Hip & Elbow Scores

Hip Score

Hip scoring is a procedure used to determine the degree of hip dysplasia in dogs and other animals and reporting the findings in a standard way.

The hip score is the sum of the points awarded for each of nine radiographic tures of both hip joints.

The British Veterinary Association uses the following criteria to determine hip score:

Norberg Angle
Subluxation
Cranial Acetabular Edge
Dorsal Acetabular Edge
Cranial Effective Acetabular Rim
Acetabular Fossa
Caudal Acetabular Edge
Femoral Head/Neck Exostosis
Femoral Head Recontouring

The lower the score, the less the degree of dysplasia present. The minimum (best) score for each hip is zero and the maximum (worst) is 53, giving a range for the total of 0 to 106. Each hip is scored separately under the BVA, so within the UK scores are usually displayed as two numbers separated by a forward slash (eg. 2/6). The scores are combined to provide a score for international comparison.

The following table compares the scores recognised by Orthopaedic Foundation for Animals (OFA), Fédération Cynologique Internationale (FCI), the British Veterinary Association (BVA) and Verein für Deutsche Schäferhunde (SV).

OFA FCI BVA SV

E A-1 > 3/hip Normal
G A-2 > 6/hip. Normal
F B-1 11-18 Normal
B B-2 19-25 Fast Normal
M C 26-35 Noch Zugelassen
Mod D 36-50 Mittlere
S E 51-106 Schwere

In the normal anatomy of the hip joint, the root (the thigh bone) is connected to the pelvis at the hip joint. The almost spherical end of the femur head (the caput, or caput ossis femoris) fits into the acetabulum (a concave socket located in the pelvis). The bony surface of the femur head and of the acetabulum are covered by cartilage. While bones provide the strength necessary to support body weight, cartilage ensures a smooth fit and a wide range of motion. Normal hip function can be affected by congenital conditions such as dysplasia, discussed in this article, trauma, and by acquired diseases such as osteoarthritis and rheumatoid arthritis.

Dysplastic hip anatomy

In a hip suffering from dysplasias, two things are commonly abnormal. First, the caput is not deeply and tightly held by the acetabulum. Instead of being a snug fit, it is a loose fit, or a partial fit. Secondly, the caput or acetabulum are not smooth and round, but are misshapen, causing abnormal wear and tear or friction within the joint as it moves.

The body reacts to this in several ways. First, the joint itself is continually repairing itself and laying down new cartilage. However, cartilage repair is a relatively slow process, the tissue being avascular.

So the joint may suffer degradation due to the abnormal wear and tear, or may not support the body weight as intended. The joint becomes inflamed and a cycle of cartilage damage, inflammation and pain commences. This is a self-fueling process, in that the more the joint becomes damaged, the less able it is to resist further damage. The inflammation causes further damage. The bones of the joint may also develop osteoarthritis, visible on an X-ray as small outcrops of bone, which further degrade the joint.

The underlying deformity of the joint may get worse over time, or may remain static. A dog may have good X-rays and yet be in pain, or may have very poor X-rays and have no apparent pain issues. The hip condition is only one factor to determine the extent to which dysplasia is causing pain or affecting the quality of life. In mild to moderate dysplasia it is often the secondary effects of abnormal wear and tear or arthritis, rather than dysplasia itself, which is the direct causes of visible problems.

Causes and effects

In canines, it can be caused by a femur that does not fit correctly into the pelvic socket, or poorly developed muscles in the pelvic area. Large and giant breeds are most susceptible to hip dysplasia (possibly due to the BMI of the individual animal), though, many other breeds can suffer from it.

To reduce pain, the animal will typically reduce its movement of that hip. This may be visible as "bunny hopping", where both legs move together, or less dynamic movement (running, jumping), or stiffness. Since the hip cannot move fully, the body compensates by adapting its use of the spine, often causing spinal, stifle (a dog's knee joint), or soft tissue problems to arise.

The causes of hip dysplasia are considered heritable, but new research conclusively suggests that environment also plays a role. To what degree the causality is genetic and what portion environmental is a topic of current debate. Environmental influences would include overweight condition, injury at a young age, overexertion on hip joint at a young age, ligament tear at a young age, repetitive motion on forming joint (i.e. jogging with puppy under the age of 1 year). As current studies progress, greater information will help provide procedures to effectively reduce the occurrence of this condition.

In dogs, the problem almost always appears by the time the dog is 18 months old. The defect can be anywhere from mild to severely crippling, and can eventually cause severe osteoarthritis.

It is most common in medium-large pure bred dogs, such as Newfoundland Dogs, German Shepherd Dogs, Labrador or Golden retrievers, Rottweilers and Mastiffs, but also occurs in some smaller breeds such as spaniels and pugs and occasionally (usually with minor symptoms) in cats.

The following conditions can give symptoms very similar to hip dysplasia, and should be ruled out during diagnosis:

• Cauda equina syndrome (i.e. lower back problems)
• Cranial (anterior) cruciate ligament tears
• Other rear limb arthritic conditions
• Osteochondritis dissecans and elbow dysplasia in the forelimbs are difficult to diagnose as the animal may only exhibit an unusual gait, and may be masked by, or misdiagnosed as, hip dysplasia.

It is also worth noting that a dog may misuse its rear legs, or adapt its gait, to compensate for pain in the forelimbs, notably osteoarthritis, osteochondritis (OCD) or shoulder or elbow dysplasia, as well as pain in the hocks and stifles or spinal issues. It is important to rule out other joint and bodily issues before concluding that only hip dysplasia is present. Even if some hip dysplasia is present, it is possible for other conditions to co-exist or be masked by it.

Elbow Score

Instances of 'front end' lameness are fairly widespread. There are certainly many cases that can be diagnosed as 'Pano' otherwise known as 'growing pains' which hit dogs usually between the ages of 5 and 10 months, when the dog is growing very rapidly still, and its tendons, ligaments and so on can't keep up with the limb growth. Lameness caused by Panosteitis can usually be eased by rest and vet prescribed painkillers. The lameness also usually travels from leg to leg, not settling in any leg in particular.

Lameness during this period too can also be a more serious condition, generalised as Elbow Dysplasia (ED). ED has several forms but the most common being Osteochondrosis (OCD) as it is more commonly known.

This is basically arthritis of the elbow joint with bony changes being present and so the ball and cup joint that an elbow is, does not roll smoothly as the dog moves causing him pain and discomfort.

Now of course, these joint deformities of varying degrees can be caused by injury to the young dog, by the dog being overweight and causing the joint stress day in, day out, OR by accident where the joint is struck, severely stretched or otherwise traumatised and changes occur whilst it is at a developmental stage.

However there is also a definite and proven genetic factor to poor quality elbow joints. For certain a VERY large percentage of the cases of ED amongst young developing Dogs are due to a genetic element.

Therefore the British Veterinary Association (BVA) and Kennel Club (KC) developed a scheme along the lines of the Hip scoring scheme around 15 years ago. An x-ray is taken of each elbow both extended and closed whilst the dog is under general anaesthetic or strong sedation. These x-rays are sent to the BVA and are 'scored' (marked according to their quality).

Unlike the Hip scheme, the highest score achievable under the KC/BVA Elbow scheme is a total of '3'. The lowest, mirroring the hip scheme is '0'. Each elbow is scored individually and so its score will be, like in hips, a total of 2 numbers, so, for example, 0:0 (excellent) or maybe 1:3 (Very Poor).

The scoring range is quite small, just 0 - 3, so there is a feeling amongst breeders that it is hard to tell which dogs have TRULY excellent elbows because there is a BIG differential between the scope a '0' score gives us, ditto a '1' score and so on. It almost calls for a '+' system, so a elbow which is in the assessors consideration 'superb' needs a 0++ and one that is 'nearly a '1' needs just a 0 or even a 0.

But that is small-print. Responsible breeders use the elbow scheme. It has been around for some time, maybe not as long as the hip scheme, and maybe there are elements to it which are not perfect, but it is not expensive to put a dog through, and elbows that are scored '0' have been proven to produce much healthier stock than those who score higher.

There is a high element of environmental factors to elbow and shoulder problems. Indeed, many puppy owners do allow them to play roughly with bigger dogs, do allow them to jump continuously up and down stairs and in and out of cars etc etc, and so allow them to get overweight and create strain on growing joints, HOWEVER, it is a breeders responsibility to do all they can, within reason, to sell buyers a healthy fit puppy, and the elbows play a very strong part in this.