Hip iSAWE 15

Question

A 64 year old man has groin pain, stiffness and a limp. He can walk about 500 metres.

Hip iSAWE 15, AP radiograph of the hip
AP radiograph of the hip. Image by Mikael Häggström, Wikimedia Commons, CC0.
  1. Describe the radiograph.
  2. What non-operative treatment is supported by evidence?
  3. How do you counsel him about total hip arthroplasty?

Answer

Radiograph

  • Joint space loss, superolateral
  • Subchondral sclerosis and cysts
  • Osteophytes
  • Tönnis grade 3 (severe)
  • Look for underlying dysplasia, FAI or AVN

Kellgren and Lawrence

GradeFeatures
0Normal
1Doubtful narrowing, possible osteophyte
2Definite osteophyte, possible narrowing
3Moderate osteophytes, definite narrowing, some sclerosis
4Large osteophytes, marked narrowing, severe sclerosis, deformity

Non-operative

  • Education, exercise and weight loss (GLA D programme)
  • Paracetamol and NSAIDs
  • Walking aid in the opposite hand
  • Intra-articular steroid for short term relief
  • Avoid opioids

Counselling for THA

  • Good pain relief in about 90% at 10 years
  • Risks include infection about 1%, dislocation 1 to 3%, leg length difference, periprosthetic fracture, VTE, nerve injury
  • AOANJRR revision rates about 5% at 10 years
  • Optimise weight, diabetes and smoking first

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.