CONDITION

Hip Dysplasia in Dogs

A developmental condition where the hip joint forms abnormally, leading to instability, cartilage wear, and progressive mobility changes.

Why this matters now

Hip dysplasia in dogs is a developmental orthopaedic condition that begins during the growth phase, though clinical signs may not become apparent until later in life. Large and giant breed dogs — including German Shepherds, Labrador Retrievers, Golden Retrievers, Rottweilers, Great Danes, and Saint Bernards — are most commonly affected, though the condition can occur in medium-sized and occasionally smaller breeds. The condition has a strong genetic component, with heritability estimates ranging from 0.2 to 0.6 depending on the breed and study population, though environmental factors including nutrition, growth rate, body weight, and exercise during development also influence expression. Signs may first appear during rapid growth phases (typically 4-12 months of age) or may not become clinically evident until secondary osteoarthritis develops in adulthood or middle age. The prevalence varies significantly between breeds and breeding populations, and selective breeding programmes have been implemented in many countries to reduce the incidence.

The progression of hip dysplasia is highly variable and does not always correlate directly with the severity of radiographic changes. Some dogs with radiographically severe dysplasia may show minimal clinical signs, while others with apparently modest changes may experience significant discomfort and functional limitation. During puppyhood and adolescence, joint laxity may produce episodes of lameness, bunny-hopping gait, or reluctance to exercise, though some young dogs compensate effectively and show few outward signs. Over time, the abnormal joint mechanics lead to progressive osteoarthritic changes — cartilage erosion, osteophyte formation, joint capsule thickening, and chronic inflammation — that tend to produce increasing stiffness, pain, and reduced mobility. The rate of osteoarthritis development and the impact on quality of life are influenced by body weight, activity level, muscle mass, and individual variation in pain tolerance and compensation strategies.

Signals & patterns

Early signals

Bunny-hopping gait

Young dogs with hip laxity may adopt a characteristic 'bunny-hopping' gait when running, where both hind legs move together simultaneously rather than in the normal alternating pattern. This gait adaptation helps stabilise the pelvis and reduces the range of hip extension and flexion during locomotion. It is often one of the earliest and most recognisable signs in growing puppies, though some owners may interpret it as a normal puppy gait pattern.

Reluctance to exercise or play

Affected puppies and young dogs may show decreased enthusiasm for vigorous exercise, tiring more quickly during walks or play sessions than expected for their age and breed. They might be slow to rise from rest, particularly after extended periods of lying down, and may show stiffness that improves with gentle movement. This reduced activity can be subtle in dogs that are naturally calm or sedentary.

Difficulty with stairs and jumping

Activities that require significant hip extension or loading — climbing stairs, jumping into cars, or getting onto furniture — may become noticeably challenging. Dogs might hesitate before attempting these movements, use momentum to compensate, or begin refusing to perform them altogether. These avoidance behaviours often develop gradually and may initially be attributed to stubbornness or training issues rather than physical discomfort.

Narrowed hind-end stance

Dogs with hip dysplasia may stand with their hind legs closer together than normal, creating a narrow-based stance that shifts weight towards the forelimbs. This postural adaptation reduces the mechanical demands on the hip joints by altering the centre of gravity. Over time, this weight redistribution may lead to increased muscular development in the forelimbs relative to the hindquarters.

Audible clicking from the hip region

A clicking or popping sound may be heard during movement, particularly during rising from rest or during specific gait phases. This sound can originate from the femoral head partially subluxating within the acetabulum or from changes in the joint capsule and surrounding soft tissues. While not always present, when audible, it often coincides with observable movement asymmetry.

Later signals

Progressive hind limb muscle wasting

Chronic pain and reduced use of the affected limbs leads to progressive atrophy of the gluteal, thigh, and hamstring muscles, creating a visibly narrower hindquarter compared to the forelimbs. This muscle loss further compromises joint stability and functional capacity, as the periarticular musculature plays a crucial role in dynamic joint support. The disproportion between fore and hind limb muscle mass may become increasingly noticeable over months to years.

Significant lameness and stiffness

As osteoarthritis progresses, lameness may become more consistent and apparent, particularly after rest (so-called 'start-up' lameness) or following exercise. Stiffness may be most pronounced in cold or damp weather and after periods of inactivity, reflecting the inflammatory and mechanical components of joint disease. The severity of lameness often fluctuates, with good days and bad days influenced by activity level, weather, and other variables.

Reduced range of hip motion

Physical examination may reveal increasingly restricted hip extension and abduction, with discomfort evident during manipulation of the joint through its range of motion. The loss of motion reflects a combination of osteoarthritic joint changes, capsular fibrosis, periarticular osteophyte formation, and muscle contracture. This reduced flexibility affects the dog's stride length and ability to perform movements requiring hip extension.

Behavioural and temperament changes

Chronic pain from progressive hip disease may produce changes in behaviour including irritability when touched around the hindquarters, reluctance to be groomed or handled, changes in sleep patterns, or withdrawal from social interactions. Some dogs may show aggression when other animals or people inadvertently bump their hips. These behavioural shifts often develop gradually and may not be immediately connected to the underlying joint condition.

Click to read about the biological mechanisms

How this is usually investigated

Investigation of suspected hip dysplasia typically combines clinical orthopaedic examination with imaging to assess joint conformation, laxity, and the presence of secondary osteoarthritic changes. The approach may vary depending on the dog's age, the clinical presentation, and whether the assessment is for screening purposes or in response to clinical signs.

Orthopaedic examination

Purpose: Clinical examination of the hips includes assessment of gait, posture, muscle symmetry, range of motion, and joint stability. The Ortolani test — a specific manipulation that assesses hip laxity by detecting subluxation and reduction of the femoral head — is particularly useful in young dogs before significant osteoarthritic changes develop. Palpation may reveal crepitus (a grinding sensation), pain on hip extension, or reduced range of motion.
Considerations: Clinical findings can be subtle, particularly in dogs that are anxious during examination or that compensate effectively for bilateral disease. Sedation or anaesthesia may be needed for reliable assessment of joint laxity, as muscle tension in an awake dog can mask significant laxity. The Ortolani sign may become undetectable in older dogs with established osteoarthritis and joint capsule fibrosis.

Standard hip radiography

Purpose: Ventrodorsal hip-extended radiography remains the most widely used imaging method for assessing hip conformation. This standardised view allows evaluation of acetabular depth, femoral head coverage, congruence of joint surfaces, and the presence and severity of osteoarthritic changes including osteophyte formation, subchondral sclerosis, and joint space irregularity. Various scoring systems (BVA/KC, OFA, FCI) provide standardised grading frameworks.
Considerations: Radiographic positioning significantly affects the appearance of the hips, and general anaesthesia or deep sedation is typically required for consistent, diagnostic-quality positioning. The hip-extended position used for standard views may actually tighten the joint capsule and temporarily improve apparent joint congruence, potentially underestimating laxity. Radiographic severity does not always correlate with clinical signs, and some dogs with significant radiographic changes function well clinically.

PennHIP distraction radiography

Purpose: The PennHIP method uses a specific distraction technique to quantify hip joint laxity by measuring the distraction index (DI) — the degree to which the femoral head can be displaced from the acetabulum. This provides a numerical measure of passive hip laxity that has been shown to correlate with the risk of developing osteoarthritis. PennHIP can be performed from as early as 16 weeks of age, offering earlier assessment than standard hip-extended radiography.
Considerations: PennHIP requires trained and certified practitioners, which may limit availability. The distraction index quantifies laxity but is one factor among several that influence clinical outcomes. Dogs with high DI values carry increased risk of developing osteoarthritis but may not inevitably become clinically affected, as other factors including muscle mass, body weight, and activity level modify the clinical expression.

CT scanning

Purpose: Computed tomography provides three-dimensional assessment of hip joint anatomy, offering detailed visualisation of bony structures, acetabular depth, femoral head coverage, and the spatial relationship between joint components. CT can be particularly useful for surgical planning, where precise anatomical measurements guide decisions about specific procedures and implant selection.
Considerations: CT requires general anaesthesia and involves exposure to ionising radiation, though the dose from a focused study is generally modest. Its primary advantage over standard radiography is the three-dimensional information it provides, which is most valuable when surgical intervention is being considered. For routine screening and monitoring, standard radiography typically provides sufficient information at lower cost.

Gait analysis

Purpose: Objective gait analysis, using force plates or pressure-sensitive walkways, can quantify weight-bearing patterns and detect subtle asymmetries that may not be apparent on visual gait assessment. This technology measures ground reaction forces, stance phase duration, and limb loading distribution, providing numerical data that can track changes over time or assess the response to interventions.
Considerations: Force plate and pressure mat analysis is typically available at referral centres and research institutions rather than general practice. Results can be affected by the dog's gait speed, the walkway surface, and the dog's level of cooperation and comfort in the testing environment. While valuable for objective assessment, gait analysis complements rather than replaces clinical examination and imaging.

Options & trade-offs

Management of hip dysplasia spans a broad spectrum from conservative approaches aimed at maintaining comfort and function to surgical interventions that address the underlying joint abnormality. The approach is typically tailored to the individual dog's age, severity of clinical signs, degree of osteoarthritis, body weight, and the expectations and circumstances of the household.

Weight management and controlled exercise

Maintaining a lean body condition is consistently identified as one of the most impactful modifiable factors in managing hip dysplasia. A landmark study demonstrated that dogs maintained at a lean body condition throughout life developed significantly less severe osteoarthritis and showed later onset of clinical signs compared to their ad libitum-fed siblings. Controlled, low-impact exercise — such as lead walking, swimming, and underwater treadmill — helps maintain muscle mass and joint mobility without the jarring impact of high-intensity activities.

Trade-offs: Achieving and maintaining lean body condition requires long-term dietary discipline and may conflict with the dog's appetite, particularly in breeds predisposed to food motivation. Restricting high-energy activities can be challenging with young, energetic dogs and may require creative approaches to mental stimulation. The benefits of weight management are gradual and cumulative, requiring sustained commitment to appreciate their impact over time.

Pharmacological pain management

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and inflammation associated with hip dysplasia-related osteoarthritis. Newer multimodal analgesic approaches may include anti-nerve growth factor (anti-NGF) monoclonal antibodies, gabapentinoids for neuropathic pain components, and tramadol or other analgesics. Joint supplements containing glucosamine, chondroitin sulphate, and omega-3 fatty acids are also widely used, though their evidence base varies.

Trade-offs: Long-term NSAID use requires periodic monitoring of renal and hepatic function, and some dogs may experience gastrointestinal side effects. The efficacy of joint supplements remains debated, with variable evidence from clinical trials. Anti-NGF therapies represent a newer option with a distinct mechanism but require regular administration and monitoring. Finding the optimal combination and dose of analgesic medications often involves a period of adjustment.

Juvenile pubic symphysiodesis (JPS)

JPS is a preventive surgical procedure performed in young puppies (typically 14-20 weeks of age) that have been identified as having significant hip laxity but before osteoarthritic changes develop. The procedure involves cauterising the growth plate of the pubic symphysis, causing premature closure that gradually rotates the acetabular roof to provide improved femoral head coverage as the pelvis continues to grow. The concept is to improve hip conformation during the remaining growth period.

Trade-offs: The procedure is only effective within a narrow age window, requiring early identification of at-risk puppies through screening (typically PennHIP). The degree of improvement in acetabular coverage depends on the timing of the procedure relative to remaining pelvic growth. JPS does not eliminate dysplasia but aims to reduce its severity, and not all puppies identified as having laxity will develop clinically significant disease.

Total hip replacement (THR)

Total hip replacement involves removing the diseased femoral head and acetabulum and replacing them with prosthetic components — typically a metal or ceramic femoral head and stem paired with a high-density polyethylene or ceramic acetabular cup. When successful, THR provides a pain-free, functional joint with near-normal range of motion. Cemented and cementless systems are available, with the choice often depending on the dog's size, age, and bone quality.

Trade-offs: THR is a major surgical procedure with significant cost and a recovery period typically spanning 8-12 weeks of restricted activity. Potential complications include implant loosening, luxation, infection, and femoral fracture, though complication rates have decreased significantly with modern implant systems and surgical techniques. Not all dogs are suitable candidates, and bilateral disease may require staged procedures with adequate recovery time between sides.

Femoral head and neck excision (FHNE)

FHNE, also known as femoral head ostectomy, involves surgical removal of the femoral head and neck, eliminating the painful bone-on-bone contact within the dysplastic joint. The body forms a fibrous pseudo-joint (false joint) in place of the removed bone, supported by surrounding muscle and scar tissue. This procedure removes the source of pain while maintaining functional mobility, though the biomechanics differ from a normal hip.

Trade-offs: FHNE typically produces good outcomes in smaller dogs (generally under 20 kg) where the muscle mass is sufficient to support the pseudo-joint, but results in larger dogs are more variable. The range of motion and limb function after FHNE are generally not as normal as after successful total hip replacement. Post-operative physiotherapy is important for optimising the functional outcome, and the recovery period requires commitment to rehabilitation exercises. The procedure is often considered when THR is not feasible due to cost, availability, or patient factors.

Common misconceptions

Misconception:

"Hip dysplasia only affects large breed dogs"

Reality:

While large and giant breed dogs are most commonly affected and have received the most research attention, hip dysplasia can occur in medium-sized and even small breed dogs. Breeds such as Pugs, French Bulldogs, and Cocker Spaniels have documented incidence of hip dysplasia. The clinical impact may manifest differently in smaller dogs, partly because their lower body weight places less mechanical stress on the joints, but the underlying developmental abnormality is the same. Awareness of hip dysplasia in smaller breeds is growing, though it may still be underdiagnosed in these populations.

Misconception:

"Bad hips on X-ray means the dog must be in significant pain"

Reality:

The correlation between radiographic severity and clinical signs is notably inconsistent in hip dysplasia. Some dogs with radiographically severe changes — marked subluxation, significant osteophyte formation, and substantial remodelling — function remarkably well with minimal apparent discomfort. Conversely, dogs with modest radiographic changes may show considerable clinical disability. Factors including muscle mass, body weight, individual pain tolerance, activity demands, and compensation strategies all influence how a given level of structural change translates into functional impact. This discordance makes clinical assessment at least as important as imaging in evaluating the condition's impact.

Misconception:

"Exercise should be avoided entirely in dogs with hip dysplasia"

Reality:

Complete exercise restriction can be counterproductive, as the periarticular musculature provides dynamic stability to the hip joint and helps distribute mechanical forces. Muscle atrophy from inactivity can actually worsen joint instability and accelerate functional decline. Controlled, appropriate exercise — particularly low-impact activities such as lead walking, swimming, and underwater treadmill — helps maintain muscle mass, joint mobility, and cardiovascular fitness while avoiding the excessive impact of uncontrolled high-energy activities. The principle is generally to encourage regular, controlled movement while avoiding activities that involve jumping, sudden directional changes, or sustained high-impact loading.

Understanding hip dysplasia involves recognising it as a developmental condition with lifelong implications that can be managed effectively in many cases through a combination of approaches. The relationship between radiographic severity and clinical impact is not always straightforward, and individual dogs often develop their own patterns of coping and compensation that evolve over time. Weight management consistently emerges as one of the most impactful modifiable factors, with evidence suggesting that maintaining lean body condition can significantly influence the progression and clinical impact of the condition. The landscape of management options continues to evolve, and what constitutes an appropriate approach often reflects the individual dog's needs, stage of life, and response to different interventions.

Last reviewed: 24 April 2026 · Dr Alastair Greenway MRCVS