Background; Osteoarthritis is the most common chronic rheumatic disorder in the world. It results in joint pain, tenderness and significant disability. Osteoarthritis of hip and knee is very important in terms of its public health significance. Significant morbidity and disability usually results from osteoarthritis of these sites. Though osteoarthritis is common, the radiologic and socio demographic patterns vary among different studies. Delayed health seeking behavior of the community in our country makes the prevalence of osteoarthritis to be underestimated. OBJECTIVE: The objective of this study is to determine the radiographic pattern of hip and Knee OA among in patients visiting orthopedic clinic at TGSH from Feb 2022 to June 2022. Materials and Methods: Hospital based descriptive cross sectional study was conducted on 225 Hip and Knee Osteoarthritis patients in TGSH to determine the pattern of hip and knee OA. Interviewer administered structured questioner was used in data collection. Data was cleaned for Completeness and then entered into SPSS version 25 manually then analysis was done. Results: A total of 225 patients with Hip and Knee osteoarthritis were studied. 59.1% of the participants were female and 49.9% were male. Of these patients 163 had knee OA and 62 had Hip OA. The mean age was 45.67 ±SD 13.607 years. Among Knee OA Obese participants were 30 (18.4%) and 66 (40.49%) were overweight. Among Hip OA Obese participants were 8 (12.9%) and 35 (56.4%) were overweight. There were 106 (64.1%) participants with bilateral knee disease while 34 (54.8) had bilateral hip disease. Trauma history with AOR and 95% CI 27.038(12.200-59.926) was found to show significant association with unilateral joint involvement pattern. Conclusion and recommendation: The study showed that Knee OA was more common than Hip osteoarthritis. MTF compartment and patellofemoral compartment involvement was more common compartment involvement. Females and middle aged were more commonly affected by OA. Majority of patients were obese and overweight. Educational status completed secondary and history of trauma were significantly associated with unilateral involvement pattern of osteoarthritis. We recommend population based study to be done on large sample size regarding prevalence and pattern of OA in Ethiopia and to evaluate the impact of obesity and trauma in the development of OA. Key word: compartment, osteoarthritis