HIP DYSPLASIA & NORM HIPS
Hip dysplasia is a congenital disease that affects mostly large breed dogs. It causes weakness and lameness to the rear quarters, and eventually leads to painful arthritis. This arthritis goes by several names; degenerative joint disease, arthrosis, osteoarthritis.
This disease is so prevalent, and so debilitating, that a special veterinary organization called The Orthopedic Foundation for Animals (OFA) was organized.
Many factors work together to cause this disease, which is a combination of a dog genetically inclined to get this disease interacting with environmental factors that bring about the symptoms. These environmental factors excess calcium in the diet of puppy food for large breed dogs, along with obesity, high protein and calorie diets, and a lack of or too much exercise. The breeding of dogs that already have hip dysplasia is one of the primary reasons the disease is still present. A dog that has hip dysplasia in one socket is prone to having a problem with the ligaments of the knee in the other leg (anterior cruciate rupture).
During the degenerative process the cartilage that lines the hip joint, called hyaline cartilage, is damaged. The damage results from the abnormal forces on the cartilage from the deformed hip socket. Small fractures can occur in the cartilage also. Eventually an enzyme is released that degrades the joint further and decrease the synthesis of an important joint protectant called proteoglycans. The cartilage becomes thinner and stiffer, further compromising its ability to handle the stresses of daily movement and weight bearing.As the problem progresses more enzymes are released, which now affect the precursors to proteoglycans, molecules called glycosaminoglycans and hyaluronate. Lubrication is negligible, inflammation occurs, and the joint fluid can no longer nourish the hyaline cartilage. This viscious cycle continues until pain occurs. The body attempts to reduce this pain by stabilizing the hip joint. New bone is deposited at the joint, both inside and out, along with some of the ligaments and muscle attachments to the area. This causes thickening and a decrease in the range of motion. This is the actual arthritis noted on a radiograph, which will not go away and will continue to progress.
Many dogs can develop hip dysplasia. Dogs that were commonly affected years ago, like German Shepherds and Labrador Retrievers, still get the disease but not as commonly as before.
According to the OFA some of the breeds with the highest prevalence are:
|Neapolitan Mastiff||St. Bernard||Boykin Spaniel||Sussex Spaniel|
|American Bulldog||Newfoundland||American Staffordshire Terrier||Bloodhound|
|Bullmastiff||Chesapeake Bay Retriever||Golden Retriever||Gordon Setter|
|Rottweiler||Chow Chow||Old English Sheepdog||Kuvasz|
|Norweigan Elkhound||Giant Schnauzer||German Shepherd||Bernese Mountain Dog|
|English Setter||Black and Tan Coonhound||Shih Tzu||Staffordshire Terrier|
|Bouvier des flandres||Welsh Springer Spaniel||Curly Coated Retriever||Polish Lowland Sheepdog|
|Portugese Water Dog||English Springer Spaniel||Pudel Pointer||Irish Water Spaniel|
Hip Dysplasia is diagnosed based on a history of weakness or lameness to the rear legs, especially after exercise or when first getting up after resting. Some young dogs will bunny hop when running, and might lie down on their stomachs with their legs stretched behind them. It is possible to palpate joint laxity on some dogs that are anesthetized (we call this the Ortolani sign). Radiography is the definitive way this disease is diagnosed. It is not perfect though, since a dog can be hip dysplasia free on the radiograph (phenotype), but can be genetically predisposed to the disease (genotype). These dogs have the potential to be carriers of the disease, yet show no symptoms themselves.
Many variables affect the degree of lameness. They include caloric intake, degree of exercise, and weather. To further add to the complication, pets with terrible looking hips on radiographs might act as if nothing is wrong, while others with barely discernible changes on their radiographs might be severely lame.
These are the x-rays of a dog with a normal pelvis. The diagram below explains why these hips are normal. View both of them at the same time if possible.
On the right side of this normal pelvis we have outlined 2 important anatomical features. The "U" shaped appearance of the neck (outlined in white), and the full rounded appearance of the head (outlined in black), are normal. They indicate a full socket with a tight fit and no signs of secondary changes due to instability of the ball and socket joint.
This dog has moderate changes that indicate it has hip dysplasia on the right side. The socket is not as rounded as it could be, and the head of the femur is slightly flattened. also, the neck of the femur does not have the U shaped indentation that is normal. You can see this better on the closeup views below.
The arrow points to the thickening in the femoral neck in the abnormal right socket. You can also visualize the slightly flattened appearance of the head of the femur and the fact that it does not fit into the socket as tight as the normal hip marked left.
This is a case of severe hip dysplasia. The arrows point to the thickened femoral neck on each side along with the secondary arthritis occurring on the left side. Notice how flat the sockets are and the lack of rounded appearance of the femoral head. This dog is probably in pain and has a difficult time walking in the rear quarters.
If left untreated the disease continues to progress, eventually causing a crippling lameness and severe pain. Correcting this problem at an early age might have prevented this.
Dogs are not the only species that gets hip dysplasia. It can also occur in cats (Maine Coons are commonly affected), although not as common as in dogs.
The white arrows outline the large amount of stool in the colon of the above cat with feline hip dysplasia. It is painful for this cat to squat to have a bowel movement, as a result it gets severely constipated.
Comparing PennHIP and OFA
Many of us with a passion for working and sporting dogs are all too familiar with Canine Hip Dysplasia, one of the most prevalent polygenic diseases affecting many of our preferred breeds. Today, there are a variety of methods that may help us to test for and diagnose the presence or probability of CHD and degenerative joint disease. Following are two articles reviewing PennHIP and OFA radiologic protocols for evaluating and predicting CHD. Fred Lanting, canine consultant and author, responds to some email list posts with his commentary promoting the PennHIP extraction method, and recommends its use over OFA protocol to screen for CHD. Drs. Keller and Corley, Diplomates of A.V.C.R. and principal radiologists of the Orthopedic Foundation for Animals (OFA), detail the research studies and scientific literature that support their position that PennHIP stress radiography remains to date an inconclusive method for reliable testing and evaluation. - Moc Klinkam
PennHIP: Misconceptions and Misinformation
By Fred Lanting
Breeders have a very interesting tool these days in the Internet and/or e-mail. Information gets out much faster than print media can disseminate it. Among the accepted characteristics of such transmission are slightly higher "I.Q." (inaccuracy quotients) and emotion levels. It seems that these minor failings are forgiven in the informal tone of this medium. However, it still behooves anyone doing the work of a journalist, commentator, or editor to be as accurate as possible, for people tend to believe anything they see "in print". Recently, there have been lively discussions on at least one list or website, excerpts of which have been circulated to others. These deal with the latest development in diagnostic-predictive techniques, and unfortunately fanciers have taken sides based on less than complete information. Understandable; I found in 35 years in chemical marketing that people make decisions based not so much on logic or reasoning, as much as on emotional leanings.
Here are some recent website quotes I've been given, and my responses. I encourage you readers to make yourselves available to one of my lectures. Better yet, to schedule one. "Have slides, will travel". E-mail me at [email protected] for details. First, the quotes and misinformation, then my answers.
Quote 1.: "(Some people) bought a dog and it turned out to be dysplastic at 2 years, when her (OFA) prelim at 10 months looked excellent. This may be an argument for using PennHIP, said to be more predictive. In the PennHIP X-rays, more laxity can be measured." This lister tries to be cautious yet seems to lean toward confidence in the newer (a decade now) method of screening dysplasia at younger ages.
Quote 2.: "... a bummer when that happens. However, studies have not shown PennHIP to be more reliable in predicting HD than OFA. In fact they show the opposite (JAVMA volume 21 #9 Nov 1, 1997); in referring to OFA: 'The study showed that a preliminary evaluation of Excellent was 100% reliable; a preliminary evaluation of Good was 97.9% reliable; a preliminary evaluation of Fair was 76.9% reliable...'. Also, (Am J Vet Res 1993; 54: pp.1021 - 1042) in referring to PennHIP: '12% of the dogs evaluated as normal at 4 months of age by the PennHIP method were later determined to have degenerative joint disease. 48% of the dogs evaluated as abnormal at 4 months of age, 57% evaluated as abnormal at 6 months of age and 38% evaluated as abnormal at 12 months of age by the PennHIP method did not have evidence of degenerative joint disease at 24 months of age'. A second study on the PennHIP method (Am J Vet Res; 1993; 54: pp.1990-1999) concludes that while a distraction index less than 0.4 is 88% reliable for predicting normal hips, a distraction index of greater than 0.4 is only 57% reliable for predicting CHD. While no method would be 100% reliable, it would appear that the OFA method is more reliable at early prediction of CHD. What bothers me most about the PennHIP method is the very high percentage (38 - 57%) of those dogs evaluated early where they predict CHD will develop, but it doesn't. Thus, if you use the PennHIP method for early evaluation, you have a very good chance of eliminating a non-dysplastic dog from your breeding program due to less than accurate results."
By the way, while the veterinary community largely uses the abbreviation CHD for Canine Hip Dysplasia, I use the lay practice of referring to it as HD, since the context is always clear that we are talking about the disease in dogs, not in humans or other animals. Now, as to the quote #2 above: far from concluding that OFA is more reliable and accurate, the cited journal references, which I have on the desk before me, can only logically lead to the realization that the opposite is true, except for the Nov.1st, 1997 reference written by Al Corley and Greg Keller of the OFA. To be fair, one must also read at the same sitting, the letter to the editor on page 487 in JAVMA's vol. 212, #4, Feb. 15, 1998 which effectively refutes those OFA conclusions. OFA statistics are skewed because not all films are sent in; PennHIP requires ALL films, whether showing horrible hips or not, be sent in and entered into the database. The OFA article did not let readers know that apples were being compared to oranges --- that the presumably higher rate of false positives PennHIP reports is a result of different definitions. OFA says a dog is dysplastic if it has loose hip joints, signs of arthritic changes or wear, or both. PennHIP diagnoses frank HD on the basis of DJD (degenerative joint disease... bony changes and remodeling). If they had included the lax-hip dogs not showing such changes, the false-positive rates would be much lower. The PennHIP evaluation not only reports as dysplastic those with obvious bone and cartilage abnormalities, but also gives an idea of the relative risk of the particular dog developing such radiographic signs later. The dog whose hip joint's femoral head looks tight and round on the OFA film but shows considerable laxity on the PennHIP view is said by the latter group to be at risk for later DJD. Which information would you want to have?
Remember, the traditional position advocated by AVMA and OFA (as well as almost all other hip schemes of the past 35 years) is the leg-extended (hip-extended) one in which the ligaments of the hip joint capsule are wound tight like the rubber band in those toy airplanes we old fogies used to play with as kids. This tends to present an artificially tight appearance to all but the worst hips, and is certainly not representative of the forces at work in the standing or walking/trotting dog. The PennHIP scheme utilizes this hip-extended view in order to best see some features that might show DJD; by the way, if you want an OFA reading, the vet need only put two films into the cassette when taking this picture. The view with the dog's legs flexed in a position like standing, but upside-down, mimics actual forces. And when the hip joints are stressed in the distraction view (femurs and femoral heads pushed away from each other and the acetabulums) and then the difference in displacement measured from the picture given when they are pressed into the sockets, why then you have a numerical, objective value: something you can use to compare with others of the same breed, for example.
Now, let's look at the predictive value of OFA's preliminary evaluations, and I won't go at length into why suddenly these are supposed to be so accurate, when in 1972 OFA led the way to a 24-month minimum for certification because of the inaccuracy of early diagnoses. Let's assume that only the very worst hips will show bony changes, and that the youngsters now being "prelim'ed" are judged primarily on laxity. The OFA is happy to predict, on the basis of very tight joints IN THE HIP-EXTENDED VIEW at a young age, that such an excellent appearance will continue to look good at 2 years (minimum age at which to certify). But remember, the view at 2 years is going to be the same type, that of an artificially wound-up joint capsule. Surely, then, one would expect fairly good agreement between the pictures at these two ages, especially if rated "Excellent" in the AVMA position. However, if one applies the more stringent evaluation protocols of the PennHIP method at the older age, one finds a disturbing number of "OFA-normals" are indeed not normal in any sense that you and I would consider so, such as compared with the mean or average in the breed. Even an unacceptably high number of OFA-Excellents at 2 years will show up in the PennHIP view to have worse hips than would otherwise be suspected. If you want to know if a bridge can bear a load of 10 tons, you shouldn't expect to run a meaningful test by driving your half-ton pickup over it. The dog also should be evaluated in the strictest method in order to tell if the reading of "excellent" has any validity. Otherwise, the breeder or the person driving a big truck over a bridge may have a false sense of security.
Those who look into professional journal articles should perhaps ask, "Where are the data showing a link between OFA-defined laxity and later DJD?" and "Where are the data on dogs diagnosed as dysplastic (based on laxity at 24 months) but who never developed the bony changes?" Since there is no such set of statistics, one must conclude that hip-extended radiographic diagnosis (alone), even at 24 months, is not "reliable" as the OFA's JAVMA article proposes, but highly unreliable, or at best, unknown. Are you as a breeder satisfied with repeatability (unfortunately described as reliability)? Suppose you were William Tell's son, and you knew that your dad could shoot a dozen arrows at the apple balanced on your head, with repeatability as to where each would go --- would you be blithely unaffected by the concept that his reliability (accuracy) might not be as good as his repeatability? You would not want even the first arrow to fly, would you? Diagnosing HD is not as threatening as that, but I for one would want the most accurate as well as the most reliably repeatable evaluations of my breeding stock's hips.
DJD appears in some individual dogs and in some breeds at later ages than in others. The breeder wants to know as early as possible, what the likelihood is that his dogs might develop DJD, and therefore wants some sort of "marker" or predictive evaluation before he sells or breeds. The panacea of gene markers (looking at DNA and finding all the sequences that cause HD) is not practical in our lifetimes (or at least not in our current dogs' lifetimes). If anybody even were to come up with cheap testing of such polygenic traits, this approach is still decades away. The OFA study reported in that JAVMA article did not include in its references any longitudinal studies to refer the reader to, even though a year or so earlier such a report by Banfield, Bartels, Hudson, et al showed almost no difference in dogs predicted to develop degenerative changes and those described as having normal hips, using the OFA-style methods. The 40 dogs described as "normal" at 2 years of age all had some "minimal or mild degenerative changes" by 9 years of age, and those 22 dogs diagnosed as dysplastic (lax joints in the hip-extended view) at 2 years had the same mild or minimal changes. Why wasn't this study included? Does it give you a warm feeling that you are using the latest and most accurate diagnostic techniques by banking on the OFA readings?
We shouldn't worry so much about false positives (a red flag that a dog might become dysplastic, but doesn't) as we should about false negatives (the dog is evaluated as normal, and later proves to be chock-full of "bad genes" that his offspring inherit). We would rather cull from the breed an occasional good dog (there are many ready to take his place) than let some covert fifth-columnist into the ranks to poison or sabotage the gene pool. In the OFA system there are false-negative rates of about 83% in 6-month-old German Shepherds, but in the PennHIP scheme, the rate is only 12% in 4-month-old dogs and 0% at 6 months (as compared to the readings at 24 months). The writer who complains about this 12% fails to acknowledge that using the OFA approach on 4-month pups gave a false-negative rate of 24%, double that of the PennHIP compression-distraction method. Even at 6 and 12 months, the OFA-type predictive tests gave false-negatives of 15% and 12% and the PennHIP stress-radiographic method showed zero false negatives for 6- and 12-month old dogs.
To rest one's case on the above-mentioned "48% of the dogs evaluated as abnormal at 4 months of age, 57% evaluated as abnormal at 6 months of age and 38% evaluated as abnormal at 12 months of age by the PennHIP method" as not having "evidence of degenerative joint disease" is to rest on the false positives. What of those dogs that did not have DJD at 2 years of age, but more laxity than the average in their breed? Are you satisfied that they have as few bad genes as do the dogs that were identified early as having a very low DI (distraction index) and still do not have DJD in old age? The PennHIP method is a far better revealer of genotype, and thus predictor of eventual DJD, in the individual and its progeny.
It should not be surprising to anyone that the looser the hips, the less accurate that a prediction of a specific grade or severity might be. HD is a developmental (DJD might not show up right away), progressive (it'll eventually be worse), multifactorial (environment has a part to play in the expression of the bad genes) disorder. Some dogs will get worse than others even with the same DI at a young age. A DI of 0.4 is not all that bad, nor all that good. You can pretty much guarantee your buyers that the pup you sell them with a 0.3 will never have DJD (HD), but you lose credibility with such a guarantee as that index creeps higher and higher. You can think of an index of 0.4 as being "40% out of the socket" if you want to oversimplify the picture, since the readings runs from a hypothetical 0 (zero would mean no ability to move in the socket) to a full luxation of 100% out of the socket, or DI of 1.0 (and of course in the worst cases, the number can be over one, but those dogs will have bad bone changes, too, so it doesn't take a rocket scientist to see they are dysplastic). In many breeds, the mean or average laxity is around 0.4 and it is worse in many other breeds. Some breeds can tolerate looser hips than a GSD and have less development of arthritic degeneration in maturity. The person who worried about the "38 - 57% of those dogs evaluated early where they predict CHD will develop, but doesn't..." isn't adding "at two years of age", and again ignores the much worse situation where at least an equally high percentage of OFA-normal dogs might develop late-onset DJD and/or pass on many bad genes to offspring. There is very good reason to presume that dogs that have no signs of DJD but have an index higher than the mean for their breed "represent a carrier state of the disease", as mentioned in the second Am J Vet Res citation above. In other words, it is a clearer picture of the genotype than the OFA approach gives. Man has advanced over his prehistoric precedents by using more tools, and we should progress in use of modern tools regarding HD as we have from the Neandertal to the Stone Age to the Bronze Age to the Machine Age, and to the Computer Age. PennHIP is such an advanced tool for the serious breeder. The inescapable conclusions are that:
- Tighter Is better;
- Position and technique (better tools) can discover covert laxity;
- PennHIP is more accurate as well as reliable and repeatable.
Most of the people on these Internet chat rooms and e-mail lists are not "professional people" by which in this context is meant trained veterinarians. Thus, it is natural that few would realize until pointed out to them, that there are significant differences between types of articles they read. Something that appears in a medical journal such as JAVMA are closely examined in a process called "peer review" before being edited and published. Both accuracy and logical reasoning are required, in addition to sound references and proper controls and procedures in the reported experimental work. On the other hand, articles that appear in newsletters, flyers, press or publicity releases, brochures, and the like, are not subject to such hurdles and requirements. The OFA press release that was carried by a number of breed magazines such as the Australian Cattle Dog publication in mid-1998 was a rather strongly biased advertisement for OFA business --- absolutely nothing wrong with that approach, by the way. The AVMA Journal version published Nov. 1, 1997 was what remained after the review process removed all the unsubstantiated claims. Now, such claims may be valid; it's just that in this case, they were not subjected to protocols regarding scientific method and therefore the "commercial version" may have been misinterpreted by some as having the weight of the reviewed version.
The optimist in me sees the day when OFA leadership will have to admit the superiority of new tools, adopt the PennHIP approach, and report such data for the benefit of the breeder. The pessimist in me wonders if the parties can put personalities aside and concentrate on science, and if I'll live long enough to see this happen.
OFA Update: The Issue of Joint Laxity and Stress Radiography
By G.G. Keller, D.V.M., MS, Diplomate of A.V.C.R., Executive Director Orthopedic Foundation for Animals, Inc. and E.A. Corley, D.V.M., Ph.D., Diplomate of A.V.C.R.
OFA does not normally respond to the various opinions expressed by individuals on Internet web sites and/or chat lines. Instead OFA maintains a web site (http://www.offa.org) to provide information that may be of value to breeders and veterinarians. However, a response to the opinions expressed by many people is prompted, as the opinions appear to have deteriorated to the point of becoming non-productive. OFA stated its position on any testing method, including PennHIP, that involved stress radiography to the breed clubs in 1994. This posting is a review of that position.
Contrary to some Internet postings, OFA, a not-for-profit organization, does support and encourage research on joint laxity and its meaning. The fact that joint laxity plays a role, but is not the only factor to be considered in development of hip dysplasia and its secondary changes of degenerative joint disease, has been recognized for over 30 years. This fact is not in dispute. The issue has been, and remains to be, the relationship of laxity that is demonstrated by forcing the heads of the femurs away from the acetabula by palpation or a fulcrum/stress device (i.e., a distraction device) to abnormal laxity (functional laxity that occurs in hip dysplasia.) Since 1972, when an independent panel of scientists classified the techniques for demonstration of joint laxity by use of an externally applied force as experimental, OFA has financially supported three research projects, recommended by external review, to answer the basic question. Dr. Belkoff, et.al. (VCOT 1: 31-36 1989) developed a device that measured the amount of force applied to the hips and noted that some dogs that demonstrated abnormal amounts of laxity were free of hip dysplasia at necropsy. These authors questioned the meaning of joint laxity as demonstrated by force. The other two projects supported by OFA are ongoing.
PennHIP is another technique for demonstration of forced (passive) laxity that is also attempting to answer the basic question of the relationship of passive laxity to functional laxity. OFA encourages their research efforts; however, OFA takes exception to the marketing techniques and claims used to promote the PennHIP testing method for clinical use, as the use of this method appears to be premature. In other words, commercialization (marketing) of the method has outreached the science.
OFA feels that general use of PennHIP as a mass screening test method for hip dysplasia is premature because:
- The primary basis for marketing PennHIP was reported by Dr. Smith, et.al. (Am J Vet Res, July 1993) using a modification of a previously described positioning, stress/fulcrum technique. The study was a survey type involving 142 dogs (105 of which were German Shepherd Dogs). The results of the study were questioned by Dr. Susan Shott of the Biostatistical Unit, Rusk Cancer Institute (Am J Vet Res, December 1993) who challenged the analysis of the data and stated: "The data does not support the authors conclusion that the DI was the most important and reliable phenotypic factor for determining susceptibility of hips to degenerative joint disease ... and that this determination could be made with an acceptable degree of accuracy as early as 4 months of age."
- Dr. Lust, et.al. (Dr. Smith was a coauthor) in a report involving 42 Labrador Retrievers (Am J Vet Res, December 1993) concluded that a DI of <0.4 at 4 months of age correctly predicted normal hips in 88% of the cases and a DI of >0.4 correctly predicted hip dysplasia in 57% of the cases. The authors further concluded that: "Distraction indices between 0.4 and 0.7 and at either 4 or 8 months of age were not associated strongly enough with evidence of disease to be clinically reliable in predicting, on an individual basis, the outcome for dysplastic hip conformation when the dogs were older."
- No breeding data based on PennHIP has been reported. Dr. E.A. Leighton (JAVMA, May 13, 1997) reported on genetic progress in improving the hip quality in German Shepherd Dogs and Labrador Retrievers in the Seeing Eye closed colony of dogs. In less than 5 generations the percentage of hip dysplasia was decreased from 55 to 24% in the German Shepherd Dogs and from 30 to 10% in the Labrador Retrievers using the hip extended position and a modified OFA evaluation procedure. PennHIP DI measurements were also made but the mean DI across generations did not change. It should be pointed out that DI was considered experimental and breeding selection criteria did not include the DI. It will be interesting to see the results when DI is included as a selection criterion.
With the above reservations, plus experience with the issue of joint laxity, OFA would be remiss in its responsibility to either endorse or reject the PennHIP testing method. In other words, the jury is still out! This leaves the breeder in a dilemma as to which testing method to use, OFA or PennHIP or both, as they are entirely different test methods for the same disease.
There is a great economic advantage to breeders for determination of the hip status at a young age and to assess the risk for development of hip dysplasia at a later age. OFA reported (Vet Clinics of No Am, May 1992) on a study of 3,369 dogs from 25 breeds. Reliability of the preliminary evaluations ranged from 71.4% in the Chesapeake Bay Retriever to 100% in the Welsh Springer Spaniel. The preliminary evaluation appeared to be breed dependent and dependent on the evaluators experience with the skeletal development of that breed at the age of evaluation.
When faced with the problem of comparing entirely different test methods for determining dysplasia, scientists evaluate the results of reported values for false negative (probability of diagnosing a dysplastic dog as normal), false positive (probability of diagnosing a normal dog as dysplastic), specificity (probability of a normal dog receiving a normal evaluation), and sensitivity (probability of a dysplastic dog receiving a dysplastic evaluation). These values for OFA preliminary evaluations by age and hip ratings, in a different population of dogs than previously reported (Vet Clinics of No Am., May 1992) have been reported (JAVMA, November 1, 1997). The false negative and false positive values for PennHIP were reported by Dr. Smith et.al. (Am J Vet Res, July 1993). No report of selectivity or sensitivity values for PennHIP were given. There were 2,332 dogs in this OFA study and 142 dogs in the PennHIP study. The limited number of dogs resulted in a larger confidence interval for the PennHIP values. Confidence intervals (CI) are determined so that one can be 95% confident that the true value lies within the calculated range. The false negative values for OFA evaluations were 8.9% (CI=5.9 to 12.9%) at 3-6 months, 6.0% (CI=4.4 to 8.0%) at 7-12 months and 3.8% (CI=2.6 to 5.4%) at 13-18 months of age. The false negative values for PennHIP evaluations were 12% (CI=1.5 to 38.3%) at 4 months and 0% (CI=0.0 to 15.4%) at 12 months of age. It appears that the probability of retaining a dysplastic dog in the breeding pool is the same for either test method.
However, the false positive values for PennHIP were significantly greater (48% at 4 months, 57% at 6 months and 38% at 12 months) than those for OFA evaluations 17.6% at 3-6 months (CI 10.8 to 26.4%), 10.0% at 7-12 months (CI 5.7 to 15.9%) and 8.5% at 13-18 months (CI 4.8 to 13.6%). It appears that the probability for removing a normal dog from the breeding pool is less with the OFA evaluations.
Dr. Adams, et.al. (JAAHA, 1998, 34: 339-47) reported (using palpation, OFA method, PennHIP, and Norberg angle measurements) on results of a study of hip laxity, in 32 dogs from 4 breeds (12 Greyhounds, 4 Labrador Retrievers, 12 Irish Setters, and 4 hound-mix) at 6-10 weeks and 16 to 18 weeks that were compared to detection of degenerative joint disease at 52 weeks of age. Five hips with evidence of subluxation but no evidence of degenerative joint disease on the OFA type evaluation of the hip extended view were eliminated from analysis. The authors concluded that DI and Norberg Angle measurements at 6-10 and 16-18 weeks were the most reliable predictors of hip dysplasia, at 52 weeks of age, with DI being more reliable than Norberg. The OFA and palpation methods at 6-10 or 16-18 weeks were not reliable predictors. This is not surprising as reliability of OFA preliminary evaluations has been shown to increase with age of evaluation. The OFA report (JAVMA, Nov. 1997) included 380 dogs evaluated at 3 to 6 months of age. The reliability was 89.6% (CI=85.4 to 92.9%) for normal evaluations and 80.4% (CI=71.4 to 87.6%) for dysplastic evaluations. The mean age was 4.8 months (19.2 weeks) and the median age was 5 months (20 weeks) which means that over half of the dogs in the OFA study were older than in the study reported by Dr. Adams.
OFA data and PennHIP data are not representative of the general population of dogs because the programs are voluntary, most dogs are in pet homes and are not radiographed, and not all radiographs of dogs radiographed are submitted for evaluation by either program. For example; if an attending veterinarian determines a dog to be dysplastic, by either method, the radiograph(s) may not be submitted to save the owner money. PennHIP collaborators may take the hip extended view first and if the radiograph shows evidence of dysplasia the DI views may not be taken or the owner may not allow submission of an obviously large DI measurement.
Breeders are aware of the economic value of early screening of dogs for determination of the hip status. They should also be aware that both OFA and PennHIP use the radiographic evaluation of the same hip extended projection as the standard for comparing with the results of the early evaluations. The OFA standard represents the consensus of 3 independent evaluations at >24 months of age by board certified veterinary radiologists. It is not clear who evaluates a radiograph submitted for PennHIP determination, but the original study reported the standard to be Dr. Smiths evaluation. This evaluation at >24 months of age has approximately 5% false negative finding as reported by Dr. Jessen (Proceedings of a 1972 symposium on hip dysplasia) and by an internal OFA study of dogs evaluated at 24 months that were re-evaluated at an older age. This is why OFA requires the 24 month certification age. Voluntary submissions to PennHIP will provide information on the range, mean and median of the DI measurements for the various breeds. The meaning of the measurements remains unclear and will require repeat studies, on the same dogs, at >24 months of age.
Breeders must be aware of the cost, strengths, and weaknesses of the test methods available for evaluation of the hip status before making the choice of a specific testing method. Once the choice is made, it must be followed for generations before progress in improving the hip status can be evaluated. OFA data has demonstrated marked improvement of the hip status in the Portuguese Water Dog (AKC Gazette, Nov 1991) and the Chinese Shar Pei (Barker, Mar/Apr 1995). OFA data on all breeds was independently evaluated and reported by Dr. Kaneene (JAVMA, Dec 1997) an epidemiologists from the Population Medicine Center at Michigan State University. The study compared OFA evaluations on dogs born between 1972 and 1980 with dogs born between 1989 and 1992. The population consisted of 270,978 dogs. The authors, having acknowledged the fact that submissions are voluntary and that there is bias due to prior screening, concluded:
We do not believe that this is the most likely explanation, because the increase in the percentage of dogs classified as having excellent hip joint phenotype (+36% [7.82 vs 10.64%]) was substantially larger than the decrease in the percentage of dogs classified as having canine hip dysplasia (-21.% [17.39 vs 13.82%]). If better screening of radiographs prior to submission to the OFA was the cause of the increase in percentage of dogs classified as having an excellent hip joint phenotype, then because it is easier to differentiate dysplastic hips from hips with normal phenotypes than it is to differentiate hips with excellent, good and fair phenotypes, we would have expected that the decrease in percentage of dogs classified as having canine hip dysplasia would have been larger than the increase in percentage of dogs classified as having an excellent hip joint phenotype.
Unfortunately, PennHIP has not been available long enough to accumulate the data necessary to evaluate the effect of this test method over time.
G.G. Keller, D.V.M., MS, Diplomate of A.V.C.R., is the Executive Director of Orthopedic Foundation for Animals, Inc. Dr. Keller received his Doctorate in Veterinary Medicine in 1973 and was in a small animal private practice until 1987 at which time he accepted the Associate Director position for the Orthopedic Foundation for Animals. He received the Masters degree in Veterinary Medicine and Surgery in 1990 and Diplomate status in the American College of Veterinary Radiology in 1994. He assumed the role of Executive Director for the Orthopedic Foundation for Animals in January, 1997.
The Importance of Good Positioning
on Canine Hip X-rays
I would like to thank Dr. Jane Brakken for help with my dogs and
allowing me the use of her x-ray room to take these photos.
Hip Dysplasia (another article on the subject)
The positioning is so bad in this x-ray that the dogs owner
should have refused to pay for it.
The purpose of this article is to teach the average dog owner how to determine if a hip x-ray is done properly on their dogs hips. The article will demonstrate correct positioning and poor positioning. It will show 2 different sets of x-rays done on the same dog on the same day. One set has good positioning, the second set has poor positioning. You will see that with poor positioning, a dogs hips can look worse than they actually are. You will also see that no matter what you do with positioning you can never make a bad hip into a good hip.
The photo of the hip x-ray above (labeled good positioning) was done on a 10 month old German Shepherd from my kennel. While the dog is slightly angled on the x-ray plate, the positioning for the hips is pretty good. The photo below (the same photo as above) shows the various points on an x-ray to look at to determine if the dog was positioned properly.
Because this article is directed to the general public, I will not attempt to use the proper medical names for a lot of the terminology in this article.
The first thing to look at in an x-ray is to see if the legs come straight down from the hips with the knee caps square and looking alike. We don't want to see one leg straight and the other going off at an angle.
The above photo has 3 sets of colored arrows (green, yellow and red).
The green arrows above point to the bone that the hip socket is built into. These bones almost look like wings. You will notice that you can see more of the wing on the right than the wing on the left. When the position is 100% perfect, both wings will look exactly alike.
The yellow arrows point to holes in the bone structure. When the body positioning is correct the 2 holes on the left side are the same shape and size as the holes on the right side. The positioning is good on this dog, but not 100% perfect. That's why the holes on the right are slightly different than the left. This is most noticeable in the lower right hole being smaller than the left side lower hole.
The red arrows above are the first things I look at when examining an x-ray. They point to the amount of pelvis bone that is covered by the leg bones on the x-ray. If you look at the pelvis, you can see that with the legs fully extended straight down, the legs overlay the very corners or tips of the pelvis. You can see the overlap through the leg bone. The picture above shows an even amount of overlap on both sides of the pelvis. The photo below shows a much larger overlap on the left of the screen than on the right of the screen. This is poor positioning.
The photo above is the same dog only a different x-ray than the first one. This second x-ray has poor positioning. Notice how much more the pelvic overlaps the leg bone (the green arrows) on the left than on the right. The result is the hip is pulled further out of the socket (the single red arrow) because of poor positioning.
The x-ray above is an example of poor positioning. Again this is the same dog as the good x-rays above. The dog is rotated. You can see the upper right hole through the body cavity is noticeably smaller on the right than the left. The pelvic wing under the leg is noticeably larger on the left than the right.
This photo graphically shows the results of poor positioning. This photo shows the same hip joint on the same dog x rayed on the same day. The hip in the red circle is a much deeper seated ball in the socket than the picture in the yellow box (which had poor positioning to produce this results).
Some people ask how the difference can be so dramatic. My feeling is that these are young dogs. They have loose ligaments (just like a young child). If I took some of the falls that my eleven year old does I would have numerous broken bones. Its the same with our dogs. As they get older their ligaments are not as loose and they will probably not stretch as much. There may not be as much of a difference in older dogs. But at a young age positioning is critical.
The importance on positioning is often over looked by the vet that is shooting the films. There may be a number of reasons for this:
- It could be lack of experience doing hip x-rays.
- It could be a money issue with him. To shoot another x-ray because he made a mistake costs him money.
- It could be that by the time the x-ray is developed and he realizes the position wasn't that good, the animal is gone or awake from being knocked out.
In my opinion, none of these are good reasons. To get good x-rays you have to have a good vet. I have a couple of local vets that are very good with x-rays. If they make a mistake they re shoot it at their expense. We just recently started to see the OFA send x-rays back to the vets because of poor positioning. When this starts to happen on a consistent basis, we will start to see much better x-rays of the dogs.
Over the years I have seen some absolutely terrible jobs of x-raying dogs. As time goes by I will continue to add poor x-rays to this article so people can learn what to look for.
There are several operations that are being done today to correct a bad hip and allow the dog to live a normal life. The x-ray below is an example of what a hip can look like after the operation. This operation needs to be done at an early age.
This is a photo of a very bad set of hips. It's questionable if surgery could even correct this dogs problem. These are hips from an 8-month old German Shepherd that came from a back yard breeder. A dog with hips like this should be put down. It is facing a life of pain.
The 2 x-rays above are of the same dog (a Border Collie). The top x-ray was taken at 8 months of age. The lower x-ray was taken at 4 years of age. This can give you an idea of what will happen to bad hips over time. Notice the thickening of the neck of the joint. The ball also shows signs of arthritis. This dog is living as a house dog where her exercise is monitored. When the pain gets bad she is given Rymadil and this seems to make her comfortable.
Same Dog 9 Months Apart
Here are photos of 2 different x-rays taken of the same dog taken 9 months apart. The first x-ray showed the dog having bad hips. If you look closely you will see the positioning is not correct. It's not that bad but it is also not perfect.
Taken Sept 2002
The second photo below shows the dog with good hips. The positioning has been improved and this has made a big difference in how the x-rays look.
Taken June 2003
My advice to anyone would be to not accept incorrect positioning of any kind. Discuss this with the vet before the x-ray. Show him this article if he has any questions. I personally will not pay for a bad x-ray.
I recently had a similar situation with a young dog that I x rayed at 6 months. The picture did not look that good but the rest of the litter was good. So I redid the X-ray at 9 months and saw an entirely different x-ray. The dog will pass OFA if the x-ray stays the same.
I would also recommend swimming a dog to build muscle mass if there is any question on the hips. The better condition a dog is in the better chance of a good x-ray. I have a friend who has watched the OFA on a yearly basis. She has noticed that there are more bad hips in the winter months than summer months.
For me this translates into dogs not being in as good physical condition in the winter months as the summer. In the future I will not be x-raying dogs in the winter. I will also make sure that my dogs are in excellent condition when the x-rays are taken.
The Following are 3 x-rays of the same dog done at different times.
January - 2003
Positioning still not correct - look at right hip
May 2003 Better but not perfect. Look at the right hip in all three shots.
This is the worst case of hip positioning that I have ever seen. The Vet that took them and gave them to the customer should get out of the business.
What you can do to prevent bad hips
With all this said - if you are reading this article and are asking yourself what you can do to make sure your dog has healthy hips? The SV in Germany (the German Shepherd Dog Club of Germany) has proven that genetics is only responsible for about 25% of the bad hips in dogs. This means that 70% to 75% of the bad hips are caused by environmental issues.
There are things that help:
1- Keep your dog thin - when I say thin I mean you need to see a definition between the ribs and loins of your dog. I cannot stress this enough. The more weight a dog carries the more pressure on the hips. This is extremely important when the dog is growing (between 8 weeks and 18 months)
2- Do not over exercise your young dog. DO NOT TAKE A PUPPY JOGGING !!! Not until its older than one year of age. Over exercise is the fastest way to destroy hips.
3- Feed a quality all-natural diet. If you dont want to feed a raw diet at least feed it an all-natural commercial diet. I have an article on the various commercial kibble - we also sell one of the best called "Honest Kitchen" We have fed this for years and feel that it's the best we can find.
We stress the diet with our puppy customers and it has made a huge difference
4- If you have a question about subluxation in a young dog - SWIM the dog!! Take the dog swimming every day for 3 or 4 months before you have x-rays taken. Swimming is the best exercise you can do for a dog. It is way better than jogging the dog. When you stop and think that subluxation means the head of the femur is loose in the socket - does it not make sense to exercise the dog so the muscles and ligaments tighten up the dog as much as possible.
5- We give our dogs 99% Glucosamine supplements - we also sell it to customers click here for details. The fact is I take the same product myself (in orange juice)
The fact is you can do all of the things mentioned above and still get bad hips. Thats the sad thing. I have bred over 350 litters in 30 years, the dogs I breed have good hips 6 to 10 generations and we will occasionally get a bad hip. I will say that the percentage of hip problems in our kennel is much much less than breeders who do not follow this protocol.
THE WORST POSITIONED HIPS I HAVE SEEN
The x-rays above were sent to me in Feb. 2006. They are the worst example of hip positioning I have ever seen. The Vet that took these should give up his day job and seek another career.
The above 2 pictures are of awful positioning. The hips are bad however, and no matter how they were positioned it would not have made them look any better.
QUESTION on Hip Positioning:
My breeder sent me the link to your web site to view x-rays - specifically positioning. (She has been breeding Bernese Mountain Dogs for over 30 years, specifically for performance dogs, not conformation).
The attached digital photos of x-rays are of my 9 month old Bernese Mountain Dog's hips, (9 months old today, Jan 21, 2007) - the films were taken December 30, 2006. He injured his legging running in the back yard on December 28, was not putting weight on it, I took him into my vet on December 30....the vet took the attached x-rays. I went back and took digital photos of the x-rays to email to my breeder. My breeder and I have been discussing....she says she is shocked my vet would even let me see these x-rays...they are some of the worse positioning she has ever seen.
I had the dog on pain pills for a week and he is now on supplements. Also have an appointment on March 19th, 2007, at the regional vet school in this area (Virginia-Maryland Vet School, in Blacksburg, VA) to have preliminary OFA x-rays taken.
The digital photos are of only TWO x-rays, his hips and his (supposedly) hyper extended left knee.
If you have a minute, please give me your input on these films?
The photo of the hips is below. This person needs to find a new vet. This is a case of really terrible positioning.
Comments on the Hip X-ray article
Thank you for that article on hip positioning. I have an associate degree in Veterinary technology that i received in 1990, radiology has always been a passion of mine. You are so correct!!!! I have worked for so many vets who do not know how to take proper x-rays and even worse they hire people off the street to do it for them and instead of training them the right way to do it or pay a little more money for an educated person to work for them. They count on owners being un-educated. I have been telling people this for years. I breed Labradors now, and my vet and i have a good
understanding she takes 2 x-rays of hips for me tells me her opinion then give me x-rays and i can choose which one i want to send to OFA. But i must say she does a great job.
Thanks again for educating the public and i think everyone should get a 2nd opinion before doing major hip surgery. AND I SO AGREE with you i have seen dogs with moderate hips dysplasia not show any signs of weakness simply from being able to swim to build there muscles.
Swimming Dogs is the best physical therapy.
TESTIMONIAL on hip x-ray article
October 15, 1998
My name is Goran and I'm living in south Sweden, I have been struggling with the result of bad position with the Swedish Kennel Club.
After reading your article and taken part of your excellent photos I have succeeded to get a veterinarian to take some new x-rays and our champion Parson Jack Russell Terrier dog has been upgraded from mild hip dysplasia on one hip and excellent on the other to excellent on both hips. I would like to thank you for the help that your article have given me.
I'm planning to write a article in our club magazine and also in the Swedish Kennel Clubs monthly magazine and if I can use your photos it will be very helpful for my work. I will also like to refer to your article if you don't have any objections about it.
All the best and thank you again.
Hi Mr. Frawley,
Over Christmas break we noticed our dog, Abbey (one year old yellow lab) had a limp on her back right let that wouldn't go away. I took her into the vet and the vet established that at least one hip, more than likely, had displaces. We brought our dog in to our vet for x-rays and we were told," both of her hips show a loose joint on palpation. Knees tight. On the x-rays her left hip is nearly out of place. The right side is in place but is also affected. At this time there are only a few minor changes associated with chronic dysplasia." We were told she would be, "a good candidate for any of the corrective surgical procedures for hips." I started doing some research and luckily came across your article. After reading your article, I tried to determine whether or not her x-rays were bad. In the x-ray, her legs do not appear straight, one is bent more than the other. There is also no overlap with the pelvis bone and the leg bone at all. There does however appear to be the same amount of space between the tip of the pelvis bone and leg bone. Also, the holes in the bone structure are fairly symmetrical.
Our vet is in Delaware and a surgeon was recommended who is also in Delaware. I feel really confused about what to do. We were both shocked because our dog came with papers. I beginning to realize that doesn't mean a whole lot. I am just going to do what I need to on my end to make sure our dogs parents don't breed again. If you can give any advice I would greatly appreciate it. I hope to hear from you.
The fact that your dog has papers means absolutely nothing in terms of hip dysplasia. The AKC is a joke in that regard. They do not require dogs to have their hips x-rayed before they can be bred. This organization holds itself up as the ultimate supporter of pure bred dogs yet they allow people to breed dogs with bad hips. Its a money thing and nothing else
With that said I cannot comment on what you should do. It sounds like the x-rays are good. You need to follow the advice of your Vet if you think he or she is reputable. It sounds like this is the case.
The smartest thing you can do is to keep this dog skinny. Skinny to the point of seeing a definition between the ribs and the loin. Skinny to the point where people (who know little about dogs) tell you your dog is too thin. Not only is this healthier for the dog it is much easier on what's left of the hips.
Then allow this dog to swim as much as you possibly can in the summer. Swimming is the best exercise there is for dogs with bad hips. It builds muscle without hurting the skeletal structure.
I would also highly recommend an all-natural diet. You can read about it on my web site. Look in the list of training articles on my web site at http://leerburg.com/articles.htm. Keep the dog on Glucosamine. We just added a liquid Glucosamine product to our product line. The liquid far out performs powdered products. The body absorbs it much better than the powder.
Good luck with your dog. I hope it turns out OK.
I wish I would have taken your article in to my vets this morning. I had my seven month old German Shepherd spayed today along with hip x-rays. The vet said the hips were in very poor condition and showed the x-rays. He said they looked so bad that he re-x-rayed her standing when she was awake and they were just as bad. Your article doesn't mention anything about hip x-rays and the dog standing up. What is your thought on that?! At first I was in an absolute panic. He said she'd need major hip surgery in three months if they didn't improve. Now, I'm researching it a bit more before I do anything drastic.
-- Thanks Shelly
Find a new Vet. Seriously. In 42 years of owning GSDs I have never heard of hip x-rays when a dog is standing. This Vet is full of you-know-what.
You have the photos of correct positioning from this article I wrote. You do not have to be a Vet to figure out if the guy gave you a good set of x-rays.
I have a 10 week old GSD and I took him to the vet for the first time and the vet did some sort of pulling test on the dogs legs to check for a hip problem. My pup yelped loudly and now the vet wants to do X-rays and thinks there is potentially a problem. The vet says that if there is something wrong they are going to fuse the bones together to prevent future problems.
Do you see anything wrong with this? Any concerns or comments would be appreciated. Thank You
Find a new vet- seriously !! This guy is full of beans. I have bred dogs for 30 years over 340 litters. This is total BULL on a 10 week old puppy. This is a perfect example of a crooked vet trying to get his hand in your wallet.
Hope all is well. I sent you a message about a year and a half ago reference my dog's hips. The vet was saying he was a candidate for the Pen hip surgery and his hips were not very good... this evaluation came after a physical evaluation at 4 months of age. Your reply was to get a new vet and tell her to get her head out of her ass.... I took your advise. I just received my dog's OFA results... OFA Good. Thanks for your advise.
PS My dog is out of Valco Vom Leerburg (Dago) - Jon Wycoff, and Zalinde Vom Leerburg (Frankie) - Jon Wycoff.
We would like to get your opinion about something our vet suggested. She would like to do a PennHIP on Dita (Hilde X CJ) and possibly a Juvenile Pubic Symphysiodesis if required. Is this a viable course of action or a load of crap? We want to do what is best for Dita in both the short and long term.
Thank you, Rip and Denise
I have written about PennHIP on my web site. I am not a fan of it and dont recommend it. It basically measures the degree of laxity in the hip to determine if the dog will be Dysplastic.
The way I look at this is that young dogs are like young people. They are loose ligamented. I was when I was young and I used to throw my knee caps out. As I aged my ligaments tightened and the problems disappeared. I believe the same thing happens with dogs they are loose ligamented not all, but a lot. As they age they tighten.
When a PennHIP is done on a loose ligamented dog its my opinion that this can give you a false negative reading.
We will do normal preliminary hip x-rays at 6 to 10 months of age. When we do the OFA we never do it when a female is in season and we try and swim them every day (not run them) for a month before the x-rays to tighten them up).
I have been breeding dogs for almost 30 years and never heard of Juvenile Pubic Symphysiodesis.
So I would have to wonder if this Vet was trying to get into your wallet.
I was sent your site by a friend who does rescue work with me. Overall the info is very good. But the last letter about the JPS surgery is incorrect. It is the newest surgery for hip dysplasia. It was developed at the university of Wisconsin. It is very very new. The long term studies are still being done.
I am sorry you have such a high disregard for veterinarians that you deem it a money making scheme by a vet vs sound medical advise. Stereotyping vets as money grubbing is as bad as someone saying that breeders do it for the money.
There are many of us out there that do this work for the love of animals ....I do not disregard your site as full of quackery because you are selling your products....
I work hand in hand with my clients to get the best for their pets.
You are in the minority.
I am sorry to say this but my feeling is that the vast majority of Vets are more concerned about making money than the care of dogs. Pushing yearly vaccinations is the perfect example. Its complete BS and anyone who defends that position is full of beans. Pushing Science Diet over a all-natural diet is just another BS move
Your profession has a public relations problem. The vast majority of Vets are arrogant asses that assume their customers are stupid (notice I said customers) If you have not figured this out then what can I say. Just today I made the decision to start a STUPID VET section.
I happen to have a very good Vet she is honest about things she does not know and we work together to keep our dogs healthy.
I really need your advice on something. My Rottie pup is 15 months old and in the past 3 months is showing signs of hip dysplasia ie:funny looking walk, wont jump up into jeep etc. Our breeders have a hip guarantee in their contract and I inquired about the guarantee tonight. They told my wife and I that we would have to pay for the X-rays (no problem) and that if she was indeed dysplasic then we could give them our dog for a new puppy or they would give us $300 dollars towards surgery. My wife and I find this policy to be quite unrealistic as we absolutely love our dog and would never give her away just because of her hips. I put a deposit down over two months ago for the first male in a litter to be born in two weeks with the same breeder. Would it be unreasonable for me to ask for the breeder to absorb the costs remaining on that dog? If I traded mine in for a puppy, they would be down a pup anyways, and would probably put mine to sleep, so what's the difference? What do you think of this breeders policy? Am I being unreasonable? My wife doesn't want me to even buy the dog off of them because of their policy. I am aware of the risks even if the dogs parents hips are certified (in this case they are) and have tried to convince her that it is just bad luck on this one. I respect your opinion and recognize your long term experience as a breeder. Where do I go from here Ed?
Your response is greatly appreciated,
You cant form any opinions until the dog is x-rayed. Read the article I wrote on correct hip positioning for hip x-rays. It's very good.
Right now you dont even know if your dog has bad hips. He could have pulled a muscle.
HOW DO I PICK A VET?
Hi I have a question. I want to get my German Shepherd Hip's x-rayed. We are going to breed her with a stud but they want an OFA "good" hip's. We live in NY and I was reading about the experienced you and people were having about wrong positions, lying Vets and etc. I wanted to know how can you know if they are experienced? We go to a Vet clinic here called Valley Cottage we called and asked if they do x-rays on hips. They said yes. it is $293 for the x-rays and $43 for the certificate. Is it reasonable, the price? That's a lot of money for not doing the job right..They seem good with dealing with animal problems but reading your article has made me wonder how do I know they are good with the x-rays of the hips. I wanted to know if you recommend anybody in NY or NJ that is very experienced with this type of job. Thank you Ed.
Ed's answer on picking a Vet
This is a complete RIP off keep looking. $293.00 for hip x-rays is ridiculous
Print off my article. Take it to where you are going to have the x-ray done (not this place) ask them if they will guarantee correct positioning like in this article. If they cant or wont guarantee then dont give them your business.
Really Bad X-rays:
This is 6 mos. old Onyx GSD. Diagnosed when she was spayed with "severe" HD.
She had been limping for a week and wanted them to check for a splinter while she was sedated. They took x-rays and this is what was shown. This is the same x-ray, just my digital camera zooming in on one. I thought you would like to see another vet who should find another career! She has since started limping again for the past week, hopefully it is just pano and not her hip.
Thank you for your web site showing the proper positioning for the hip x-ray,
I would never pay for an X-ray that was so poorly done. The vet is incompetent.
Hello Ed, I have just read your article about the importance of good positioning and it's really helpful. I have decided to repeat my GS x-rays because they are not good enough I think.
I send you an x-ray done to a Border Collie of 3 years and a half, that I think is really good, almost perfect, so you can put it in your article if you want to. Thanks a lot for your dedication and lovely work.
Too bad more Vets don't know how to position hip x-rays like this Vet did them.
I acquired my GSD earlier this spring from the training director at the local schutzhund club. Here is the breeders website: http://www.vomhuelsman.com/ & here is the line breeding:
http://www.pedigreedatabase.com/gsd/para.utkoma?fadir=318978&modir=340576We thought everything was fine until strangers pointed out his awkward gait as a sign of HD. We took him to the vet who X-rayed him with the diagnosis of having HD. They were sent onto a "specialist" who also confirmed it. The breeder takes the stance that you do in your article on correct positioning: 1. Bad positioning 2. Loose joints 3. etc. He told me not to let it get me down yet but there is that long shot chance that with even good lines the dog may have got it. I just re-read your article today and my dog's x-ray looks very similar to the one you used as an example of bad positioning resulting in a false positive, which has brought me hope. My question: My pup still shows the physical symptoms of HD especially the "bunny-hopping" motion. Can a dog not have HD and still show the outward physical signs? Have you seen pups that show the typical physical symptoms of HD at a young age, but don't actually have it? Love the site and the videos!
P.S. I am currently looking for somewhere to start swimming him.
You dont mention how old this dog is now, but young dogs and pups grow through some very weird growth stages. Its possible for them to have a weird gait, and grow into a normal hipped dog. If you really like this dog, I would re xray him at some point after you have him in really good muscle.
Take the article on hip positioning with you to the vet, and make sure the positioning is good before you pay for anything. Better yet, go to a specialist for the xrays as it usually doesnt cost much more and they have a lot of experience in taking the films. The vet we use does not even sedate or anesthetize the dog for this, and I feel its a more accurate picture of the joints and much easier on the dog. I xray my young dogs between 6 and 8 months old and then again at 2 years of age.
If a specialist evaluated your xrays though, and confirmed a diagnosis of HD, I would be hopeful but not too hopeful.
I came across your website and was reading your questions and answers about hip xrays, dysplasia, etc. I noticed you mentioned that you prelim your dogs between 6 and 10 months of age. Why those ages?
I prelimed a male weimaraner at 15 months. He came in as mild dysplasia with Subluxation checked off. I called OFA and spoke to the prelim vet, Dr. Keller. He stated that there was No arthritis or change in the ball or socket, but because there was more subluxation in my guys hips than other Weims of his age, he marked it mild. Was 15 months a bad age? Dr. Keller mentioned he has had dogs growing at that timeframe that he marked off mild, and when they got their regular OFA sent in after the 2yr mark, they came in passing. He said my guy could be growing and tighten up in time because the subluxation was all that was noticed. I have put him on Pala-tek just in case this was true. My vet also agreed, as he wasnt sure if my boy would pass or borderline due to the xrays being breed specific. Wasnt sure how they graded Weims. Also, he went through major intestinal surgery at 10months of age. Dropped a ton of weight for about 2-3wks. Didnt know if this could have something to do with him growing, or ligiments and muscles forming again, etc.
When coming out of the anesthesia from the xrays, he wasnt real normal till the next day. Still droopy tired in the A.M. Normal at dinner time.
Also, have you seen this happen? If so, would you wait a certain time past the 24month mark. His mother OFA Excellent at 30 months. His father Excellent at 24. He has a ton of Excellents and goods, and his brother was prelimed at 11months and came in Good.
Please let me know. This is a multiple BOB dog and I will do anything to possibly have him pass.
We xray at the age we do because we dont want to wait until the dog is 15 or 24 months old to know hip status. If the dog has a problem we want to know earlier, rather than later.
I dont know what you feed this dog, but I would get him on a raw diet and get him in very good condition before I xrayed him again. I wouldnt put an age limit on it, but when he was in tip top shape I would re do the films. We all like to see OFA excellent dogs in our dogs pedigree but it is no guarantee that you will not have a dysplastic dog. Genetics play a role, but so do exercise, diet and environment.
If you search our site on the terms hip dysplasia you will find a lot of information.
Read this article on feeding a raw diet. Its a work in progress but there is a lot of good information there.
You can also go to our Feeding Dogs Page for a list of articles and books that will be helpful to you.
My name is Chris and I found your website via a google search on Lab Hip Displasia. You must get tons of email so I hate to bother you but my friend Jennie is totally distraught. The attached xray was taken of her 6 month old male yellow lab puppy. The dog lives in Durham, NC and got the Xray when he went in to get fixed. The Vet told Jennie this was the worst hips she every seen on this old of a puppy. I am going to call my VET for a second opinion but was hoping you could take a look at the XRAY and tell me what you think. The dog came from a NC breeder and the parents were both certified with good hips. What things should Jennie be doing over the next few months, 6 months, and several years.
Thank you in advance for your time,
If this is the worst set of hips your vet has seen then he lack experience. While the hip is not great it certainly is not TERRIBLE. His comments are one of the reasons that I lose respect for Vets - They have to earn my respect before I listen to them - there are too many out there who lack experience or are more interested in your wallet than your dog's health.
Hello I came across your site as I researched CHD. I had gotten a really bad hip x-ray that I submitted to OFA, it was rejected. I was dumb so I got another from the same vet, it was accepted but the dog was rated as "mild dysplasia" on notes it said unilateral due to subluxation, I was devastated but accepted it. After I read your site and your photos I re examined the original films and for lack of a better word they sucked! A few days ago I got her re-X-rayed and attached is the film. Please tell me what you think, I know it's not perfect (film or the hips) but just want to know if I should be overly concerned. Also about CHD I have been doing alot of research and I am not truly convinced that all forms of chd are hereditary. Unilateral for example happens about 85% of the time on the left hip...why? have you ever heard of a decease that likes "sides" that much? ALso if it is true that there are a multitude of genes that contribute to CHD then why is it so prevelant? what little I know about physiology, the more complex something is the more rare it is. Also why X-ray when we should just isolate these so-called CHD genes and just scan for them? oh yeah they cant seem to "find" (isolate) these genes. I dont know it just doesnt make any sense to me, it is either over my head or over their heads as well. Please let me know what you think of the x-ray all opinions welcome. I emailed this to two of the addresses because I didnt know which one.
Ps. I love your site. Oh and the x-rays are of an adult female Fila Brasileiro 3mths to her next heat cycle.
I no longer use the OFA I honestly believe that it is a flawed process run by inexperienced people.
I completely disagree with the rating on your dog. This dog does not have bad hips.
I do agree that there is far more than genetics going on to cause bad hips. I write about it in my article on positioning - over exercise at a young age, over weight at a young age, feeding a shitty diet (I believe that a raw all-=natural diet leads to healthy bone and joint development).
So in closing dont listen to these fools. I remember a female I had back in the early 1990s. The OFA told me the same thing about her hips mildly dysplastic I completely disagreed. I bred her a number of times. She had 56 pups and not one had bad hips, in fact several had OFA excellent hips.
First I would like to thank you for the excellent article on proper positioning for hip x-rays.
A friend recently had a dog x-rayed for OFA. Her vet said the x-ray was normal. And the OFA result was mild dysplasia. I told my friend not to worry too much at this point. That first she should take her dog to an orthopedic vet and get x-rays with sedation and proper positioning and I sent her your article on proper positioning. If the x-ray looks good she can resubmit to OFA and if it looks bad she can find out what the orthopedist suggests for managing her dog's condition.
My question to you is... how does she find a really good orthopedic vet?
What do you look for when choosing an orthpedist?
And should she tell the vet that her dog has already OFAed mild dysplasia? Would that taint the opinion?
My breed has submitted less than 100 x-rays for OFA ratings and hasn't received an excellent rating in the last 11 years. Has OFA tightened their standards over the years or something? My breed is not known for having hip dysplasia but they are so small that it might not be noticed without x-ray if they were dysplastic. I wonder if OFA has some sort of quota system in place so that too many dogs in a breed won't receive an excellent rating and make the statistics for the breed so good that people will not to be inclined to use OFA.
And I wonder if I would be better off just taking dogs to a good orthopedic vet and getting an opinion on hips before breeding rather than submitting to OFA.
Thanks for your input.
If you cant get referrals from other people who have had good experiences and results from orthopedics vets, then I would Google search your area for board certified orthopedic veterinarians.
If a vet is good, I dont think it matters if you tell them about previous radiographic results. They should be able to see for themselves the status of the dogs joints.
You will get varying opinions about the value of OFA, some people wont breed or buy pups from stock that is not OFAd. We personally feel that a qualified orthopedic vets opinion is good enough for us. We stand behind our puppies either way.
So I went and got the X-ray. My dog is in very bad shape. It is probably my fault. The vet says she has really bad hips and he wants to do a total hip replacment which I am not so sure about. I should agree, I haven't decided yet. I am going to get a couple of more opinions but after all she is 6 years old and I think it will be too risky. Right know I am just thinking on some sort of pills I should start her on. Stop working her you know probably just let her be a pet. But please have a look a the photo's and give me your opinion which probably won't be very positive but life sucks and you have to deal with it. Any ways enough talk.
Thanks for the quick reply. The x-ray is not perfect but I think probably could have been worse. Please tell me what you think I should do at this stage.
Ed's Response :
These are some of the worst hips I have seen. I agree with your vet, this dog either has to have new hips or he will have a very very painful life. I cant remember the last time I recommended a dog have new hips.
My name is Darryl I am a small GSD breeder in Ireland and have recently brought my 14 month old male dog for a pre- X-ray as he developing into a super young dog and will certainly want to use him on my bitches.
I brought him to my vet and much to my surprise and upset she told me my dog had terrible hips and should in no way consider him as a stud dog. Needless to say I was shocked and very upset at the prospect of not been able to stud him and indeed end his promising ring career.
I was unsure of the results so I posted a page on the gsd database and included photos of the x-rays............ Oh my God!
What a response all said the same.. "the vet should be banned from taking x-rays" etc etc. I was also sent a link to an article that you ran and was amazed and educated at the same time. "The Importance of Good Positioning on Canine Hip X-rays" This was a fantastic article and armed me with the information I needed to return to my vet without looking like a fool.
I have attached the x-rays so you can see and will let you know how I got on.
I am fully aware also that because the x-rays were bad does not mean that a new set will improve his hip score however it will give me the correct information as to decide his future (fingers cross).
Those x-rays are horrible! Its impossible for any vet to give an evaluation based on those. Wow!
Id find a new vet right away but not until I gave that one a piece of my mind. She should refund your money.
I wish you the very best. Let me know how your young dogs hips turn out.
I wanted to drop you a note as I totally appreciate your writings on hip dysplasia. To me, its very confusing in dealing with vets and the mis-information that is out there. Your articles are clear and concise for the layman. However, I still cant figure out good hips from bad. Was hoping you could tell me if these are bad hips, ok hips, or good, excellent. My vet says I should have my dog fixed, never breed her and she is destined for a life of pain. It was a shock as this pup comes from some pretty serious well known foundation stock amongst all OEBs out there today. She is one year old and I had planned to breed her. Would really appreciate your view. My vet actually tried to get me to spay her when she had her in the office recently. I wanted to punch her! She does not seem to like my breed either so I am planning to find a more open minded vet but was curious if she was playing me or not. She said it was one of the worst she has ever seen. Thanks again and Happy Holidays.
I hate to say it but the hips do not warrant breeding.
Fact is, only about 30% of bad hips come from genetics. So those who say their dogs come from a great bloodline of good hips are only 1/2 correct.
The rest is a good diet, not over exercising the dog as pups and keeping the dog THING from puppyhood to xrays age.
I dont know which of those you did wrong or if it was the genetics.
This dog will not have pain, its just not good enough to breed.
I have two xrays here I want you to look at. The one on the bottom was taken in Jan (8 months old). Purposively the second xrays are of the same dog 3 months later.
Now, I am no expert. But these do not look like the same dog to me.
I thought I would shoot these to you and see what you think.
Both hips are bad - the positioning on the top x-rays is terrible. I would not have paid the Vet fees on that.
Pass that on to your vet :-)
Please find attached the x-ray photo of 3.5 months old Ca de Bou (perro dogo mallorquin). Vet gave us the very worst prognosis for the future of this puppy. I'm on the crossroad of making a decision - to grow a "different" dog or to give up.
So far the puppy is active, only some sypthoms of early dysplasia are noticed.
I'd be greatfull to hear your opinion about this.
Gretefully yours -
Indre from Lithuania
I am sorry to say that these are terrible hips. Some of the worst I have seen.
Hi Mr. Frawley,
I know that you must be getting hundreds of emails and sorry to keep you busy. I have a 15 month old toy poodle who has been diagnosed with hip dysplasia based on the attached x-rays. Looking at your website, I believe that these x-rays are not good quality, and I was wondering if you could give me a feedback on them. The vet is recommending surgery and, because of the poor quality of the x-rays, I am not quite sure if I agree with the vet's surgery solution.
Appreciate your feedback.
Your Vet is an absolute crook. A HANDS-DOWN THEIF.
He needs to learn how to position a dog for a hip x-ray. This positioning sucks.
I will add this email to web page I have done on incompetent vets.
We recently purchased a 4 month old German Shepherd. We took her to one vet within our 48 hour time limit who said the dog was fine. On the 10th day we took her to another vet because she wasn't eating or acting right. Immediately the second vet said her hips were horrible, that she has hip laxity, dropped hocks, and poor confirmation. We are at a loss what to do as our family has already bonded with her, and our 48 hours are up with the breeder. We don't want her to be in pain. I've enclosed very poor pictures of the xrays. From your website I'm not sure that the positioning is very good on these xrays, and the exposure on the films doesn't appear to be very good either.
Your second vet is a scam artist. Please pass this comment along to him or mail him my email.
The positioning on these goof balls x-rays is terrible. He needs to go back to school and learn how to take hip xrays.
I will add your email to my web page on VETS THAT DONT DESERVE RESPECT.
I took my dog into a PetSmart today for a free exam to be told that I should get hip x-rays for $450. I only moved to the US this year and don't have any Vet referral so I was wondering if you might be able to tell me what to look for and if you know of any specific vets that I should contact.
Your hip positioning segment was excellent information and I already feel a lot more informed.
Appreciate your help,
This is absolutely a RIP OFF. Just another reason to prove that Pet Smart is clueless about dog training and canine care. To allow a Vet to come into their store and tell people this is irresponsible.
A hip x-ray including the fees to send it into the OFA should be no more than $150.00 TOPS. Anyone who charges more than that is a con. There are a lot of good vets out there. Get on the phone and start to make some phone calls. Get prices for a hip x-ray including the fees to send the film to the OFA (if that's what you want to do).