Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi
Part 5 of 11 in Diagnosis and Management of Arthritis in Joints
Diagnosing Joint Arthritis: Why X-Rays Come Before an MRI
September 6, 2026
Patients frequently arrive at Dr. Mannu Bhatia's clinic already carrying an MRI scan, assuming it is the right test to bring. He uses his Jivo Masterclass session to correct that assumption directly.
The X-ray comes first
In Dr. Bhatia's own words, X-rays are the most informative diagnostic test for determining whether a patient has arthritis. For anyone around 60 years of age presenting with hip or knee pain, an X-ray should be the first investigation, since it is highly indicative of what is actually happening inside the joint. On imaging, arthritis shows up as joint space narrowing, the formation of osteophytes (bone spurs), and subchondral sclerosis, the thickening of bone just beneath the cartilage. Together, these findings tell the doctor whether the patient needs surgery or can be managed conservatively with medication and physiotherapy.
MRI has a narrower, later role
An MRI becomes useful specifically when the X-ray looks normal but the patient's symptoms persist and have not responded to medication or physiotherapy. It can then reveal cartilage defects, associated cartilage tears, and synovitis, findings that an X-ray cannot show directly. Where MRI is not available, Dr. Bhatia noted that the X-ray alone remains quite informative for guiding treatment. Ultrasound has its own limited role, useful for detecting joint effusions, inflammation, and tendon tears.
Blood tests and physical examination
Alongside imaging, Dr. Bhatia relies on routine blood work, including a complete blood count (haemoglobin often falls in autoimmune disease such as rheumatoid arthritis), ESR and CRP. On physical examination, he always compares the affected joint against the opposite, healthy side, checking for swelling, deformity, tenderness, reduced range of motion, and the characteristic waddling gait of a painful joint.
This article is based on a Jivo Masterclass session conducted by Dr. Mannu Bhatia, Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Mannu Bhatia taught doctors across Africa on February 2, 2025.
FROM THE LIVE Q&A
Moderator
What is the best NSAID to use for osteoarthritis?
Dr. Mannu Bhatia
I would not advise continuous use of NSAIDs, since they can have a harmful effect on the kidneys over time. Short-term use for pain relief is fine.
Frequently Asked Questions
How affordable are these surgeries at your facility?▼
They are very affordable in India, around half the cost of the same surgery in Nigeria, and much less than the cost in Europe or the US, with better results.
What is the definitive treatment for osteoarthritis?▼
The definitive treatment is that the patient should be visiting the doctor regularly. If the condition is detected and treated at an early stage, that is the definitive treatment. A patient who ignores an ACL injury, skips the recommended MRI, skips the recommended surgery and skips the medicines is the one who progresses to osteoarthritis and eventually needs a knee replacement. Patients with a problem in one knee who don't get it treated often go on to develop the same problem in the other knee, then the hips, then the spine. The definitive treatment is listening to the doctor and following through, whether that means physiotherapy or treatment for rheumatoid arthritis.
I have a patient with intermittent elbow pain, treated with oral and topical NSAIDs followed by PRP injections. What is the outcome of PRP for this patient in Ethiopia?▼
I am not a strong advocate for PRP. Once the joint surface and the cartilage are already gone, PRP cannot regenerate them, so I don't believe it delivers a real result. I would want to see the patient's X-rays, and an MRI if needed, before deciding what should actually be done.
What are the absolute contraindications for joint replacement?▼
As surgical techniques progress, more countries are attempting these surgeries, but two things need to be in place regardless: a genuinely sterile operating theatre, and excellent post-operative facilities, since that is what actually gets the patient the benefit of the surgery. There are no absolute contraindications beyond the patient having a poor overall medical condition, for example a cardiac condition that would make operating on them risky.
Is it possible to do a bilateral hip replacement in a patient with a slipped hip joint?▼
Bilateral hip replacement can always be done, either in the same sitting or with a gap between the two sides, depending on the patient's condition. If the body can tolerate it, both sides can be done together. If the body, or the finances, don't allow that, there can be a gap in between, but rehabilitation and the expected result need to be planned accordingly.
Should a patient get an X-ray or an MRI for suspected arthritis?▼
An X-ray first. Dr. Bhatia considers it the most informative test for arthritis, and recommends it as the first investigation for anyone around 60 with hip or knee symptoms. MRI is reserved for cases where the X-ray is normal but symptoms persist despite medication and physiotherapy.
What does an arthritic X-ray show?▼
Joint space narrowing, osteophytes (bone spurs), and subchondral sclerosis (thickened bone beneath the cartilage), findings that indicate whether surgery or conservative management is the right course.
What blood tests are used to evaluate arthritis?▼
A complete blood count, since haemoglobin often falls in autoimmune arthritis, along with ESR and CRP as general inflammatory markers.
In This Series: Diagnosis and Management of Arthritis in Joints
- 1.Diagnosis and Management of Arthritis in Joints
- 2.What Is Arthritis? Understanding Its Main Types and Causes
- 3.Who Is at Risk of Osteoarthritis: Age, Weight, Occupation and Injury
- 4.Recognising Joint Arthritis: Pain, Swelling, Crepitus and Instability
- 5.Diagnosing Joint Arthritis: Why X-Rays Come Before an MRI
- 6.Non-Surgical Management of Arthritis: Weight, Physiotherapy and Mobility Aids
- 7.Medicines and Joint Injections for Arthritis: What Works and What Doesn't
- 8.When Arthritis Needs Surgery: Hip, Knee, Shoulder and Elbow Replacement
- 9.Recovery After Joint Replacement: Rehabilitation and Activity Limits
- 10.Joint Replacement Case Studies: Patients Who Travelled From Africa for Surgery
- 11.The Cost of Joint Replacement Surgery in India for International Patients