Here are a few of the most frequently asked questions about the PennHIP method. The answers to these questions may raise additional questions. For more detailed answers, please explore the relevant areas of this web site.
PennHIP (University of Pennsylvania Hip Improvement Program) is an organized collaborative effort consisting of the Veterinary School at the University of Pennsylvania (VHUP) and a worldwide network of nearly 1200 certified PennHIP-trained veterinarians from 24 countries. PennHIP's primary objective is to reduce the frequency and severity of hip dysplasia in all breeds of dogs. PennHIP is attempting to accomplish this goal through the implementation and widespread utilization of a new stress-radiographic technique (X-ray). Through the network of certified veterinarians implementing this technique, PennHIP is amassing a large scientific database on the etiology (cause), prediction and genetic basis of canine hip dysplasia (CHD).
The PennHIP method is a different way to assess, measure and interpret hip joint status. It consists of three separate radiographs: the distraction view, the compression view and the hip-extended view. The distraction view and compression view, developed by Dr. Smith, are used to obtain accurate and precise measurements of hip joint laxity and congruity, respectively. The hip-extended view is used to obtain supplementary information regarding the existence of DJD in the hip joint.
To summarize, PennHIP is composed of three major components
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A growing body of scientific information from multiple independent laboratories confirms that the PennHIP method surpasses other diagnostic methods in its ability to measure hip joint laxity and accurately predict the onset of DJD. The PennHIP method can be performed on dogs as young as sixteen weeks of age compared with two years using the standard technique. The data generated by PennHIP allows breeders to confidently identify the members of their breeding stock with the tightest hips and the best breeding potential. Pet owners are able to obtain an estimate of their dog's risk for developing DJD and, if necessary, make lifestyle adjustments for their dog to enhance the quality of their pet's life. The PennHIP interpretation will also permit breeders to assess the progress they are making with their breeding program.
PennHIP is performed only by certified individuals who have undergone training and have successfully demonstrated their expertise in performing the technique. In addition to the special radiographs developed by PennHIP, the method also incorporates the standard hip-extended view into the interpretation of hip joint integrity. Upon request, your PennHIP veterinarian can make a copy of the hip-extended radiograph for submission to the OFA at the time your dog has PennHIP radiography. You do not have to abandon the OFA view or schedule a separate appointment to have it done.
In 1983, Dr. Gail Smith from the University of Pennsylvania School of Veterinary Medicine began to research and develop a scientific method for the early diagnosis of CHD. Multiple scientific disciplines - including biomechanics, orthopedics, clinical medicine, radiology, epidemiology and population genetics - have been incorporated during the development of PennHIP. This research resulted in a diagnostic method capable of estimating the susceptibility for CHD in dogs as young as sixteen weeks of age.
In 1993, Dr. Smith established PennHIP, a cooperative scientific initiative, to serve as a multi-center clinical trial of the new hip dysplasia diagnostic technology. The program was successful and quickly grew beyond the capacity and purpose of a university research laboratory. Initially, the University of Pennsylvania licensed PennHIP to outside biotech companies in order to make the technology available for widespread public use and to allow Dr. Smith and his colleagues to continue their research at the School of Veterinary Medicine. PennHIP has recently been reacquired by the University of Pennsylvania and is now a not-for-profit organization.
Through a sophisticated biomechanical study, it was found that the hip is loosest when positioned in a neutral or "standing" orientation (also called the stance-phase of weight bearing). It was reasoned that this point is also the optimal patient position for measuring maximal hip joint laxity on a radiograph. Ironically, the standard hip-extended method was found to put the hip in one of its tightest configurations.
Next, passive hip laxity was radiographically monitored in dogs as they matured. It was shown that 1) the radiographic measurement of passive hip joint laxity by the PennHIP method was accurate in dogs as young as sixteen weeks of age, and 2) hip laxity was the primary risk-factor to predict the development of DJD. Specifically, the looser the hip joint according to the PennHIP method, the greater the chance that it will develop DJD.
The PennHIP method also incorporates the hip-extended radiograph to evaluate for evidence of DJD.
To obtain diagnostic radiographs, it is important that the patient and the surrounding musculature be completely relaxed. For the comfort and safety of the animal, this requires sedation and/or general anesthesia. Typically, three separate radiographs are made during an evaluation. The first is the compression view where the femurs are positioned in a neutral, stance-phase orientation and the femoral heads are pushed fully into the sockets. This helps show the true depth of the hip socket and gives an indication of the "fit" of the ball in the socket. The second radiograph is the distraction view. Again, the hips are positioned in a neutral orientation and a special positioning device is used to apply a harmless force to cause the hips to displace laterally. This position is the most accurate and sensitive for showing the degree of passive hip laxity. Passive hip laxity has been shown to be the primary risk factor associated with the development of DJD. A hip-extended view is also included for the sole purpose of examining for existing joint disease such as osteoarthritis. The PennHIP procedure has been safely performed on thousands of patients.
PennHIP has studied the efficacy of this method from the eight weeks up to three years of age. The PennHIP method can be reliably performed on a dog as young as 16 weeks old. Passive hip laxity at 16 weeks correlates highly with later hip laxity. In other words, a dog's hip laxity at 16 weeks will be much the same at one year, two years or even three years. The accuracy of laxity measurements for German Shepherd Dogs less than 16 weeks of age is not high enough to be of clinical use. Other breeds require study to determine the earliest reliable age of evaluation.
The looser the joint, as determined by the PennHIP method, the greater is the chance that the hip will develop DJD. (The standard hip-extended method can actually mask true hip joint laxity). There are obvious advantages to screening dogs for hip joint laxity at 4 months of age (or six months, 1 year, etc.) as opposed to waiting until 2 years of age. The reliability of the PennHIP method slightly improves with age, with one year 1 year being marginally superior to 6 months, which in turn is marginally better than 4 months. For all dogs, we recommend when possible, to use the mean (average) of repeated evaluations to get a more reliable estimate of a dog's hip laxity status (phenotype).
To obtain diagnostic quality radiographs, the musculature around the hip joint must be completely relaxed. For the comfort and safety of the animal, this requires either heavy sedation or general anesthesia. The selection of the individual sedation/anesthesia protocol is left to your PennHIP veterinarian's discretion, so long as the dog is sufficiently sedated to obtain a diagnostic quality radiograph (and, of course, so long as the drugs and dosages used are safe).
The total fee for a PennHIP evaluation is determined by the
veterinarian providing the service. It is important to remember
that the total service includes sedation/anesthesia, 3 radiographs,
office consultation and all charges associated with mailing and
film evaluation. You will not find it necessary to write a separate
check for evaluation fees or mailing of your dog's films. The
film evaluation charge will be included in the total cost of a
PennHIP evaluation.
Your PennHIP veterinarian will likely charge more for the analysis because it consists of 3 radiographs rather than one. (Also, he/she incurred costs of training, quality assurance testing and purchasing the necessary equipment, not to mention the lost wages of closing the practice for 1 - 3 days for the training seminar.)
After many studies, both in the PennHIP laboratory and in independent laboratories, there is no evidence to suggest that the PennHIP procedure is any more harmful than the standard hip-extended procedure. Certainly, in dogs having extreme laxity and pain associated with hip dysplasia, any manipulation of the hip (e.g. OFA, PennHIP, routine physical examination) can potentially cause transient discomfort (1- 2 days). PennHIP is aware of only a handful of cases (from over 20,000 dogs) that have exhibited discomfort after the procedure. All such claims are followed up and no long-term pain or untoward effects have been observed. The OFA has issued a statement to breed clubs suggesting that the PennHIP method harms hips. There is absolutely no basis to this claim.
We have been able to demonstrate that the PennHIP method surpasses other diagnostic methods in its ability to accurately predict susceptibility to developing DJD. This finding has been corroborated recently by an independent laboratory. The PennHIP method can be performed on dogs as young as sixteen weeks of age compared with two years using the standard technique. The ability to receive an early estimate of a dog's hip integrity is important whether the dog's intended purpose will be for breeding, for working or as a family pet. The data amassed and analyzed by PennHIP will allow breeders to confidently identify the members of their breeding stock with the tightest hips. The PennHIP evaluation will also permit breeders to assess the progress they are making with their breeding program as they strive to reduce the amount of hip laxity in their dogs. Pet owners are able to assess their pet's risk of developing DJD. This enables them to make lifestyle adjustments for their dogs and, if necessary, to enhance the quality of their pet's life.
PennHIP differs from other methods in some very fundamental and important ways:
The heritability of the diseased phenotype evaluated in the hip-extended view has not been studied in most breeds of dogs in the USA. PennHIP is working with many breed clubs with an interest in determining the heritability estimates for their particular breed. Estimates for the heritability of passive hip laxity (DI) drawn from analysis of full pedigrees for the breeds examined thus far have yielded high values (e.g. for German Shepherd Dogs, heritability = 0.48; Labrador retrievers, heritability = 0.60).
Estimates of heritability of the dysplastic phenotype subjectively scored from the conventional hip-extended radiograph are not available for most breeds of dogs in the USA. Only a few published reports in as many breeds of dogs exist worldwide. To our knowledge, the OFA has not published heritability estimates for the subjective OFA phenotype.
As technology advances, the veterinary professional community will offer and utilize improved methods of disease diagnosis. The dog breeding community will also endorse those methods that help them achieve their goals of reducing the frequency of hip dysplasia in dogs while maintaining other desirable traits and features. The PennHIP technology and research have been and will continue to be fully presented to the veterinary medical community for its review. PennHIP has been received enthusiastically as a major step toward reducing the frequency of CHD. We encourage and welcome continued scientific examination and comparison of PennHIP to any available or new methods of canine hip dysplasia diagnosis. We emphasize, however, that the forum to debate the relative scientific merits of competing technologies is the peer-reviewed scientific literature and not commercial pamphlets, press-releases to breed clubs for publication in breed-club magazines, or web sites.
In 1996, the AKC board of directors announced plans to remove all health
and genetic information from the official AKC registration and to include it
along with PennHIP information in the newly conceived "Information and
Health Database". We have recently learned (July 1998) that the AKC plans
to re-energize this initiative. We anxiously await progress from the AKC on
this very important issue. Meanwhile, we are currently working with other organizations,
nationally and internationally to present the PennHIP technology and the positive
impact it holds for reducing Canine Hip Dysplasia. The PennHIP method has been
adopted by several countries and is gaining wide spread interest internationally.
To obtain the name of a veterinarian in your area who is trained and certified to perform the PennHIP procedure, follow the link to find a certified PennHIP veterinarian. If there is not a veterinarian near you presently, additional veterinarians are currently being trained throughout the country.
Until appropriate randomized and controlled clinical trials are designed and conducted, it is premature to use the Distraction Index as an indication for hip surgery, either remedial or preventive. At present several different surgical procedures (Triple pelvic osteotomy, Juvenile symphysiodesis) have been advocated by some veterinary surgeons to prevent the development of arthritis (degenerative joint disease) later in life in dogs with excess joint laxity (loose hips). None of these procedures have undergone scientific clinical trials that have proven THEIR EFFICACY in preventing the onset or slowing the development of arthritis in dogs with hip dysplasia. Although WE ARE not fundamentally against the use of preventative surgical management of dogs with excessive hip laxity, WE FEEL THE WHOLESALE CLINICAL USE OF PURPORTEDLY PREVENTIVE SURGICAL PROCEDURES BEFORE ADEQUATE TESTING IS CONDUCTED, IS UNJUSTIFIED. WE ADVISE CAUTION! It may be that in the future when good evidence exists to support the efficacy of these procedures their use will be encouraged.
