Knee osteoarthritis grades: what your X-ray grade means
Doctors often describe knee osteoarthritis with the Kellgren-Lawrence grade, a scale from 0 to 4 based on an X-ray. A higher grade means more visible joint damage. The grade does not decide your treatment by itself, because it may not match how much pain you feel.
The five grades
| Grade | What the X-ray shows | Symptoms often described |
|---|---|---|
| 0, normal | No bone spurs. Normal joint space. | No osteoarthritis symptoms. |
| 1, doubtful | Possible narrowing of the joint space. Possible small bone spurs. | Occasional mild ache. Brief morning stiffness. |
| 2, mild | Definite bone spurs. Possible mild narrowing. | Mild pain after activity. Stiffness after sitting that eases with movement. |
| 3, moderate | Several bone spurs. Definite narrowing. Some hardening of the bone. Possible mild deformity. | Frequent pain, worse on stairs or squatting. Morning stiffness of 10 to 30 minutes. |
| 4, severe | Large bone spurs. Severe narrowing or no joint space left. Hardened bone with deformity. | Persistent pain, including at rest or at night. Limited movement. Bow legs or knock knees may develop. |
In Malay, people often search for this as "sakit lutut tahap 4". That usually refers to grade 4 on this scale.
Why your grade may not match your pain
Some people with a high grade have moderate symptoms. Others with a lower grade have more pain. An X-ray has other limits too:
- It shows bone well, but not cartilage, meniscus, ligaments or the joint lining.
- A standard front view does not assess the joint behind the kneecap.
- Doctors can grade the same X-ray differently.
- Standing X-rays show the joint space under body weight more reliably.
How treatment decisions are made
Osteoarthritis has no cure, but it does not always get worse over time. Your doctor weighs your pain, your ability to walk and work, your examination, your X-ray and your general health.
| Approach | Examples | Usually considered |
|---|---|---|
| Self-care and exercise | Strengthening and fitness exercise, weight loss if overweight | At every stage |
| Supportive care | Physiotherapy, walking aid, supportive footwear, hot or cold packs | When symptoms affect daily activity |
| Medicines | Pain-relief gels and tablets chosen for your health conditions | When pain limits activity |
| Injections | Steroid injection into the joint, which may ease pain for weeks or months | When other treatments have not helped enough |
| Surgery | Osteotomy, partial knee replacement or total knee replacement | When other treatments fail and daily life is seriously affected |
Surgery cannot guarantee that all symptoms go away, and it carries risks that need discussion with your surgeon.
When to see a doctor
- Knee pain that limits walking, stairs or sleep
- Swelling that keeps returning
- A knee that gives way, locks or changes shape
- Pain that continues despite exercise and simple pain relief
Seek urgent care for a hot, swollen knee with fever, or if you cannot bear weight after an injury.
This page is general information. It cannot diagnose your condition or tell you which treatment suits you. See a registered doctor about your own symptoms.