How to Read an Osteoarthritis X-Ray or MRI Report

Many people first learn they have osteoarthritis from a short written report attached to an X-ray. Phrases such as joint space narrowing, subchondral sclerosis or grade 3 can sound alarming, and they rarely come with an explanation. Understanding these words helps you ask better questions and see which treatment options are realistic for your joint. This guide translates the most common terms, explains what an MRI adds, and shows how the findings connect to decisions about treatment.

The most common words in an X-ray report

An X-ray does not show cartilage directly. It shows bone, and the radiologist judges the cartilage by the gap between the bones. That is why most terms describe the bone and that gap.

Terms you are likely to see:
• Joint space narrowing: the gap between the bones is smaller than normal, which suggests the cartilage has thinned. Reports often say whether it is mild, moderate or marked, and on which side of the joint.
• Osteophytes: small bony outgrowths at the edges of the joint, sometimes called bone spurs. They are the joint's reaction to uneven load.
• Subchondral sclerosis: the bone just below the cartilage looks denser, because it is carrying more load than it should.
• Subchondral cysts: small fluid-filled spaces in that bone, usually seen in more advanced wear.
• Malalignment or varus/valgus: the leg axis is bowed inward or outward, which shifts load to one side of the knee.

None of these words alone tells you how much pain you should have. Some people with clear changes on the image have few symptoms, and others with mild findings struggle every day. The report is one piece of the picture, alongside your symptoms and the examination.

What the grade or stage means

Many reports give a grade, most often on the Kellgren-Lawrence scale from 0 to 4. It is a simple way to summarise the X-ray.

Roughly speaking:
• Grade 1: doubtful narrowing and possible small osteophytes.
• Grade 2: definite osteophytes, the joint space may be slightly narrowed. This is often called early osteoarthritis.
• Grade 3: moderate narrowing, several osteophytes, some sclerosis. This is a moderate stage.
• Grade 4: large osteophytes, marked narrowing, severe sclerosis and deformity. This is advanced osteoarthritis.

Doctors in some countries describe the same picture as stages I to IV, and for the knee the term gonarthrosis is common, for the hip coxarthrosis. The names differ, the idea is the same.

The grade matters because treatment options change with it. At grades 1 to 3, exercise, weight control, physiotherapy and various injections have real room to help. At grade 4, the joint surfaces may be close to touching, and replacement often becomes a realistic topic. Even then, the decision depends on your pain, your activity level and your general health, not on the number alone.

What an MRI adds and when it is needed

An MRI shows soft tissues that an X-ray cannot: the cartilage itself, the menisci in the knee, ligaments, tendons, fluid in the joint and changes inside the bone. It is not always needed for osteoarthritis, but it is useful when the X-ray looks mild and the pain is strong, or when an injury is suspected.

Terms you may find in an MRI report:
• Chondral defect or cartilage thinning, often graded from 1 to 4 by depth.
• Bone marrow oedema: swelling inside the bone under damaged cartilage, often linked to pain.
• Meniscal tear or degeneration in the knee.
• Effusion: extra fluid in the joint, a sign of irritation or inflammation.

These details help a doctor judge whether a non-surgical approach makes sense. City Medical Centre in Moscow, for example, reviews scans free of charge before deciding on its regenerative osteoarthritis treatment with PRP and SVF injections. The clinic uses PRP more often at a mild stage and adds SVF, cells from a small sample of the patient's own fat tissue, when changes are more pronounced, mainly at early and moderate stages.

Questions to ask once you have the report

A report becomes useful when you turn it into questions. Write them down before the appointment so that the conversation stays focused on your joint rather than on general advice.

Helpful questions include:
• Which stage do you see, and is it the same in all parts of the joint?
• Do the images explain my pain, or could something else be contributing, such as the spine or a tendon?
• Is there inflammation or fluid that should be treated first?
• Which options fit this stage, and what can each realistically change?
• What would make you recommend joint replacement, and am I at that point?
• When should the images be repeated?

It also helps to know that images age. An X-ray from three years ago may no longer show the current state of a joint that has been getting worse. Most specialists will ask for recent images before recommending injections or surgery. Keep the files themselves, not only the written text, because a second doctor will want to look at the pictures with their own eyes.

Using your scans for a second opinion

If you are unsure about the advice you received, a second opinion based on the same images is a reasonable step. It is especially worth asking when the choice is between a long course of conservative treatment and an operation.

To make a remote review work well, send the full image files rather than photos of a screen, include the written reports, and add a short description of your symptoms, previous treatments and other health conditions. Mention anything that could rule out injections, such as cancer, pregnancy, blood clotting disorders, an acute infection or serious heart, kidney or liver disease.

City Medical Centre offers a free first consultation and free review of X-ray, MRI or ultrasound images, which can be sent before the visit, and an online consultation is possible. A coordinator arranges the appointment. The clinic states openly that at an advanced stage the doctor will say if replacement is the more realistic option. A clear reading of your report, from any qualified specialist, is the best starting point for a decision you will not regret.