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The Truth About Osteoarthritis X-ray Results

By: | Tags: | Comments: 0 | February 15th, 2020

Osteoarthritis – Do I need an X-ray and what does my X-Ray really mean?


Being diagnosed with Osteoarthritis (OA) can be scary and can lead to a lot of questions. There’s a lot of misinformation out there and it’s easy to see why: OA is very common, with about 1 in 5 adults over 45 years of age in England having been diagnosed with OA of the knee, and with over 6.5 million people having sought treatment from their GP for OA of the hip and knee. We can all reel off a list of friends or family who have OA in some form, and with so many people having been given varying advice by different healthcare individuals, the wires can get crossed and facts get confused with fiction.


Current research on X-rays for OA

As physiotherapists, we see many patients who have been diagnosed with OA, and many of those patients associate this diagnosis with terms like “bone-on-bone”, “wear and tear” and “degeneration”. These terms sound scary, but there is good news! Recent studies have shown that the relationship between OA and pain is not as strong as we once thought.


In 2015 there was a BIG study which looked at X-rays of over 4,000 hips. Of the X-rays that were positive for OA, only 24% of those people were actually in pain. Many X-rays showed joint changes that we used to consider “degeneration.” But in 76% of those X-rays, there was no hip pain at all! Because of studies like this, we are learning that these X-ray findings are not necessarily diagnostic of a bigger issue, but more a normal part of getting older –  much like getting grey hairs or wrinkles on our skin, we should expect changes in our joints as well. These changes are normal and are often not associated with pain.


In the same study the researchers found that of the people who reported consistent hip pain, only 9% showed a positive X-ray for hip OA. So it can go both ways. Just like you can have OA without pain, you can also have pain without any changes in your joints whatsoever.



What should I do with this information?

The take home message here is to avoid relying too much on a diagnosis of OA, especially if you were diagnosed by X-ray. Your best bet is to have a full assessment by a qualified physiotherapist that you trust. This assessment can highlight areas that can be modified, like strength, range of motion, activity levels and life stresses, which all have been linked to pain. By addressing these factors, you may not change what is shown on the X-ray, but you can significantly decrease (or eliminate!) pain and improve your quality of life. 


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References: Arthritis research UK, Prevalence of osteoarthritis in England and local authorities: Tower Hamplets via
Kim, C et all. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ 2015