Kellgren Lawrence Grading Scale(Keywords: Kellgren Lawrence Grading Scale, chiropractic books, hip arthritis, femero acetabular impingement syndrome, developmental hip dysplasia, Pincer, Cam) Kelgren and Lawrence have produced a useful, and relatively straight forward grading system for X-rays of the arthritic hip. Their system considers:
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"Doubtful narrowing of joint space and possible osteophytic lipping."
"Definite osteophytes, definite narrowing of joint space."Notice again the presence of a "Pincer" deformity. Earlier this was simply categorised as early osteoarthritis. Now we know it's simply a feature of Femero Acetabular Impingement Syndrome, a condition that in it's early phase responds extremely well to Chiropractic management of the hip, and even in it's more advanced phase, responds moderately well.Prevention, it's better than a cure.
"Moderate multiple osteophytes, definite narrowing of joints space, some sclerosis and possible deformity of bone contour.""I'm a 52 yr old female diagnosed with severe osteoarthritis of the hip last year. I first realised all was not well last year when, after bathing I attempted to stand upright with feet together and noticed that my right knee protruded a fair way. The medical treatment I have received to date has been very lacking and I've been very unimpressed. I was recommended by a good friend to see her chiropractor and I readily agreed as was in a lot of pain with a very pronounced limp. After only a couple of sessions, the pain and the limp are virtually gone. I now only attend on a as and when basis and the relief is almost immediate. I cannot thank my chiropractor enough for the help and advice he has given me. I dread to think what sort of condition I would be in by now had I not consulted him. I have found your website invaluable for information on my affliction. Many thanks." J These are the X-rays that J sent me: I suggested she send her chiropractor a bottle of excellent red wine. Maybe a case! Notice the multiple osteophytes, the loss of joint space and the deformity of bone contour of the femoral head. This is verging on Grade 4. Well done, doc! Notice too the CAM deformity: Femoral Acetabular Impingement Syndrome FAIS, in my opinion should be part of the routine chiropractic examination of each and every patient, especially the young patient. It takes only 60 seconds to do range of motion tests of the hips after all. Detected at 25, with the correct chiropractic management, I believe this progression to the pain and disablility of an arthritic hip, and likely total hip replacement could be prevented.
"Large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone contour."The next two views are not from a Chiropractic clinic. Frankly I think it unlikely that Chiropractic can help a Kellgran Lawrence Grade 4. Time to find a good orthopaedic surgeon. If you have a short leg, ask him if s/he can compensate for it. If your pelvis is level, plead with him to make sure that are still level after the surgery!
In both these two X-rays we see the typical features of a Kellgren Lawrence Grade 4: This large osteophytes, the dramatic sclerosis, the complete loss of joint space superiorally, altered bony contour and cysts within both the acetabulum and ball. And in the first the presence of Developmental Hip Dysplasia, and the second a CAM deformity in Femoro Acetabular Impingement Syndrome. In the examination of the hip, DDH has a pronounced INCREASED range of motion, whereas in FAIS the ROM is DECREASED. In the young adult, a decreased Hip ROM should immediately raise suspicion of FAIS. Treated promptly with chiropractic... a stitch in time...
LEVEL OF ACTIVITYKellgren Lawrence Grading ScaleSometimes it may be tragic if FAIS or DDH is detected in a young sportsman or woman, but in my opinion they should be immediately advised to live a normal active life, but extreme sports are strictly contraindicated.The child with DDH is often hypermobile and will excel at gymnastics, but later in life....
OBESITYKellgren Lawrence Grading ScaleI have taken an active interest in treating the arthritic hip for more than five years now. I have no figures or research to back me up, but in my experience the obese patient is not likely to respond to the chiropractic management of the arthritic hip. Nor any other treatment, apart from surgery of course.Unless they are ready to commit to a weight loss programme, I will no longer accept them as a patient. It's a waste of their money, and our time. Sometimes you have to be cruel to be kind...
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