Should We Be Operating on Dogs Before They Have Hip Pain? The Evolving Controversy in Canine Hip Dysplasia.

By Steve Mehler, DVM, DACVS

For generations, veterinarians have been taught a relatively simple approach to canine hip dysplasia.

If a dog wasn’t painful, we watched.

We monitored body condition, recommended appropriate exercise, managed weight carefully, and introduced medications or surgery only if clinical signs eventually developed.

It was a logical strategy. After all, why perform orthopedic surgery on a dog that appears perfectly happy?

Today, however, advances in biomechanics, diagnostic imaging, and our understanding of osteoarthritis have challenged that traditional mindset. Increasingly, orthopedic surgeons are asking a difficult question:

Are we waiting too long?

The answer is far from straightforward, which is why this remains one of the most interesting controversies in veterinary orthopedics.

Hip Dysplasia Is Not the Same Thing as Osteoarthritis

One of the biggest misconceptions surrounding hip dysplasia is that arthritis suddenly appears once a dog begins limping.

That isn’t how the disease develops.

Hip dysplasia begins with joint laxity—an abnormal looseness of the hip joint.

Instead of the femoral head fitting tightly within the acetabulum, the joint experiences excessive movement during normal activity.

Every step creates tiny amounts of abnormal motion.

That repetitive instability causes microscopic damage to cartilage.

Inflammatory pathways become activated.

Bone begins to remodel.

Cartilage slowly deteriorates.

By the time many dogs develop an obvious limp, osteoarthritis has often been developing silently for months—or even years.

In other words, pain is frequently one of the last signs of disease rather than the first.

The Traditional Approach

Historically, veterinarians often managed asymptomatic dogs conservatively.

Recommendations commonly included:

    ●    Maintaining a lean body condition

    ●    Regular low-impact exercise

    ●    Physical rehabilitation when appropriate

    ●    Nutraceuticals in selected patients

    ●    Anti-inflammatory medications once pain developed

    ●    Surgery reserved for dogs with significant clinical disease

This approach still has merit.

Many dogs with mild hip laxity never become severely affected.

Some remain remarkably comfortable throughout their lives.

That reality is one reason this debate exists.

The Preventive Surgery Argument

Orthopedic surgeons who advocate for early intervention start from a different premise.

If instability causes arthritis…

and arthritis cannot be reversed…

then shouldn’t treatment focus on preventing instability before permanent cartilage damage occurs?

That philosophy has led to procedures specifically designed for young dogs before substantial osteoarthritis develops.

Juvenile Pubic Symphysiodesis (JPS)

JPS is performed in very young puppies, generally between 12 and 20 weeks of age.

The procedure closes part of the growth plate of the pelvis, allowing continued growth to gradually improve coverage of the femoral head.

It is minimally invasive compared with later reconstructive procedures, but timing is everything.

Once the puppy is beyond the ideal age window, the opportunity is lost.

Double and Triple Pelvic Osteotomy (DPO/TPO)

For slightly older but still skeletally immature dogs, DPO or TPO may be considered.

These procedures rotate the acetabulum to improve coverage of the femoral head and increase joint stability.

Unlike JPS, they are considerably more invasive but can preserve the native hip joint in carefully selected patients.

The key phrase is carefully selected.

These surgeries are not intended for dogs with advanced osteoarthritis.

They are preventive procedures aimed at preserving joint health before irreversible damage occurs.

Why Not Operate on Every Dog?

Because hip dysplasia is unpredictable.

Not every puppy with hip laxity develops debilitating arthritis.

Breed, genetics, body condition, muscle mass, activity level, and environmental factors all influence progression.

Some dogs with substantial radiographic changes remain comfortable for years.

Others develop severe arthritis despite relatively modest imaging abnormalities.

Performing preventive surgery on every dog with hip laxity would inevitably mean operating on dogs that may never have needed surgery.

Every operation carries risks.

There are anesthesia considerations.

Recovery time.

Financial costs.

Potential complications.

These realities make appropriate patient selection absolutely critical.

Early Detection Changes the Conversation

Perhaps the biggest lesson from recent research is not that every puppy needs surgery.

It’s that every at-risk puppy deserves an informed discussion.

Screening tools now allow veterinarians to identify hip laxity long before traditional hip radiographs performed at skeletal maturity.

These may include:

    ●    Thorough orthopedic examinations

    ●    PennHIP evaluation

    ●    Screening radiographs when appropriate

    ●    Breed-specific risk assessment

    ●    Evaluation by a veterinary orthopedic surgeon

The goal isn’t to create more surgical candidates.

The goal is to identify the relatively small population of dogs that may truly benefit from early intervention while avoiding unnecessary procedures in those unlikely to progress.

What Happens Once Arthritis Is Established?

Unfortunately, once significant osteoarthritis develops, preventive procedures such as JPS and DPO/TPO are generally no longer appropriate.

At that stage, treatment shifts toward managing pain, improving function, and maintaining quality of life.

Options may include:

    ●    Weight management

    ●    Physical rehabilitation

    ●    NSAIDs and multimodal pain management

    ●    Disease-modifying therapies where appropriate

    ●    Total hip replacement

    ●    Femoral head ostectomy (FHO) in selected patients

These procedures can dramatically improve quality of life, but they treat the consequences of instability rather than preventing them.

So…Who’s Right?

This is what makes the debate so fascinating.

The evidence does not suggest that every dog with hip laxity should undergo surgery.

Nor does it support ignoring hip laxity until a dog becomes painful.

Instead, the evidence points toward something more nuanced.

Early surgery appears to provide the greatest benefit for appropriately selected young dogs with demonstrable hip laxity before significant osteoarthritis develops.

For many other dogs, conservative management remains entirely appropriate.

The challenge—and the art of veterinary medicine—is determining which patient belongs in which group.

My Perspective

I don’t believe every puppy with hip dysplasia should undergo preventive surgery.

But I also don’t believe we should wait until every dog is limping before discussing the available options.

Hip dysplasia is a disease that begins long before most owners recognize it.

Our job isn’t simply to treat arthritis once it develops.

It’s to identify which patients may benefit from preserving their joints before irreversible damage occurs.

The future of canine orthopedics may not be about operating earlier.

It may be about identifying the right patients earlier.

And that is where science, clinical judgment, and thoughtful discussions with owners become most important.