By Gwen Francisco, BA, MFA, LVT, CVPP
“A proposed framework for practical multimodal management of osteoarthritis in growing dogs”
Marcellin-Little DJ, Hulse DA, Huntingford, JL, Grubb T, Brunke MW, Pechette A, Frank B.
Front. Vet. Sci., 27 April 2025
Sec. Anesthesiology and Animal Pain Management
Volume 12 – 2025 | https://doi.org/10.3389/fvets.2025.1565922
Recent studies have amply demonstrated the importance of early diagnosis of osteoarthritis in canine patients, but few are as comprehensive as a recently published review of OA in puppies and young dogs. A group of highly credentialed clinicians participated in this review, which described the unique presentation of the disease in growing dogs and offered practical guidance for preventing and managing OA in dogs during this life stage.
The authors acknowledge that an OA diagnosis in young dogs is relatively uncommon because osteoarthritis “is seldomly detected based on its common triggers (joint subluxation or joint instability).” Rather OA is discovered because of the synovial or subchondral bone inflammation that results from subluxation and instability. Growing dogs often aren’t diagnosed until the inflammation causes significant acute pain and limb disuse. Unfortunately, subluxation can lead to the development of OA within weeks to months, long before puppies demonstrate pain and reluctance to use a limb.
Early diagnosis and treatment
Early diagnosis and treatment of OA are keys to alleviating acute pain and preventing the development of chronic, life-long pain. The report maintains that clinical signs are much more limited in early OA and therefore are easier to control. Early diagnosis also offers opportunities to “modulate growth by adjusting food intake, to control the timing of neutering, and to prevent excessive weight gains.” As the authors explain, “Maintaining lean body condition delays the onset and slows the progression of OA. It also increases longevity and is essential for overall quality of life.”
While osteoarthritis is acknowledged as the most common orthopedic condition in dogs, young dogs can be tough to diagnose since they often exhibit intermittent symptoms. According to the review, “Hip dysplasia in dogs with transient hip subluxation and bilateral elbow dysplasia may not have a severe impact on gait in the short term and may not be readily confirmed on radiographs because hip subluxation is intermittent and because elbow subluxation may be impossible to document on radiographs before the development of osteophytes.”
Clinicians should be aware that mobility and function are rarely compromised in puppies with early stage OA. Also, unlike dogs with chronic osteoarthritis, young dogs with early OA usually do not have loss of muscle mass or loss of joint function. The report recommends using the Ortolani sign during hip joint palpation with all young dogs to diagnose hip subluxation before the onset of hip OA. (See the CARE video here on how to perform an Ortolani exam)
As with adult dogs, changes in a puppy’s behavior can be an indicator of developing osteoarthritis. Loss of playfulness and mobility, reluctance to jump into the car or go for a walk are “likely surrogate markers of the presence of chronic pain.”
The review characterizes puppies with a high risk of developing OA as healthy puppies with conformational abnormalities who are likely to engage in high-intensity athletic activity as well as puppies from breeds known to get early onset OA.
Treatment of young dogs
Treatment of young dogs with OA starts with involving the pet caregiver. “Dog owners should understand what joints and limbs are affected by OA, what physiologic, physical, and functional responses are observed at the time of evaluation and anticipated in the future,” say the authors. Owner education and cooperation is imperative for successful treatment. The review recommends “patient centered rather than clinician centered” care and advocates for consistent care through case management realized by licensed veterinary technicians.
Multimodal treatment for young dogs is strongly recommended. Along with appropriate nutrition, joint supplements including marine-sourced Omega 3 fatty acids, UC II (Undenatured Collagen Type II) and FortetropinÔ (egg yolk) are suggested. It’s important to note that FortetropinÔ has not been studied in growing dogs. Polysulfated glycosaminoglycan (PSGAG, Adequan®) can be used to address the increased production of collagen destroying MMPs in OA, according to the authors. Early use may help reduce the degradation of articular cartilage.
Pharmaceutical management centers on non-steroidal anti-inflammatories since most of the safety and efficacy research on medications in young dogs is focused on NSAIDs. The authors explain that “NSAIDs should be the first treatment choice because the available data supporting their efficacy is stronger than other pain medications.” The review offers a table listing NSAIDs that have been approved for puppies in the United States and minimum age requirements for each product.
Monoclonal antibodies that target nerve growth factor (LibrelaÔ) and the oral NMDA receptor antagonist amantadine are also discussed, but those drugs carry caveats due to limited safety and efficacy research in puppies. Data for amantadine in young dogs is minimal. Librela is not indicated in dogs less than 12 months because NGF (the target of Librela) is required for normal growth and development of the nervous system and safety studies have not been performed in growing dogs. Caution is also recommended for use of gabapentin due to the lack of research in puppies.
The review uses a table to summarize its pharmaceutical recommendations based on the stage of the disease. Healthy but high risk puppies would benefit from diet guidelines, exercise and joint supplements. Young dogs experiencing pain from OA may need NSAIDs, amantadine, gabapentin or anti-NGF mAbs.
The authors discuss intraarticular injections of orthobiologics and viscosupplementation products, saying these “appear safe” but warn there is no research on their use in puppies. Platelet rich plasma (PRP) and autologous or allogenic mesenchymal stem cell (MSC) therapies are called “safe and beneficial to dogs with OA” and note that a combination of MSC and PRP “has reported benefits to manage OA.” IA injections of radioactive tin (SynovetinÒ) to manage OA has not been studied in puppies and young dogs. The authors suggest that “IA injections can be used as an alternative to surgery in patients who are poor surgical candidates” or following surgery if joint effusion and pain persist.
For puppies with severe joint problems
For puppies with severe joint problems, the authors suggest surgical corrections before trying joint injections. Hip laxity in growing dogs can be addressed by altering the acetabular orientation through juvenile pubic symphysiodesis (JPS), though there is a narrow time window for this procedure to be effective- typically between 16-20 weeks of age. In older puppies, a similar outcome can be achieved through the much more invasive procedures, double or triple pelvic osteotomies (DPO/TPO). These procedures can benefit dogs with hip laxity, but results results depending on the severity of hip laxity prior to surgery and OA may still develop. Total hip replacement typically isn’t performed in puppies and if this procedure is being considered in the future, medical management to should be pursued until the surgeon determines the dog is a suitable candidate. Young dogs for with THR is not an option may gain pain relief from a femoral head ostectomy (FHO).
Elbow dysplasia is most often found in large breed dogs and can be managed conservatively or with surgery such as removal of osteochondral fragments combined with ulnar osteotomy to improve joint congruity. The authors cast doubt on the long-term benefits of these procedures and remind us that “most dogs with elbow dysplasia develop OA which progresses over time.”
Patellar luxation in the growing dog can result in severe displacement, growth abnormalities and tissue changes. Dogs with mild patellar luxation can be managed without surgery; more severe forms may require surgery. The authors warn that osteoarthritis progresses in these dogs, even when managed conservatively.
Cranial cruciate ligament injury can occur in puppies, especially working and sporting dogs that begin training before skeletal maturity. These injuries are often managed with surgery. Interestingly, the review tells us that OA in dogs with cranial cruciate ligament injury is more severe than dogs with patellar luxation, possibly due to a stronger inflammatory reaction. Surgeons may choose to manage these injuries with a tibial plateau leveling osteotomy (TPLO), but the review warns that this surgical procedure may interfere with the proximal tibial growth plate.
Osteochondral fragments from osteochondritis dissecans (OCD) can be found in the stifle, shoulder, elbow and tarsus, most often in young, male, large breed dogs. Fragments can be removed surgically but, again, the review cautions that most joints with OCD develop OA. Similar warnings arise in dogs being treated for conformational abnormalities, particularly when they involve the antebrachium, suggesting that “antebrachial deformities should be managed without delay in puppies.”
Management of osteoarthritis
Management of osteoarthritis in young dogs is often introduced in phases with an initial focus on nutrition, weight control, activity oversight, physical rehabilitation, and nutritional supplementation. The next phase adds an NSAID and other medications, followed by joint injections or – if addressing a severe joint problem – a surgical procedure. The authors prioritize management options in a table, according to the stage of the disease.
A healthy/low risk puppy, for example, would benefit from exercise, a healthy diet and potentially supplements such as omega 3 fatty acids, Adequan and UCII. High risk puppies or young dogs already affected by the disease may need pharmaceuticals, joint injections, surgical corrections or salvage procedures.
The authors lament the dearth of literature in young dog OA in spite of how insidious and debilitating the disease can be in puppies. This is likely because the impact of OA in growing dogs is less severe or less obvious than in older dogs. But it’s vital to remember that OA is a progressive disease that can bring chronic pain and reduced quality of life to our patients’ middle and later years.
The review stresses that caring for OA patients requires a life time plan that is realistic and affordable for the pet owner. Consistent communication and individualized therapy plans are strongly recommended as is a focus on efficacy. “The efficacy of OA management steps is particularly important when treating early OA in puppies because management steps with minimal efficacy are unlikely to be sustained over the long term by owners,” warns the report.
The review reminds us that the primary management goals of OA in puppies are to alleviate pain and decrease joint inflammation. While early diagnosis is challenging, it is achievable with a proactive approach and can provide a significantly higher quality of life for the entire life of our canine patients.