X-ray of osteoarthritis of the hip joint

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Author: Mikael Häggström [notes 1]

Hip joint with no signs of osteoarthritis.

The most commonly used radiographic classification system for osteoarthritis of the hip joint is the Kellgren-Lawrence system (or K-L system).[1] It uses plain radiographs.

Kellgren-Lawrence system
Grade Description
0 No radiographic features of osteoarthritis
1 Possible joint space narrowing (normal joint space is at least 2 mm at the superior acetabulum)[2] and osteophyte formation
2 Definite osteophyte formation with possible joint space narrowing
3 Multiple osteophytes, definite joint space narrowing, sclerosis and possible bony deformity
4 Large osteophytes, marked joint space narrowing, severe sclerosis and definite bony deformity

Osteoarthritis of the hip joint may also be graded by Tönnis classification. There is no consensus whether it is more or less reliable than the Kellgren-Lawrence system.[3]

Severe (Tönnis grade 3) osteoarthritis of the hip.
Tönnis classification[4]
Grade Description
0 No osteoarthritis signs
1 Mild:
  • increased osteosclerosis
  • minor joint space narrowing (normal joint space is at least 2 mm at the superior acetabulum)[2]
  • no or minor loss of head sphericity
2 Moderate:
  • small bone cyst
  • moderate joint space narrowing
  • moderate loss of head sphericity
3 Severe:
  • large bone cysts
  • severe joint space narrowing, or joint space obliteration
  • severe deformity of the head


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. Zdravko Jotanovic, Radovan Mihelic, Gordan Gulan, Branko Sestan, Zlatko Dembic (2015). "Osteoarthritis of the hip: An overview ". Periodicum biologorum 117 (1). Archived from the original. . 
  2. 2.0 2.1 Lequesne, M (2004). "The normal hip joint space: variations in width, shape, and architecture on 223 pelvic radiographs ". Annals of the Rheumatic Diseases 63 (9): 1145–1151. doi:10.1136/ard.2003.018424. ISSN 0003-4967. 
  3. Terjesen, Terje; Gunderson, Ragnhild B (2012). "Radiographic evaluation of osteoarthritis of the hip ". Acta Orthopaedica 83 (2): 185–189. doi:10.3109/17453674.2012.665331. ISSN 1745-3674. 
  4. . Tönnis Classification of Osteoarthritis by Radiographic Changes. Society of Preventive Hip Surgery. Retrieved on 2016-12-13.