When Karen Raspatello realized her dog, Nola, might be suffering from hip dysplasia, she knew what she was in for. And she knew whom to call. Karen and her husband had already undergone a similar experience with their other German Shepherd, Savannah, successfully treated with total hip replacement surgery by Kimberly Agnello, DVM, MS DACVS, orthopedic surgeon at Penn Vet’s Ryan Hospital.
“Savannah came from a puppy mill,” Karen said. “Her symptoms came on suddenly right after she turned four years old. One day when she tried to get up, she just yelped.” Karen and her husband rushed Savannah to their veterinarian, Dominick Pulice, VMD, of Perkiomen Animal Hospital. Dr. Pulice, a Penn Vet grad and member of the Penn Vet Dean’s Alumni Council, took X-rays and diagnosed Savannah with severe hip dysplasia. Therapeutic options included pain medication or surgery. He recommended Penn Vet and Dr. Agnello.
“The hip is a ball-and-socket joint,” explained Dr. Agnello. “The ball is the head of the femur and the socket is the acetabulum of the pelvis. In a dysplastic hip, the head of the femur and acetabulum just do not fit together properly.”
Laxity and incongruity of the hip joint leads to abnormal wear and tear in the joint, resulting in pain and inflammation, and eventually the development of osteoarthritis. Osteoarthritis is a form of joint inflammation (arthritis) that is characterized by chronic deterioration or degeneration of the joint cartilage, which results in pain and decreased function of the joint.
Hip dysplasia is one of the most common skeletal diseases seen in dogs. Gender does not seem to be a factor, but some breeds are more likely to have a genetic predisposition for hip dysplasia than other breeds. Large and giant breeds are most commonly affected, including the Great Dane, Saint Bernard, Labrador Retriever and German Shepherd Dog. Small breed dogs can also be affected, but are less likely to show clinical signs.
The signs of hip dysplasia can begin when dogs are still young and physically immature. Early in the progression of the disease when dogs are only months of age, the pain from hip dysplasia results from the laxity in the hip joint. When dogs present later in life, as with Savannah and Nola, the pain from hip dysplasia is due to the development of osteoarthritis. Early onset usually develops after four months of age. There are also cases of later onset, where hip dysplasia develops later due to osteoarthritis, a form of joint inflammation (arthritis) that is characterized by chronic deterioration or degeneration of the joint cartilage.
Numerous drugs are available to control the signs of osteoarthritis brought on by hip dysplasia. The most common are non-steroidal anti-inflammatory pain relievers, which can be used during bouts of lameness and pain. These drugs inhibit prostaglandin release, which decreases the inflammatory process and therefore, less pain is produced. However, these medications can have side effects such as gastrointestinal upset and the formation of ulcers or even liver and kidney damage.
“We didn’t want to medicate our dog for the rest of her life,” Karen said. “We thought there was a better way to treat her.”
Surgical options included a femoral head and neck excision, which eliminates hip pain by removing the femoral head and neck and initiating the development of a fibrous false joint that permits ambulation. The false joint is less stable with a reduced range of motion than the normal joint, which in turn, can cause an abnormal gait.
When Karen and her husband learned that a total hip replacement would be the treatment of choice for reestablishing normal, pain-free limb function and joint mechanics for their dog, they called Dr. Agnello. Dr. Agnello explained that this surgical procedure resulted in a high degree of success and a quick post-op recovery of about two to three months. Karen and her husband made their decision.
“My husband and I talked about it, and we decided this would be the best way to go for Savannah,” said Karen. “With a hip replacement, Savannah would have the best chance to lead a healthy and happy life.”
”Savannah had severe hip dysplasia and osteoarthritis. When examining her hip joint at the time of surgery, she had no cartilage left with bone rubbing on bone, which as you can imagine was very painful. With that severe of disease, it was amazing she was still able to walk before the hip replacement.”
Within two weeks of their initial consult at Penn Vet, the surgery was performed and Savannah was able to go home the next day. “She had to be in a crate for a while,” said Karen, “but she was on pain medication for just a few days. Honestly, her recovery time was not long at all. And now, she runs around like nothing ever bothered her. She’s a regular dog, and she’s happy.”
“Dr. Agnello was great,” said Karen. “She took extra time to answer all of our questions and address our concerns.”
So when Nola, Karen’s eight-year-old German Shepherd, started to show signs of decreased activity, difficulty rising and reluctance to run or jump, Karen feared her dog might be suffering from the same problem that had plagued Savannah. “She was walking funny and she just didn’t play as much,” said Karen.
Nola was a more serious case, however. When Karen and her husband first took her in when she was four, she was suffering from heat stroke and needed to have her spleen removed. Not long after that, Nola developed a hernia and again underwent surgery. As if these health challenges weren't enough, Nola's lungs started to fill with a bloody foam. She was diagnosed with a shunting vessel around her heart called a Patent Ductus Arteriosus (PDA), which was successfully repaired by Karen’s veterinarian.
When Nola started to show symptoms like Savannah’s, Karen and her husband took Nola back to their vet, who took X-rays and once again diagnosed hip dysplasia. “We knew exactly what to do,” said Karen. “Dr. Agnello did such a great job with Savannah, we immediately made an appointment.”
On June 10, Nola underwent the same surgery as Savannah and her recovery has followed the same path. Dr. Agnello recommended some exercises to help rehabilitate Nola’s hip, which Karen says were critical in her recovery.
“She’s walking around now like a normal dog. She’s taking three walks a day, and even climbing some stairs,” said Karen. “It’s a miracle, really. I put my dogs’ lives in Dr. Agnello’s hands, and I would do it 100 times over.”