| 
               
            It
            was pointed out to me that the evaluation chart on the BCCA health
            page that attempts to compare hip scores from a number of
            organizations and different countries doesn’t stack up in real
            life.  How exactly do the different scores compare?  Thus
            this article was born, and a somewhat strange trip it has been. 
            To save those of you who are easily bored, I will cut to the chase
            and present my conclusions first.  Hip evaluation is
            subjective.  It depends on humans and as such is liable to
            human error.  First there is the person taking the original
            X-rays, their skill and their patience with positioning and
            technical knowledge in making those X-rays.  Then there is the
            consistency of the evaluation.  Go to a dog show for a four day
            weekend, and see totally different line ups of winners at all
            levels.  It is subjective judgment.  For sure some dogs
            will consistently win more than others, but they will be beaten at
            times too.  Hip evaluation too is subjective.  That being
            said consistency is better than we might expect.  Still, if you
            have a dog that appears perfectly sound, has a family of dogs with
            good hips and you get a borderline or dysplastic evaluation, don’t
            just accept it, reshoot and resubmit.  Always go to a
            veterinarian experienced at shooting hip X-rays rather than relying
            on one who does one every year or so.  However, if you are
            looking to buy a dog and at least the parents do not have some kind
            of adult health clearance, or if you want to breed to a dog and it
            lacks hip evaluation, I am with Dr. Corley of the Orthopedic
            Foundation for Animals (OFA), you can pretty much bet that it failed
            to achieve a normal hip evaluation.  Caveat emptor.  
              
            Hip
            Dysplasia 101 
            Canine Hip Dysplasia (CHD) is broad term used to describe
            malformations of the hip joint which can lead to secondary joint
            diseases (degenerative joint disease (DJD), arthrosis and (osteo)arthritis),
            pain and lameness.  The hip joint is described as a ball and
            socket joint.  The top of the thigh bone (the femur) has a ball
            shaped protrusion which optimally fits snugly into a corresponding
            depression in the pelvic bone.  This depression is called the acetabulum.
             Strictly speaking CHD is not a single disease, and I have
            always thought it would be more helpful to breeders if the
            particular cause of the problem was described.  The major cause
            of CHD is subluxation of the femoral head out of the
            acetabulum.  This may be the result of excessive laxity in the
            tendons holding the bones together, or because the acetabulum and
            head of the femur are poorly matched – the acetabulum is too
            shallow.  Poor quality cartilage lining the joint may also
            exacerbate the condition causing the bones to grind against each
            other and cause pain.  CHD is hereditary and a major gene is
            believed to be responsible.  Having a genetic marker may make
            all the hip evaluation methods unnecessary.  However,
            environment does play a role in the development of pathology in dogs
            with poor hip formation.  Heritability relates the genetic
            basis of the disease or trait (genotype) with what is actually
            expressed or seen (phenotype).  It is expressed as a number
            between 0 and 1 or a percentage and the higher the heritability the
            more the phenotype reflects the genotype, and the greater effect
            selection can have in eradicating a problem. 
              
            The
            severity of the radiographic changes does not correlate to the
            degree of impairment the dog experiences.  Some dogs with
            dysplasia may never show clinical signs.  The amount of stress
            to which the joint is exposed, the dog’s weight, exercise –
            amount and type, even the weather may influence clinical signs. 
            Dogs which are heavily muscles are less likely to show signs of
            dysplasia because the muscles support the joint and keep the bones
            tightly aligned; similarly small, light weight dogs are far less
            likely to show signs even if the joints look dreadful on X-rays.
             Lameness is most often seen between 5-8 months or around 5
            years of age. 
              
            Once
            degeneration of the hyaline cartilage lining the hip joint begins it
            is self perpetuating.  The initial damage is caused by poor
            matching of ball to socket causing rubbing. This damages cartilage,
            sometimes even breaking pieces off.  The damaged cartilage
            releases enzymes that increase the breakdown of the cartilage and
            also decrease formation of proteoglycans molecules that are used to
            repair and make new cartilage.  The cartilage becomes less
            elastic and also thinner, so that it provides less cushioning of the
            joint.  Pieces of cartilage and enzymes leak into the fluid
            filled capsule between the two bones and destroy the
            glycosaminoglycans (GAGs) and hyaluronic acid that are used to make
            more cartilage in a healthy joint.  Joint fluid acts like oil
            to lubricate the joint and keep it moving freely, but in the
            dysplastic joint fluid is depleted and loses the ability to block
            inflammatory cells, which further damage and inflame the joint. The
            synovial membrane lining the joint is eroded exposing the nerve
            endings in the bone beneath the cartilage.  To increase joint
            stability and reduce pain new bone is laid down along the edges of
            the joint surface, within the joint capsule and along ligament and
            muscle attachments – bone spurs.  This reduces the range of
            motion of the joint. 
              
            Assume
            the position 
            Diagnosis of CHD is based on X-ray findings in a large scale
            screening of dogs.  Radiographic technique has been
            standardized worldwide.  Optimally (it is required by some
            agencies) the dog is heavily sedated or anesthetized to ensure full
            muscle relaxation.  It is then laid on the table on its back
            (dorsal recumbency) with the hind limbs extended behind it. 
            The femurs are parallel with each other, with the spine and the
            table top.   The patellae (knee caps) are centered over
            the shafts of their respective femurs.  This requires rotating
            the patellae inward.  The pelvis should appear fully symmetric. 
            Most organizations require that the X-rays be permanently identified
            with the dog’s registration and/or name, the name of the
            veterinarian or hospital taking the X-ray, and the dog’s microchip
            or tattoo number.  
              
            Pregnant,
            lactating or estrus bitches may have greater hip laxity and X-rays
            should be taken one month after the pups are weaned, or before
            estrus, and two to three months after estrus.  Inactive dogs
            may also have increased laxity, and it is recommended that dogs be
            in good physical condition – also important if you plan to breed. 
              
            Diagnostic
            quality should be assessed by the evaluating agency upon receipt and
            those X-rays unsuitable for evaluation should be returned to the
            veterinarian to be repeated.  Problems can include poor
            position, an X-ray that is too light or too dark, or which is
            blurred due to movement of the animal.  
              
            The
            Orthopedic Foundation for Animals (OFA) 
            OFA is the primary screening organization in North America, but they
            receive X-rays for evaluation from all over the world. The X-rays
            are randomly assigned to three board certified veterinary
            radiologists for evaluation (there are 20 to 25 consulting
            radiologists located throughout the USA both in private practice and
            academia).  Hips are evaluated considering breed, sex and age.
            At least 9 areas of the hip are evaluated.  The front and back
            rims of the acetabulum, the top and bottom acetabular margins, the
            head of the femur (ball joint), the fovea capitus – a flattened
            area on the top of the ball, the acetabular notch, the junction
            between the head and neck of the femur (the stem that attaches it to
            the rest of the bone) and the trochanteric fossa (a depression
            between the neck and the other nubbin of bone sticking up at the top
            of the femur.  Each area is examined for deviation from the
            breed normal and the fit of femoral head in the acetabulum. Unlike
            other evaluations, the Norberg angle (NA, see under BVA/KC) is not
            measured.  The hips collectively will be assigned to one of
            seven different phenotypical (physical) conformations.  Three
            of these are normal (excellent, good and fair), one borderline and
            three dysplastic (mild, moderate or severe).  Dogs rated normal
            are assigned OFA numbers, and the information is placed on the OFA
            website www.offa.org .  If
            they have a verified (by the veterinarian taking the X-rays)
            identification – tattoo or microchip – the data will be included
            on AKC registration certificates for any offspring the dog produces. 
            While a report is generated on dogs assigned other grades, unless
            the owner has chosen the option of open database the score will not
            be made public, nor will there be public record that the dog has
            been evaluated.  
              
            Assignment
            is based on consensus, if two examiners assign excellent and one
            good, the hips will be scored excellent, if one says excellent
            another good and the third fair, the hips would be assigned a good
            rating.  
            Excellent:
            Superior hip conformation in comparison to other animals of the same
            age and breed.  Deep seated femoral head in well formed
            acetabulum, the socket almost completely covers the ball and there
            is minimal joint space. 
            Good:
             Slightly less than superior, well formed hip joint, ball
            congruent with socket and well covered. 
            Fair:
            Minor irregularities in the hip joint. The hip joint is wider than
            the good phenotype so that the ball slips slightly out of the socket
            resulting in mild incongruency.  There may be a slight inward
            deviation of the weight bearing surface of the socket, so that it
            looks somewhat shallow (This finding is normal for some breeds, but
            not Beardies.) 
            Borderline: 
            Usually more incongruency than the minimal amount seen in the fair
            hip, but no arthritic changes that would define the hip as
            dysplastic.  Bony changes can not definitively be described as
            arthritic changes as opposed to normal anatomic variation in that
            particular dog.  Resubmission is recommended, usually in 6
            months, at which time the original X-ray will be compared to the new
            one.  In over 50% of dogs no changes will be apparent and the
            hip will be assigned a normal, usually fair, rating.  
            Mild:
            Significant subluxation so the ball is partially out of the socket. 
            The acetabulum is usually shallow, only partially covering the
            femoral head.   There are usually no arthritic changes,
            and if the dog is young 24-30 months it is advisable to resubmit
            X-rays when the dog is older to track the change.  CHD is a
            chronic, progressive disease.  Most owners probably follow the
            dog with their own vet or orthopedist, however. 
            Moderate:
            Significant subluxation with the femoral head barely seated in the
            acetabulum.  Secondary arthritic bony changes are usually seen
            along the femoral neck and head, bone spurs, and changes in bone
            structure – sclerosis -  are also common. 
            Severe: 
            Marked dysplasia with the femoral head partly or completely out of
            the shallow acetabulum.  There are large amounts of secondary
            arthritic change as described above.  
              
            It
            should be noted that until the 90s the criteria for the 7 categories
            were not precisely defined and scoring was left entirely to the
            examiner’s discretion. 
              
            Reports
            will also include other findings that might be inherited including
            transitional vertebrae and spondylosis.  Transitional vertebrae
            are malformations of the spine occurring between the major divisions
            most commonly lumbosacral, but sometimes thoracolumbar.  The
            last lumbar vertebra has anatomical characteristics of the sacrum. 
            Transitional vertebrae rarely produce clinical signs and dogs can be
            used for breeding, although it is recommended they are not bred to
            other dogs with transitional vertebrae.  Spondylosis is the
            production of smooth new bone between the vertebrae, and ranges from
            small bone spurs to complete bridging.  Sometimes it is caused
            by spinal instability, but generally no cause is found and it
            usually does not produce clinical signs.  It should not
            preclude use of the dog for breeding, but is thought to be
            inherited.  
              
            OFA
            looked at 1.8 million X-rays evaluations by 45 radiologists, and
            found that 94.9% of the time all three radiologists agreed the hip
            should be scored normal, borderline or dysplastic.  The exact
            designation – excellent, good, fair, borderline, mild, moderate or
            severe – was agreed upon 73.5% of the time.  Two radiologists
            agreed on the score and the third differed by one grade 21% of the
            time.  Two radiologists agreed and the third was within 2
            grades of that designation 5.4% of the time.  This is good for
            a subjective assessment.  OFA will only assign a number to dogs
            older than 24 months, and accuracy improves as the dog ages and
            arthritic changes become more apparent.  Preliminary hip
            evaluation will be performed on X-rays submitted on puppies 4 months
            and older but less than 24 months.  Evaluation is performed
            in-house by OFA’s own radiologists and not sent out. 
            Accuracy compared to adult evaluation improves the closer the puppy
            is to 24 months.  Pups receiving a preliminary excellent
            evaluation were all (100%) deemed normal (excellent, good or fair)
            as adults.  Percentages for preliminary good was 97.9% and for
            fair 76.9%.  Reliability for 3-6 month puppies was 89.6%, 7-12
            months 93.8% and 13-18 months 95.2%. 
              
            Bearded
            Collies currently rank 117th on the OFA breed list
            (although this includes non AKC breeds and even some cats).  Of
            4040 dogs evaluated 15.3% were assessed excellent and only 6.1%
            dysplastic.  This suggests a clear improvement from when I
            first entered the breed over 20 years ago.  My skeptical side
            wonders though how many X-rays are not submitted because the
            referring vet reads the X-ray as dysplastic?  We cannot really
            know what the true incidence of CHD is in the breed.  The AKC
            has no requirement of OFA or other hip evaluation for breeding
            stock.    
              
            Because
            three board certified radiologists evaluate the X-rays it is
            unlikely that a problem with the hips will be missed.  OFA
            offers extensive advice to breeders on selecting dogs for breeding,
            and the website includes easy access to information on parents,
            siblings and half-siblings tested.  However, participation is
            strictly voluntary. 
              
            BVA/KC
            The British Veterinary Association/Kennel Club scoring method is
            used in Britain, Ireland, Australia and New Zealand to score each
            hip joint separately based on the severity of changes in 9 specific
            morphologic radiographic criteria – see below.  Each
            criterion is scored from 0 (ideal) to 6 (worst).  The final
            score is given between 0 and 53 for each hip or a total of 0-106 for
            the two combined.  The scoring is done by three board certified
            radiologists or small animal surgeons from an available panel. 
              
            Norberg
            Angle (NA):
            gives a measured assessment of several features: the degree of
            congruence between the femoral head (FH) and acetabulum; the length
            of the cranial acetabular edge (CrAE) which gives a relative
            indication of acetabular depth and a measure of coxofemoral
            subluxation (laxity).  A line is drawn between the centers of
            the two femoral heads (FHC) and a second line from each FHC to the
            junction between the dorsal and cranial acetabular edges.  In
            normal hips this will be 105o or more.    
            Subluxation
            (SL): is
            based principally on the level of congruence between the FH and
            acetabulum.  The general fit is assessed by the relationship
            between the FHC and the underlying image of the dorsal acetabular
            edge (DAE).  The cranial joint space is seen as a shadow
            between the CrAE and adjacent cranial articular margin of the FH. 
            Cranial
            acetabular edge (CrAE):
            minor alterations in the shape, contour and possibly length of CrAE
            are indicators or poor articular congruence; more severe changes are
            consequences of chronic instability, marginal wear and joint
            remodeling. 
            Dorsal
            acetabular edge (DAE):
            the DAE traverses the FH almost vertically and extends beyond it
            slightly cranially and caudally forming a well defined interface.
            Its clarity varies markedly depending on radiographic technique. 
              
              
            
              
                
                  | 
                     Score/
                    parameter 
                   | 
                  
                     NA
                    (o) 
                   | 
                  
                     Subluxation 
                   | 
                  
                     CrAE 
                   | 
                  
                     DAE 
                   | 
                 
                
                  | 
                     0 
                   | 
                  
                     105
                    & over 
                   | 
                  
                     Femoral
                    head well centered in acetabulum 
                   | 
                  
                     Even
                    curve, parallel to FH throughout 
                   | 
                  
                     DAE
                    has slight curve 
                   | 
                 
                
                  | 
                     1 
                   | 
                  
                     100-104 
                   | 
                  
                     FHC
                    lies medial to DAE.  Lateral or medial joint space
                    increases slightly 
                   | 
                  
                     Lateral
                    or medial ¼ CrAE flat and lateral or medial joint spaces
                    diverge slightly 
                   | 
                  
                     Loss
                    of S curve only in the presence of other dysplastic change 
                   | 
                 
                
                  | 
                     2 
                   | 
                  
                     95-99 
                   | 
                  
                     FHC
                    superimposed on DAE. Medial joint space increase obvious 
                   | 
                  
                     CrAE
                    flat throughout most of its length 
                   | 
                  
                     Very
                    small exostosis on cranial DAE 
                   | 
                 
                
                  | 
                     3 
                   | 
                  
                     90-94 
                   | 
                  
                     FHC
                    just lateral to DAE. ½ FH within acetabulum 
                   | 
                  
                     CrAE
                    slight bilabiation 
                   | 
                  
                     Obvious
                    exostosis on DAE especially cranially and/or minor “loss
                    of edge” 
                   | 
                 
                
                  | 
                     4 
                   | 
                  
                     85-89 
                   | 
                  
                     Femoral
                    head centre clearly lateral to DAE. ¼ femoral head within
                    acetabulum 
                   | 
                  
                     CrAE
                    moderate bilabiation 
                   | 
                  
                     Exostosis
                    well lateral to DAE and/or moderate “loss of edge” 
                   | 
                 
                
                  | 
                     5 
                   | 
                  
                     84-80 
                   | 
                  
                     Femoral
                    head centre well lateral to DAE.  Femoral head just
                    touches DAE 
                   | 
                  
                     CrAE
                    gross bilabiation 
                   | 
                  
                     Marked
                    exostosis all along DAE and/or gross “loss of edge” 
                   | 
                 
                
                  | 
                     6 
                   | 
                  
                     79
                    and less 
                   | 
                  
                     Complete
                    pathological dislocation 
                   | 
                  
                     Entire
                    CrAE slopes cranially 
                   | 
                  
                     Massive
                    exostosis from cranial to caudal DAE 
                   | 
                 
              
             
              
            Cranial
            effective acetabular margin (CrEAM):
            Earliest detectable abnormalities are minor exostosis, which may be
            seen as slight rounding of the junction between CrAE and DAE. 
            Acetabular
            Fossa (AF):
            In unstable hips the AF and notch are sites of new bone formation. 
            Increased opacity and loss of distinct margins around the
            caudomedial acetabulum gives an impression of the amount of new
            bone, and loss or partial obscuring of the normally clear shadow
            represents increased fat. Detectable new bone is closely associated
            with and parallels marked SL. Exact assessment is hard, but in dogs
            where changes are seen total scores will already be way above
            average. 
            Caudal
            acetabular edge (CdAE):
            this segment of the acetabulum is subject to the widest range of
            variation, and depends largely on the pelvis/film angle as well as
            individual differences in conformation, scored only 0 to 5; changes
            are mostly due to exostosis together with signs of wear in advanced
            cases. 
            FH
            and neck exostosis:
            exostosis is the formation of new and abnormal bone on a bone’s
            surface. 
            FH
            recontouring:
            extent to which FH shape is altered as a result of instability. 
            Usually only seen in extreme cases, but hard to evaluate
            numerically. 
              
              
            
              
                
                  | 
                     Score/ 
                    parameter 
                   | 
                  
                     CrEAM 
                   | 
                  
                     AF 
                   | 
                  
                     CdAE 
                   | 
                  
                     FH
                    & neck exostosis 
                   | 
                  
                     FH
                    recontouring 
                   | 
                 
                
                  | 
                     0 
                   | 
                  
                     Sharp
                    clean cut junction of DAE & CrAE 
                   | 
                  
                     A
                    fine bone line curves medial & caudal from caudal end of
                    CrAE 
                   | 
                  
                     Clean
                    line 
                   | 
                  
                     Smooth
                    rounded profile 
                   | 
                  
                     NIL 
                   | 
                 
                
                  | 
                     1 
                   | 
                  
                     Indistinct
                    junction of DAE & CrAE 
                   | 
                  
                     Slight
                    increase in bone density medial to AF. “Fine line” hazy
                    or lost 
                   | 
                  
                     Small
                    exostosis at lateral CdAE 
                   | 
                  
                     Slight
                    exostosis in “ring form” &/or dense vertical line
                    adjacent to the trochanteric fossa (“Morgan Line”) 
                   | 
                  
                     FH
                    does not fix in circle due to exostosis or bone loss 
                   | 
                 
                
                  | 
                     2 
                   | 
                  
                     Very
                    small exostosis or very small facet 
                   | 
                  
                     “Fine
                    line” lost in AF & ventral AE hazy due to new bone.
                    Notch at CdAE clear 
                   | 
                  
                     Small
                    exostosis at lateral & medial CdAE 
                   | 
                  
                     Slight
                    exostosis visible on skyline &/or density on medial
                    femoral head 
                   | 
                  
                     Some
                    bone loss &/or femoral head/neck ring of exostosis 
                   | 
                 
                
                  | 
                     3 
                   | 
                  
                     Facet
                    &/or small exostosis &/or slight bilabiation 
                   | 
                  
                     Incomplete
                    remodeling of acetabulum with edial face lateral to AF.
                    Ventral AE lost. AF hazy. Notch irregular 
                   | 
                  
                     Large
                    exostosis and narrow notch at CdAE 
                   | 
                  
                     Distinct
                    exostosis in “ring” formation 
                   | 
                  
                     Obvious
                    bone loss & distinct exostosis giving slight conical
                    appearance 
                   | 
                 
                
                  | 
                     4 
                   | 
                  
                     Obvious
                    facet &/or obvious exostosis &/or moderate
                    bilabiation 
                   | 
                  
                     Marked
                    remodeling. Medial face of acetabulum clearly lateral to AF.
                    Ventral AE lost. Notch partly closed 
                   | 
                  
                     Marked
                    exostosis and “hooking” of lateral end of CdAE 
                   | 
                  
                     Obvious
                    complete collar of exostosis 
                   | 
                  
                     Gross
                    remodeling. Obvious bone loss & exostosis gives mushroom
                    appearance 
                   | 
                 
                
                  | 
                     5 
                   | 
                  
                     Gross
                    exostosis &/or gross bilabiation 
                   | 
                  
                     Gross
                    remodeling. Dense new bone throughout acetabulum. CaAE notch
                    lost and AF obscured 
                   | 
                  
                     Gross
                    distortion due to mass of new bone in acetabulum. Notch lost
                    completely 
                   | 
                  
                     Massive
                    exostosis giving mushroom appearance 
                   | 
                  
                     Very
                    gross remodeling with marked bone loss and much new bone 
                   | 
                 
                
                  | 
                     6 
                   | 
                  
                     Complete
                    remodeling of CrEAR. Massive exostosis &/or gross facet 
                   | 
                  
                     Complete
                    remodeling and new articular surface, well lateral to AF.
                    Notch lost 
                   | 
                  
                     Void
                    (no grade 6 for this parameter) 
                   | 
                  
                     Massive
                    exostosis & infill of trochanteric fossa and below FH 
                   | 
                  
                     FH
                    is improperly shaped due to maldevelopment of FHC 
                   | 
                 
              
             
              
            Owners
            receive a report on their dog which gives the NA for each hip, as
            well as the score for each criterion - so it is easier to identify
            where there are problems, and these scores are tallied to give the
            final score for each hip.  Heritability from the BVA/KC scheme
            is 70% (estimated 30-50% depending upon country for FCI). 
            There is no translation of the numerical score into a dysplasia
            grade, but the BVA recommends breeding dogs with a score of 5 or
            less for each hip (10 combined) or clearly below the mean score for
            the breed.  Breed mean score is listed and updated regularly on
            the BVA’s website www.bva.co.uk/public/documents/CHS_Hip_Scheme_Breed_Mean_Scores.pdf 
            Currently
            based on 2910 Beardies evaluated the BMS is 11 with a range from
            0-79.  Prior to 2000 the Australian KC gave a grade as well as
            a numerical score, but this was discontinued as it was found to be
            unreliable.  Sadly, many breeders in Australia and New Zealand
            still aren’t testing hips on their dogs.  In part this may be
            because there is a scarcity of radiologists approved to evaluate
            their X-rays.   Like OFA the scheme is completely
            voluntary.  There are no Kennel Club restrictions as to which
            dogs are used, even those that are severely dysplastic.  Many
            breeding dogs are still untested in all these countries. 
              
            FCI 
            The Fédération Cynologique
            Internationale is the umbrella organization for more than 80
            national kennel clubs in most European countries, Russia, South
            America and Asia.  Their scientific committee described a 5
            grade scoring system from A (normal hip joint) to E (severe hip
            dysplasia).  The grades are defined descriptively based on the
            size of the NA, degree of subluxation, shape and depth of the
            acetabulum and signs of secondary joint disease.  Over the last
            40 years many Western countries have implemented mandatory
            radiographic hip evaluation as a prerequisite for breeding. 
            Dogs must be at least 1 year of age for official scoring.  Hips
            are usually scored by a single examiner per breed club or within a
            country, although there are some exceptions.  Dogs with
            moderate or severe CHD are barred from breeding in most countries. 
            There are usually specific breeding restrictions for those with mild
            dysplasia.   The FCI classifications are based on
            evaluations of dogs between 12-24 months of age (certain breeds are
            assessed only after 18 months).  When older dogs are examined,
            secondary arthritic changes are assessed with regard to the dog’s
            age.  Publication of results varies between the individual
            breed clubs.       
            A:
            No signs of HD.  The femoral head and acetabulum are
            congruent.  The craniolateral acetabular rim appears sharp and
            slightly rounded.  The joint space is narrow and even. 
            The Norberg angle is about 105o.  In excellent hip
            joints the craniolateral rim encircles the femoral head somewhat
            more in caudolateral direction. 
            B:
            Near normal hip joints.  The femoral head and acetabulum
            are slightly incongruent and the NA is about 105o OR the
            femoral head and the acetabulum are congruent and the NA is < 105o. 
            C:
            Mild HD.  The femoral head and the acetabulum are
            incongruent, the NA is about 100o and/or there is slight
            flattening of the craniolateral acetabular rim.  No more than
            slight signs of osteoarthrosis on the cranial, caudal or dorsal
            acetabular edge or on the femoral head and neck may be present.  
            D:
            Moderate HD.  There is obvious incongruity between the
            femoral head and the acetabulum with subluxation.  The NA is
            > 90o (only as a reference).  Flattening of the
            craniolateral rim and/or ostearthrotic signs are present. 
            E:
            Severe HD.  Marked dysplastic changes of the hip joints,
            such as luxation or distinct subluxation are present.  The NA
            is < 90o.  Obvious flattening of the cranial
            acetabular edge, deformation of the femoral head (mushroom shaped,
            flattening) or other signs of osteoarthrosis are noted. 
              
            The
            individual breed club selects the person who evaluates the X-rays. 
            Training and competence varies enormously from self trained
            veterinarians or in some cases lay persons to highly skilled board
            certified radiologists or small animal surgeons.  Quality of
            scoring varies accordingly and it can be extremely difficult or
            impossible to compare grades between countries.  Within a
            single country each regional breed club may have its own evaluator
            leading to inconsistency within the same country.  The best
            information on evaluation is probably found on the website of the
            Italian fondazione salute animale (FSA) – http://www.fondazionesaluteanimale.it/CENTRALE/index.html 
            – it is not surprisingly in Italian.  In general, Western and
            Northern European countries employ evaluators of a similar caliber
            to those used by other systems. 
            For
            some of the many attempts to compare hip schemes in Europe with OFA
            here is a small sample: 
            www.leonberger.com/Leo
            World/hd.html ; www.ofbridgefour.com/UK/17_hip_system.htm
            ; http://malinut.com/ref/library/hips 
              
            South
            Africa’s
            Hip Scoring Scheme under KUSA (Kennel Union of South Africa)
            according to FCI rules and regulations scores each hip and gives an
            FCI grade.  Prior to 2007 5 grades were given 0 normal hips; 1
            marginal to mild/moderate dysplasia; 2 moderate to severe dysplasia;
            3 severe dysplasia; 4 very severe dysplasia.  These remain
            listed.  There are 6 approved evaluators. 
              
            Ontario
            Veterinary College (OVC): 
            There is no official Canadian Kennel Club hip evaluation scheme. 
            Some breeders use OFA and some OVC.  Hips considered normal are
            classified normal/pass with no further sub-grading.  Those that
            do not pass, receive grade I (least severe, roughly equivalent to
            OFA borderline), grade 2 (mild dysplasia), grade 3 (moderate
            dysplasia) or grade 4 (severe dysplasia). 
              
            Japan
            Animal Hereditary Disease Network (JAHD): 
            Until JAHD was established Japanese breeders had their dogs’ hips
            evaluated by either OFA or BVA.  Dogs must be at least a year
            old and evaluation is by a point system similar to, but different
            from, BVA.  To find the details go to their website www.jahd.org/
            but it is in Japanese. 
              
            PennHIP
            (University of Pennsylvania Hip Improvement Program): As
            has been pointed out the majority of hip scoring schemes rely upon
            primarily subjective evaluation of X-rays, albeit mostly by skilled
            professionals with board training.  In most cases dogs should
            be at least 12 months old for reliable evaluation and in the
            meantime breeders and owners spend money developing and showing dogs
            that could be saved if they were known to be dysplastic.  Even
            worse, the numbers of dysplastic dogs produced has only dropped
            relatively modestly and we are a long way from eradicating this
            debilitating problem.  Enter PennHIP.  Their goal was to
            produce an evidence based technique with hard data.  They train
            each veterinarian and veterinary technician approved to take the
            three X-ray views required, and they also wanted a technique which
            could accurately identify dysplastic dogs as young as 3 to 4 months. 
              
            PennHIP
            relies upon three different views of the hip (to see typical X-rays
            go to http://www.pennhip.org/ph_method.html).
             The traditional X-ray hips extended view is used to look for
            signs of DJD only.  In this position the femur is pushed into
            the acetabulum with the result that it can make hips look much
            better than they are, particularly before DJD sets in. The
            distraction view still has the dog lying on its back, but the
            stifles are flexed and the legs held out to either side by a forced
            distraction device.  This pulls the femur away from the
            acetabulum as far as the hip construction allows.  Laxity is
            2.5 to 11 times that of the traditional view.  Specially
            machined circular gauges are placed over the X-ray to match the
            cortical margin of the acetabulum and the femoral head.  The
            distance between the centers of these two circles d is the joint
            laxity.  Because d varies with the size and age of the dog as
            well as the distance of the dog from the film, this is corrected for
            by dividing d by the radius of the circle covering the femoral head
            r to give the Distraction Index (DI).  Ideally the centers of
            the circles would be identical and the DI would be 0.  DI has
            no units and can range from 0 to 1 or more.  The higher the DI
            is the looser the hips are and the greater the risk of CHD.  In
            the compression view the femurs are positioned in a neutral,
            stance-phase orientation and the femoral heads are pushed fully into
            the sockets.  The Compression Index (CI) is measured in the
            same way as DI and measures hip joint congruity – how good a match
            the FH and acetabulum are.  For proper evaluation of DI and CI
            the muscles around the hip must be completely relaxed and can only
            be evaluated in dogs that are deeply sedated or under general
            anesthesia.  
              
            Papers
            evaluating PennHIP have been published in refereed journals but
            originate from the lab that developed the technique.  They
            compared the accuracy of evaluating hips at 4, 6, 12, 24 and 36
            months between standard OFA scoring scheme with a board certified
            radiologist, measuring the Norberg angle and DI.  Compared to
            results obtained at 24 months the DI was remarkably predictive at 4
            and 12 months.  OFA at 4 months was little better than random,
            and even at 12 months not felt to be clinically helpful.  NA
            fared better, but was not nearly as good as DI.  To assess the
            correlation between DI and the risk of developing DJD, DI and DJD
            was compared in adult dogs.  In a study or 142 German shepherd
            dogs, only one hip < 0.3 showed signs of DJD (however the mean
            age of the dogs was only 20 months).  All hips with a DI of 0.7
            or greater showed evidence of DJD.  In a second study, dogs
            assessed at 4, 12 and 24 months of age were followed longitudinally
            to see if they developed DJD.  The study looked at the
            predictive value of DI, NA, OFA score, weight and sex.  DI was
            the most significant prognostic factor for all age groups and the
            strength of its predictive power increased with age.  For some
            breeds, such as rottweilers, DI can be higher than 0.3 and the dog
            due to other factors will be less prone to DJD than GSDs, but the
            higher the DI these dogs have the more likely they are to get DJD. 
            For this reason, a core population of members of the breed has to be
            established to determine the maximum “safe” DI for the breed.  
              
            A
            study of 4 breeds evaluated by the OFA method (English Setters,
            Portuguese water dogs, Chinese Shar-peis and Bernese Mountain Dogs)
            showed mean direct heritabilities of 0.17, 0.30. 0.31 and 0.30
            respectively.  Such figures help explain why using OFA it has
            been hard to eradicate CHD.  By Contrast heritability for DI in
            GSDs and Labrador retrievers is 0.50 and 0.60.  
              
            The
            PennHIP evaluation generates a confidential report made directly to
            the owner. Each hip is evaluated with DI and CI measurements, as
            well as for DJD, cavitation and other changes. The PennHIP database
            is closed to the public, although they are contemplating opening the
            database for dogs with normal hips.  (PennHIP is now
            administered by ICG, International Canine Genetics, which is owned
            by Synbiotics Corp.)  PennHIP compiles statistics by breed
            semi-annually from the data it has collected.  These are
            currently sent only to participating PennHIP veterinarians, although
            if you ask the researchers they will pass the data on.   Currently
            there are 50 Bearded Collies in the PennHIP database with an average
            DI of 0.57, and range from 0.27 to 1.17.  (The percentiles are:
            25th: DI = 0.71; 50th: DI = 0.57; 60th: DI = 0.54; 75th: DI = 0.44.) 
            For comparison, my two Beardies that I ran PennHIP on back in 1994,
            one at 82 months had a DI of 0.29 on both hips and the other at 27
            months was 0.38 on the right hip and 0.33 on the left.  Both
            were OFA good.    
              
            Comparing
            methods: 
            There have been relatively few studies beyond those by PennHIP
            assessing accuracy of a particular method or comparing methods. 
            I have already reported OFA’s findings.  A 2008 paper in
            Veterinary Radiology & Ultrasound compared interobserver
            agreement in the assessment of standard X-rays and its effect on
            agreement in diagnosis of canine hip dysplasia and routine FCI
            scoring.  The research group was Belgian.  There were 9
            experienced and 21 inexperienced evaluators. With regard to whether
            the X-rays could be assessed, 68% of the experienced but only 46.5%
            of the inexperienced evaluators said they could.  However,
            consistency of evaluation was not good, one dog receiving a range of
            FCI scores from excellent to moderately dysplastic.  The study
            questioned the credibility of the FCI screening method for CHD as it
            is applied in most European countries.  A study, also Belgian,
            in 2008 in the AVMA’s American Journal of Veterinary Research
            compared OFA and BVA/KC databases on the prevalence of CHD, and the
            relationship of CHD to body weight and height.  They found a
            very high correlation between the ranking order and the percentage
            of dysplastic dogs by breed between the two registries.  Not
            surprisingly they also found weight and height, but particularly
            body mass index correlated with incidence of CHD – big, heavy dogs
            are most likely to get CHD. 
              
            Conclusions: 
            While, with the exception of PennHIP and NA, most methods used to
            assess hips structure are subjective, the requirement to assess
            particular landmarks, especially when assigning a point value to
            each, increases the accuracy of evaluation and the likelihood that
            abnormalities will be detected.  These abnormalities will more
            likely be found as the dog ages, and so it is preferable that dogs
            be assessed or reassessed once they have passed their second
            birthdays.  In order to significantly reduce the incidence of
            CHD all or at least most breeders should score their breeding dogs
            and also nonbreeding relatives and then use that information to
            determine whether to breed a dog and where.  PennHIP probably
            has the greatest potential for reducing the incidence of CHD, but
            until we have a significant number of Beardies assessed we can only
            guess at the safe DI for the breed.  Because three X-ray views
            are needed and the number of trained evaluators relatively few, the
            cost far exceeds that of other methods.  Getting back to the
            initial question of how the various hip scores compare the answer is
            not exactly.  Due to the subjectivity of evaluation you can
            submit the same X-ray to the same agency at different times (or take
            a new X-ray and submit it) and get different evaluations, or the
            same X-ray to different agencies and get very different assessments. 
            On the whole though, probably the best bet is the chart from OFA (I
            have left off SV – which is only for GSDs).  However, the
            average OFA Beardie is Good, while the average BVA Beardie is 11
            (total), and I would probably say A-1 and A-2 are the equivalent of
            OFA excellent, B1 good, B-2 good to fair and C fair to borderline! 
              
            
              
                
                  | 
                     OFA 
                   | 
                  
                     FCI
                    (Europe) 
                   | 
                  
                     BVA
                    (UK, Australia) 
                   | 
                 
                
                  | 
                     Excellent 
                   | 
                  
                     A-1 
                   | 
                  
                     0-4
                    (no > 3/hip) 
                   | 
                 
                
                  | 
                     Good 
                   | 
                  
                     A-2 
                   | 
                  
                     5-10
                    (no > 6/hip) 
                   | 
                 
                
                  | 
                     Fair 
                   | 
                  
                     B-1 
                   | 
                  
                     11-18 
                   | 
                 
                
                  | 
                     Borderline 
                   | 
                  
                     B-2 
                   | 
                  
                     19-25 
                   | 
                 
                
                  | 
                     Mild
                    dysplasia 
                   | 
                  
                     C 
                   | 
                  
                     25-35 
                   | 
                 
                
                  | 
                     Moderate
                    dysplasia 
                   | 
                  
                     D 
                   | 
                  
                     36-50 
                   | 
                 
                
                  | 
                     Severe
                    dysplasia 
                   | 
                  
                     E 
                   | 
                  
                     51-106 
                   | 
                 
              
             
               
               
            Glossary: 
            Cranial:
            towards the head. 
            Caudal:
            towards the tail. 
            Dorsal:
            towards the spine. 
            Ventral:
            towards the belly. 
            Medial:
            towards the midline 
            Lateral:
            away from the midline (towards the flank) 
           |