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KEYWORDS
Hip dysplasia Hip laxity Hip subluxation Hip osteoarthritis Ortolani test
KEY POINTS
Hip dysplasia is a common developmental disorder of the dog consisting of varying de-
grees of hip laxity, progressive remodeling of the structures of the hip, and subsequent
development of osteoarthritis.
Hip dysplasia is a juvenile-onset condition, with clinical signs often first evident at 4 to
12 months of age.
A presumptive diagnosis of hip dysplasia can be made by collection of a thorough history
and performance of a comprehensive physical examination.
The Ortolani test is a valuable screening tool for hip dysplasia, particularly in the juvenile
patient.
INTRODUCTION
SIGNALMENT
Breed
Any size or breed of dog can be affected with hip dysplasia but the condition is most
commonly diagnosed in large and giant breed dogs. Breeds with the most evaluations
by the Orthopedic Foundation for Animals for hip dysplasia over the last 40 years
Sex
Multiple large prevalence studies show no sex predilection associated with hip
dysplasia.3–6 However, several studies suggest that male neutered dogs may be at
increased risk for development of hip dysplasia, especially when neutered early.7–10
Definitions of early neutering associated with increased incidence of hip dysplasia in
these studies included dogs that were younger than 5.5 months, 6 months, and
12 months of age at the time of neutering.
Age
Juvenile patients
Hip dysplasia is by definition a juvenile-onset condition. Clinical signs of hip dysplasia
are often first evident at 4 to 12 months of age.11–13 Onset of signs is typically gradual
and progressive, although an acute onset of signs may be seen, most often in juvenile
patients. Dogs with this acute onset of signs are typically more severely affected, with
pain thought to be caused by stretching and tearing of joint capsule and other sup-
porting structures, along with acetabular microfracture.13 Evidence of hip laxity is
not present at birth but may be detectable as early as 7 weeks of age.11 Clinical signs
noted by the owner are listed in Table 1.11–14
Adult patients
Several reasons may exist for initial presentation of dysplastic patients older than
12 months of age. The patient may have had signs as a puppy that went unnoticed
by the owner, undiagnosed by the family veterinarian, or there was a delay in referral.
Alternatively, some dogs may not exhibit clinical signs until later in the disease pro-
cess, often associated with progression of osteoarthritis. These cases may exhibit
clinical signs similar to juvenile patients but clinical signs in older patients are often
Table 1
Clinical signs of hip dysplasia
more referable to osteoarthritic changes, rather than signs associated with laxity and
subluxation. Because clinical signs of hip dysplasia in older patients are most often
gradually progressive, an adult patient presenting for acute onset of hind limb lame-
ness attributed to hip dysplasia should be carefully screened for other conditions.
Table 2
Common differential diagnoses for dogs with hip pain and no history of trauma
Juvenile Adult
Iliopsoas strain Iliopsoas strain
Legg-Calvé-Perthes disease (small breeds) Lumbosacral stenosis
Slipped capital femoral physis Neoplasia
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Ortolani test
The author’s preference when assessing hip subluxation in juvenile patients is to
perform a combination of the Barlow and Ortolani tests (commonly referred to as
an Ortolani test), as described by Chalman and Butler18 in 1985. The patient is heavily
sedated or anesthetized and placed in dorsal recumbency. An assistant stabilizes the
thorax and head of the dog to ensure true dorsal recumbency is maintained. The
examiner is behind the patient, looking toward the head. The examiner grasps the sti-
fles and ensures the femurs are positioned perpendicular to the floor (Fig. 1). Each hip
is tested sequentially, as follows. Gentle pressure is applied down the shaft of the fe-
mur toward the acetabulum (Fig. 2A). While maintaining this downward pressure, the
hip is slowly abducted until a palpable clunk is noted. The angle of the medial aspect
of the femur with a line perpendicular to the examination table is noted at the time of
reduction of the hip and recorded as the angle of reduction (see Fig. 2B). If no
palpable or audible reduction of the hip is noted, this is a negative Ortolani test result.
The hip is then adducted until subluxation is noted, palpable as a dorsal deviation of
the proximal femur. The angle of the medial aspect of the femur with a line perpen-
dicular to the examination table is recorded as the angle of subluxation (see
Fig. 2C). The test is often repeated 2 to 3 times for each hip to ensure accuracy
and precision of the measurements. The reduction and subluxation angles, as well
as the nature of the reduction (crisp or soft) are recorded. These data may be useful
to quantify hip laxity, follow progression of changes over time and to judge candidacy
for surgical interventions such as juvenile pubic symphysiodesis or triple pelvic
osteotomy.
Fig. 1. Examination of a patient using the Ortolani test. The patient is placed in dorsal re-
cumbency with an assistant to stabilize the thorax and head. The examiner stands behind
the patient, grasping the stifles, with the femurs positioned perpendicular to the floor.
Hip Dysplasia 5
Fig. 2. Examination of the left hip using the Ortolani test from the examiner’s perspective,
paired with drawings depicting effects of the test on the coxofemoral joint. (A) Gentle
pressure is applied down the shaft (arrow) of the left femur with the examiner’s right
hand, causing subluxation of the hip. (B) While maintaining this downward pressure
(arrow), the hip is slowly abducted (curved arrow) until a palpable clunk is noted. The
angle of the medial aspect of the femur with a line perpendicular to the examination table
is measured at the time of reduction of the hip and recorded as the angle of reduction
(angle q). (C) The hip is adducted (curved arrow) while continuing to maintain downward
pressure (arrow) until subluxation is noted, palpable as a dorsal deviation of the proximal
femur. The angle of the medial aspect of the femur with a line perpendicular to the exam-
ination table is recorded as the angle of subluxation (angle q).
associated with increasing severity of the Ortolani, suggesting increased laxity could
be semiquantified with the test. The same study showed the association between DI
and Ortolani was weaker in dogs with radiographic osteoarthritis, suggesting that
remodeling in such cases led to a negative or decreased Ortolani sign, despite laxity
of the hip. Ortolani testing has been shown to provide a 92% to 100% sensitivity for
identifying laxity in juvenile dogs older than 4 months of age that later developed radio-
graphic signs of hip dysplasia.20–22 Specificity in those studies study was 41% to 79%,
suggesting Ortolani evaluation might best be used as a screening test and other tests,
such as DI measurements, may be better for confirmation of diagnosis. However, a
study evaluating Ortolani in younger dogs (6–10 weeks of age) revealed a lower sensi-
tivity for detecting dysplastic dogs (55%), so caution should be used when proclaim-
ing a young puppy free of hip dysplasia using the Ortolani test alone.23 Additionally,
subluxation tests may become less productive as dysplasia progresses.19 As dorsal
acetabular rim wear and acetabular infilling increases in severity, reduction of the sub-
luxated hip becomes less distinct or no longer palpable. Therefore, the Ortolani and
other subluxation tests may be less valuable for evaluating older dogs with suspected
hip dysplasia.
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SUMMARY
With proper attention to collection of history and physical examination findings, the
clinician can eliminate differential diagnoses and make a presumptive diagnosis of
hip dysplasia. The Ortolani test is a valuable tool for identifying juvenile dogs affected
with this condition. Further diagnostics can then be prioritized, contributing to prompt
diagnosis and appropriate treatment.
ACKNOWLEDGMENTS
The author would like to thank Jonathan Blakely, DVM for providing the line draw-
ings used in this article.
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