Osteoarthritis hip - grading

Osteoarthritis of the hip can be graded according to severity on imaging.

Conventional radiograph grading
  • grade 0: normal
  • grade 1: possible joint space narrowing and subtle osteophytes
  • grade 2: definite joint space narrowing, defined osteophytes and some sclerosis, especially in acetabular region
  • grade 3: marked joint space narrowing, small osteophytes, some sclerosis and cyst formation and deformity of femoral head and acetabulum
  • grade 4: gross loss of joint space with above features plus large osteophytes and increased deformity of the femoral head and acetabulum
 MRI grading
  • grade 0: normal
  • grade 1: inhomogeneous high signal intensity in cartilage (T2WI)
  • grade 2: inhomogeneity with areas of high signal intensity in articular cartilage (T2WI); indistinct trabaculae or signal intensity loss in femoral head & neck (T1WI)
  • grade 3: criteria of grade 1 and 2 plus indistinct zone between femoral head & acetabulum; subchondral signal loss due to bone sclerosis
  • grade 4: above criteria plus femoral head deformity

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