In a severe hip arthritis X-ray, the joint space is absent, which means the cartilage has worn away, and the bones can rub against each other. It may also show the development of bone spurs and deformity of the bones in the joint.

Once hip arthritis progresses to a severe stage, walking and standing can become difficult.

While doctors can confirm the diagnosis with X-rays, they may use other imaging tests when planning surgery and identifying secondary causes.

The best treatment for severe cases involves either total hip replacement or hip resurfacing.

This article discusses symptoms and signs of severe hip arthritis, including what X-rays show. It also examines treatment.

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The hip is a ball-and-socket joint — the ball of the thigh bone fits into the socket of the hip bone. In a healthy hip, cartilage covers the bone surfaces, cushioning and protecting them. Also, the joint has a lining, which produces fluid that lubricates the cartilage.

Different types of arthritis can affect the hip, but the most common type is osteoarthritis. Osteoarthritis typically results from wear and tear that comes with aging. The cartilage gradually wears away, and the protective joint space decreases in size.

In more serious cases, the joint space can disappear completely, allowing the bones to rub against each other. The damaged bones may also form spurs. These are growths that form in joints over time.

The most frequent symptom of osteoarthritis is pain, but people may also experience:

  • stiffness
  • decreased range of motion
  • locking of joints
  • unequal length in the legs
  • flexion contracture, or the inability of a flexed joint to fully straighten
  • severe knee pain

As the condition advances, the symptoms increase in intensity. By the time the condition reaches a severe stage, it can be debilitating.

Imaging tests such as the following can help doctors assess the bone and soft tissues of the hip:

  • X-ray
  • CT scan
  • MRI scan

X-rays can provide detailed views of dense structures such as bone. These scans can show:

  • changes in the bone
  • the size of the joint space
  • the presence of bone spurs

Doctors may order imaging tests to confirm a diagnosis. Imaging can also show the severity of degeneration and help doctors monitor the progression of the disease.

CT and MRI

CT and MRI scans are usually not necessary to diagnose hip osteoarthritis.

However, doctors may sometimes use CT scans for surgical planning. Because MRI scans can show irregularities in soft tissue in addition to those in the bones, they can help identify secondary causes.

MRI scans can be valuable in determining whether someone has early stage osteoarthritis. They can also detect other conditions around the hip, including:

  • a labral tear, which occurs when the cartilage around the hip tears
  • avascular necrosis, which occurs when the blood supply to the hip is interrupted and bone tissue dies
  • certain types of fractures, or breaks in the bone

Yes, severe arthritis is apparent on an X-ray.

Doctors may use the Kellgren and Lawrence grading scale below for X-ray osteoarthritis assessment. This grading system describes how an X-ray of severe hip arthritis differs from those of less advanced cases.

GradeLevel of osteoarthritis Characteristics
Grade 1doubtful• possible narrowing of the joint space
• subtle spur formation around the joint head
Grade 2mild• definite joint space narrowing and spur formation
• hardening of the bone below the cartilage
Grade 3 moderate• marked joint space narrowing, small spurs, and some hardening of the bone below the cartilage
• deformity of the head of the thigh bone and socket of the hip bone
Grade 4severe• disappearance of the joint space
• also presents features of the earlier grades
• can include larger spurs and advanced deformity of the head of the thigh bone and socket of the hip bone

X-ray types

The types of X-rays healthcare professionals may use to diagnose hip arthritis are an anterior-posterior view and a frog-leg lateral view.

The anterior-posterior view shows the hip joint and the upper part of the thigh bone. The frog-leg lateral view offers a better view of the hip joint and neck of the thigh bone.

A cross-table lateral X-ray may also be beneficial. It provides a view of the acetabulum, which is the socket of the hip bone where the head of the femur fits.

In severe cases, standing, walking, and bending can become very difficult because of the degenerative changes in the joint.

Also, the muscles surrounding the hip may weaken and get smaller. This can further increase strain on the joint and make movement challenging.

Once hip arthritis becomes severe, the best treatment options are surgical procedures.

Total hip replacement

An arthroplasty — or total hip replacement — involves removing the damaged ball-and-socket joint and replacing it with a plastic, metal, or ceramic joint.

Research indicates that this procedure is highly effective in reducing pain and restoring function. While it does carry some risk of complications, the expected life span following the procedure is 15–20 years.

Hip resurfacing

Hip resurfacing entails removing damaged cartilage and bone and replacing them with a metal shell. Also, instead of removing the ball from the joint, a doctor caps it with a metal covering.

Because this procedure allows doctors to make revisions more easily than in total hip replacement, it can be suitable for people who are younger than 60. This procedure also carries a risk of complications, but research indicates that the results are comparable to those of standard hip replacement.

Learn more about treatment options for osteoarthritis.

An X-ray of severe hip arthritis shows deformity in the bones that make up the joint, including the ball of the thigh bone and the socket of the hip bone.

The X-ray also reveals spur formation and the absence of the cartilage that usually cushions the joint. All these effects can make walking difficult.

Because X-rays show the effects of hip arthritis, this type of imaging allows a doctor to confirm a diagnosis.

Treatment usually involves total hip replacement or hip resurfacing. Doctors consider total hip replacement very effective, and the results from hip resurfacing are comparable.