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)
|