Kellgren Lawrence Grading Scale

Hip arthritis

(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:

  1. Joint space narrowing
  2. Osteophytic lipping
  3. Sclerosis
  4. Bone contour deformity

Kellgren-Lawrence Grade 1:

"Doubtful narrowing of joint space and possible osteophytic lipping."

X-ray of arthritic hip.

Note in the above X-ray:

  • The presence of a short leg. Research indicates a higher prevalence of hip (and knee) arthritis associated with a leg length inequality. LEG LENGTH INEQUALITY Research ...

  • In the right hip, the "unroofed" hip and the inclined acetabulum. Developmental hip dysplasia. DEVELOPMENTAL HIP DYSPLASIA ...

  • In the left hip, the presence of a Pincer deformity: FEMERO ACETABULAR IMPINGEMENT SYNDROME. The vital diagnositic question: Is this "osteophytic lipping" or a Pincer spur? FEMERO ACETABULAR IMPINGEMENT SYNDROME ...

  • There is "doubtful" narrowing of the joint space in both hips, and certainly osteophytic lipping / Pincer deformity in both hips. Clinically, this 50-year old patient had fairly severe right hip pain, restricted hip flexion and internal rotation and pain in the groin with walking for four years. After 8-10 chiropractic treatments of the hip and sacroiliac joint he says the pain is 70-80% less, and he can walk relatively normally for the first time in several years. FEMERO ACETABULAR IMPINGEMENT SYNDROME CASE FILE ...

Kellgren Lawrence Grade 2:

"Definite osteophytes, definite narrowing of joint space."

An example of Kellgren Lawrence Grade 2 arthritic hip.

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.

Neglected it progresses unerringly as in this Kellgren Lawrence grade II case.

Kellgren Lawrence Grade 3:

"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."


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.

Kellgren Lawrence Grade 3 example of a arthritic hip.

Kellgren Lawrence Grade 4:

"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!

LEG LENGTH INEQUALITY ... the significance of a short leg.

Kellgren Lawrence Grade 4 example of an arthritic hip.

Typical features of how developmental hip dysplasia if not carefully managed leads unerringly to hip arthritis. Notice the shallow socket, the sloping acetabulum and the unroofed femoral head.

Clinical note: every young person complaining of groin pain needs a thorough hip examination, including X-ray. If the range of motion is increased a clear distinction needs to be made: is this hypermobility of the hip OR hip dysplasia. The former can lead a relatively normal life, but in a case like the one above, the young patient with hip dysplasia must accept that some limitation of certain activities is vital if they are to escape disability, pain and total hip replacement.

Kellgren Lawrence Grade 4 arthritic hip.

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...


Kellgren Lawrence Grading Scale

Sometimes 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....


Kellgren Lawrence Grading Scale

I 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...



Kellgren Lawrence Grading Scale

For the hyaline cartilage to regenerate, which research in the Netherlands proves it can, it needs to be "unloaded" (= weight-loss), the joint needs to be set in movement (= Chiropractic) and the synovial fluid must contain the right ingredients. A rich soup, fully oxygenated (I have no figures, but I'm fairly sure smokers are less likely to respond well to the chiropratic management of hip arthritis) and rich in glucosamine and chondroitin sulphate.

Unfortunately research shows that patients with hip arthritis do not respond any better with glucosamine chondroitin suplphate in tablet form, than patients on a placebo. GLUCOSAMINE CHONDROITIN sulphate ...

So my nutritional programme for patients with hip arthritis is:

  1. A home-made chicken bones extract (research from Harvard), CHICKEN BONES bouillon...

  2. Omega 3 capsules
  3. A tablespoon of ground flax seed CHIROPRACTIC HELP Obesity in the Chiropractic clinic /Flax seed.

  4. Regular, at least 2-3 times per week, fatty fish.

USEFUL LINKS @ Kellgren Lawrence Grading Scale

Physical Therapists providing a Chiropractic adjustment?

Many insurance companies now only pay for physical therapists to provide a chiropractic adjustment; that's in the face of powerful research proving that inclusion of DCs to perform their own technique would save them a good deal of money. One has to conclude that political medicine has gone off on another tack to contain our profession.

It's being successful with some doctors of chiropractic quitting. Others become involved in some dodgy practices, like demanding that patients sign up for a whole year of treatment in advance, in order to stay in business.

In recessionary times, the going is tough when the insurance won't pay.

Is the day approaching for a new Wilk versus the AMA and the insurance companies?

The chiropractic profession has tried hard to stay on the moral high ground; those who stoop to unscrupulous practices need to be exposed and disciplined if we are not to stoop to the low blows that medicine has often resorted to contain and eliminate us.

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