We know that there isn't a good correlation between what XRays show and how patients feel.  Nor is there good correlation between what XRays show and what the person's journey with OA will look like.  Individuals with severe changes on XRay can have relatively little pain and individuals with mild changes can really struggle.  And an XRay looking worse over time doesn't necessarily mean that the person's function is worsening.

The process of diagnosing should now involve a review of whether the person demonstrates the known risk factors for OA.

A thorough hands-on assessment of the joint in question should also be done in the examination room and allows a physician or a physiotherapist to rule out other conditions such as bursitis and ligament or tendon tears.

From there, the diagnosis of osteoarthritis can be made.

In general, XRays and advanced imaging, such as MRI, do not change how osteoarthritis is managed.  When there is an unusual presentation of symptoms, however, or when another potential diagnosis needs to be ruled out, imaging continues to serve a role.