteoarthritis is present. Since hip dysplasia is a heritable condition, no affected dog should be bred from, and all affected dogs should be desexed.

What is Juvenile Pubic Symphysiodesis (JPS)?

Juvenile Pubic Symphysiodesis (JPS) is a surgical procedure that is undertaken early in life while the pelvis is still developing, and may substantially reduce the severity of hip dysplasia once full maturity is reached. JPS surgery is far less invasive and far less costly than other surgical procedures such as total hip replacement which are sometimes done once hip dysplasia is fully established. After JPS, the development of osteoarthritis and pain can be significantly reduced. Therefore, JPS surgery can enormously reduce the costs associated with ongoing medical management of hip arthritis, primarily in middle-aged and older dogs.

JPS uses a surgical technique known as electrocautery to create scarring in the growth plate on the pelvic floor. This results in early cessation of bone growth at this growth plate. As the rest of the pelvis continues to grow, the “sockets” of the pelvis rotate outwardly onto the “balls” of the femur, providing a better fit between ball and socket, with less instability.

JPS may sound involved but it causes minimal discomfort. Activity should be restricted for about 10 days after surgery, and pain relief medication is provided. Follow-up X-rays may be optionally taken at least three months post-operatively to assess the degree of treatment success, check for ongoing hip dysplasia and predict outcomes and any management required.

For best results, JPS should be performed when puppies are 14-16 weeks of age, while the pelvis is still growing rapidly. Since the growth of the pelvis slows as the puppy matures, surgery between 16 and 20 weeks of age may still be beneficial, and a good outcome is still possible, but the response is expected to be greater when surgery is done earlier. JPS is unlikely to be beneficial in dogs older than 20 weeks of age. Therefore, in order to have the option to help a young dog with hip dysplasia with JPS surgery, early diagnosis (at 14-16 weeks of age) is critical.

What is the prognosis after surgery?

After JPS, approx. 85-90% of dogs will have substantially improved anatomy and a very high likelihood of not requiring more involved (and more costly) specialist surgery later in life, such as double pelvic osteotomy and total hip replacement (approx. $10K per hip!). Some dogs will still develop hip osteoarthritis after JPS, but it is likely to occur much later in life than it would have without JPS. It is also likely to be much milder and easier to manage, with far less anti-inflammatories and pain killers, cartilage preserving injections, and other dietary arthritis supplements than otherwise would have been required.

Unfortunately, 5-10% of dogs will have marginal or no improvement. These are likely to be those puppies most severely affected by hip dysplasia at the time of diagnosis. The images below were taken on one of our patients prior to and after JPS surgery.

For any at-risk breed we advise:

1. At 14-16 weeks of age, we X-ray the hips (under general anaesthesia). To assist and encourage owners of at-risk puppies to check for hip dysplasia early, we offer a reduced fee for screening radiographs which is around 50% of the normal cost for this service.

2. If we find evidence of significant hip dysplasia (determined either by joint laxity or X-Ray changes), we recommend proceeding to JPS surgery (while still under anaesthesia). The total cost of JPS surgery inclusive of the initial radiographs can be discussed with your veterinarian before booking in for radiographs. Note that we will only recommend JPS if we find significant hip dysplasia. If only mild hip dysplasia is found, and we don’t feel that surgery will give a substantial chance for improvement, we will not recommend surgery. Instead, we will discuss other management techniques.

3. Three months or more beyond surgery, we may optionally take follow-up X-rays to assess the pelvis and any apparent response to surgery, or ongoing concerns with the hips. If you are planning to desex your puppy (we always recommend this when your puppy has hip dysplasia), follow-up X-rays can be delayed until desexing, when they can easily and more economically be done under the same anaesthetic.

If the puppy’s hips are normal on X-ray, can it be desexed at the same time (at 14-16 weeks)?

Generally not. While it might seem convenient to desex your puppy while they are already under anaesthetic for X-rays, we recommend in the majority of cases, that desexing be delayed at least until your puppy has undergone all (or the majority) of their growth.

Waiting until your puppy reaches their full mature size before desexing has proven benefits for skeletal and joint health. The age at which we recommend desexing will vary depending upon the breed and expected growth of your puppy. This topic is usually discussed during puppy vaccination visits. Please feel free to discuss early diagnosis of hip dysplasia and corrective JPS surgery with any of our veterinarians.