HIPS & ELBOWS

Understanding the scores behind the certificate

Hip and elbow screening uses carefully positioned X-rays to look for abnormal joint development and signs of osteoarthritis. The results help owners understand their dog’s joints and allow breeders to make better-informed decisions. Hips are given numerical scores, while elbows are graded from 0 to 3.

LOWER IS BETTER—but hips and elbows use two different scoring systems.

Section 1: Understanding Hip Scores

Each hip is assessed separately across nine different features of the joint. These examine how well the ball fits into the socket, the shape and stability of the joint, and any secondary arthritic changes.

Each hip can receive a score from 0 to 53:
• Left hip: 0–53
• Right hip: 0–53
• Combined total: 0–106

A score of 0 represents no radiographic evidence of hip dysplasia in the areas assessed. As the score increases, the amount of abnormality or arthritic change seen on the X-ray also increases.

LEFT HIP 4 + RIGHT HIP 6 = TOTAL HIP SCORE 10
Written as: 4:6 or 4/6 — Total 10

LEFT HIP 4 + RIGHT HIP 18 = TOTAL HIP SCORE 22

The split matters. A total score does not tell the whole story. A dog with a relatively even result across both hips is different from a dog whose total is caused mainly by one significantly poorer hip. Always ask to see the full left-and-right result, not only the combined number.

Section 2: What counts as a “good” hip score?

There is no single pass or fail number that applies fairly to every breed. Hip scores should be considered against the current published median for that breed, as well as the scores of parents, siblings and other close relatives.

The BVA recommends breeding from dogs with scores below or close to their breed median. A lower score means less radiographic evidence of hip dysplasia, but no score can guarantee what every puppy will inherit.

For breeds or developing populations without enough published data, results should still be recorded and compared across families and generations. Building honest long-term data is more valuable than testing one dog and viewing the result in isolation.

DO NOT JUST ASK, “HAS THE DOG BEEN HIP SCORED?”
ASK, “WHAT WAS THE LEFT SCORE, THE RIGHT SCORE AND THE TOTAL?”

Section 3: Understanding Elbow Grades

GRADE 0

Radiographically normal. No evidence of elbow dysplasia was identified on the submitted X-rays.

GRADE 1

Mild osteoarthritis.

GRADE 2

Moderate osteoarthritis, or a primary elbow lesion without osteoarthritis.

GRADE 3

Severe osteoarthritis, or a primary elbow lesion together with osteoarthritis.

LEFT ELBOW 0 + RIGHT ELBOW 2 = OVERALL ELBOW GRADE 2

The two grades are not added together. The higher grade becomes the dog’s overall result because breeding decisions must take account of the more affected joint.

The BVA recommends breeding only from dogs with an elbow grade of 0.

Section 4: What the X-rays can and cannot tell us

A dog may move normally and show no obvious signs of discomfort while still having changes visible on X-ray. Equally, a hip or elbow score alone cannot tell us exactly how much pain or limitation an individual dog experiences. Screening results are an important part of the picture, but they should be considered alongside the dog itself, its relatives, previous generations and long-term health.

WHAT THEY CAN SHOW:

WHAT THEY CANNOT PROMISE:

GENETICS ARE ONLY PART OF THE PICTURE

Joint development is multifactorial. Genetics are important, but they are not the only influence on how hips and elbows develop. Growth rate, body condition, nutrition, injury and the type and amount of exercise during development can all play a part.

Puppies should be kept at a healthy, lean body condition and given appropriate exercise as they grow. Environmental factors should never be used to dismiss poor joint results or excuse repeated problems within a bloodline. This is why BBU looks at the individual dog alongside relatives, previous generations and long-term health data.

Section 5: More than one dog, more than one generation

A score is a piece of evidence—not the whole breeding programme.

Hip and elbow dysplasia are multifactorial. Genetics matter, but development and environmental influences also play a part. Good results in both parents reduce risk; they do not erase it.

Responsible breeding means looking beyond a single certificate. Consider both parents, previous offspring, siblings, grandparents and repeated results across the family. Continue collecting health information after a dog has been bred from and throughout its lifetime.

TEST. RECORD. COMPARE. FOLLOW UP.

Health information becomes powerful when it is collected honestly across generations.

Section 6: How screening is done

• The dog must be at least 12 months old for the official BVA schemes.
• The dog must be permanently identified by microchip.
• X-rays are taken by a vet under heavy sedation or anaesthesia.
• Hip and elbow X-rays can usually be taken during the same appointment.
• The images are submitted for independent assessment under the official scheme.
• Owners should retain the complete certificate and make it available when a dog is used for breeding.
• Correct, standardised positioning is important. The dog must be positioned accurately so the joints can be assessed consistently; poor positioning can affect how the hips or elbows appear on the X-ray and may make the result less reliable.

Section 7: What puppy buyers should ask for

□ Results for both the mother and father
□ The complete certificate—not simply “health tested” in an advert
□ The left hip, right hip and combined hip score
□ The elbow grade
□ Confirmation that the certificate belongs to the correct microchipped dog
□ Relevant results from close relatives where available
□ Honest information about mobility problems within the wider family
The age of the dog when the hip and elbow screening was carried out

“HEALTH TESTED” IS NOT A RESULT.
Ask what was tested, when it was tested and what the result actually was.

Health records should create knowledge, not decoration.

Bullbreeds United supports transparent testing, accurate recording and long-term follow-up. Results should never be hidden because they are imperfect. Honest information helps breeders understand their lines, identify patterns and make better decisions for the dogs that come next.

Scoring explanations are based on the British Veterinary Association Canine Health Schemes. Owners should discuss their individual dog’s results with their veterinary surgeon.

BREED-SPECIFIC HIP SCORES

Hip scores should be compared with the current published data for that breed, with lower scores generally being preferable. The five-year breed median is a comparison point, not a target or pass mark. Breeding decisions should also consider the full left-and-right split, close relatives, previous generations and the wider bloodline rather than relying on one number alone.

Breeders should aim for a total hip score around, and ideally below, their breed’s five-year median. This keeps decisions grounded in real data for that breed, rather than one universal number.

English Bulldog

Five-year median: 20
Based on 21 dogs

French Bulldog

Five-year median: 12
Based on 12 dogs

Alapaha Blue Blood Bulldog

Five-year median: 14
Based on 39 dogs

American Bulldog

Five-year median: 16
Based on 82 dogs

Old English Bulldog

Five-year median: 18
Based on 30 dogs

Old Tyme Bulldog

Published five-year median: 19
Based on only 1 dog – INSUFFICIENT DATA FOR A RELIABLE BREED MEDIAN

A figure based on a single dog cannot reliably represent an entire breed. This highlights the need for more owners and breeders to submit verified results so meaningful breed-specific data can be built over time.

THE MEDIAN IS A COMPARISON POINT—NOT A PASS MARK.

Small sample sizes may not represent the wider breed. A dog’s full left-and-right score, relatives and wider bloodline must also be considered alongside the median, not reduced to a single number.

BUILDING THE EVIDENCE OUR BREEDS NEED

Kennel Club registration is not required for a dog to be assessed through the official BVA Hip and Elbow Dysplasia Schemes. Both registered and unregistered dogs can have their X-rays assessed and receive an official certificate. However, while results for eligible Kennel Club registered dogs may appear publicly through the Royal Kennel Club Health Test Results Finder, owners of unregistered dogs or breeds not recognised by the Kennel Club receive their official results but may have no accessible public dog-by-dog record. This means valuable results for Victorian Bulldogs, Old Tyme Bulldogs, Old English Bulldogs and other independently registered bullbreeds can remain scattered across private certificates rather than contributing to a clear picture of the breed.

Bullbreeds United Registry

The Registry will collect verified hip and elbow results and connect them to the correct dog using permanent microchip identification. The following will be recorded:

Left hip score
Right hip score
Combined hip score
Individual elbow grades
Overall elbow grade
Certificate evidence
Parents, offspring and other relatives
Later mobility and longevity information
Date of screening and the dog’s age when screened

As more verified results are collected, Bullbreeds United aims to calculate meaningful breed-specific medians, compare generations, identify patterns within bloodlines and measure whether breeding decisions are genuinely improving joint health.

ONE CERTIFICATE TELLS US ABOUT ONE DOG. A VERIFIED GENERATIONAL DATABASE CAN HELP US UNDERSTAND AN ENTIRE BREED.

WHERE OFFICIAL DATA IS MISSING, WE SHOULD BUILD IT—HONESTLY, ACCURATELY AND OVER TIME.

Imperfect results must be recorded rather than hidden. Honest data is essential if we genuinely want to understand and improve our breeds.