This review summarized nonsurgical methods for managing canine hip dysplasia (CHD) and associated osteoarthritis (OA). The levels of evidence (I-IV) developed to evaluate orthopedic surgery were used to categorize reviewed studies, including 3 level IV, 4 level III, and 7 level II studies. Nonsurgical management methods included activity restriction, weight management, acupuncture, and methods for joint disease modulation (polysulfated glycosaminoglycans [PSGAGs], antioxidants, mesenchymal stem cell [MSC] therapy, and extracorporeal shock wave therapy [ESWT]). Of the 3 level IV studies examining activity restriction, 1 supported and 2 contested it as adequate means for managing CHD and OA. Two level II studies supported weight restriction through dietary limitation as an effective management for hip OA. Two level III and 3 level II studies provided evidence supporting the use of PSGAGs, MSC, or ESWT for modulation of joint disease; support for antioxidant use was considered questionable. On review of 3 level II studies and 1 level III study, there was conflicting evidence on acupuncture benefits. Several conclusions included weight management as an important component of preventing and managing OA; benefits of modulation of joint disease with PSGAGs, MSC, and ESWT; lack of level I studies in veterinary literature; and the need for studies investigating physical rehabilitation

CHD and subsequent OA are among the most common musculoskeletal issues seen in practice, and many nonsurgical treatment modalities have been proposed. The authors reminded practitioners that they have an obligation to patients, clients, and the credibility of their profession to follow the data when possible. It is important to recognize gaps in data in order to recognize when additional studies are warranted.—Robin Downing, DVM, CVPP, CCRP, DAAPM

Canine hip dysplasia: Reviewing the evidence for nonsurgical management. Kirkby KA, Lewis DD. VET SURG 41:2-9, 2012.