Conventional radiographic grading of the knee has been used for 30 years and is based around the presence of osteophytes. About 50% of subjects from the general population meeting traditional radiographic criteria are asymptomatic or have no signs of clinical disease. Recent development in the use of different radiographic grading systems involve more attention to joint space and categorization of discrete radiographic findings. These techniques include new grading scales that use a combination of separate radiographic features; microfocal radiography and digitized image analysis of joint space. It is hoped these might reflect more closely the pathological processes and correlate more closely with clinical severity.