Osteoarthritis of the knee joint: an eight year prospective study (original) (raw)
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Rheumatology International, 2012
Details of the development of early knee osteoarthritis (OA) are largely unknown. The prevalence and progression of radiographic knee OA over 6 years in middle-aged subjects with chronic knee pain is investigated. In a prospective population-based study, tibiofemoral (TF) and patellofemoral (PF) radiographs were graded in 128 subjects (mean age 45 ± 6.2 years) for the presence of osteophytes and joint space narrowing (JSN). Radiographic progression was defined as: (i) the presence of osteophytes and/or JSN in subjects with no previous OA or (ii) an increase in the grade and/or number of already existing osteophytes and/or JSN. Altogether 56% (72/128) of subjects had knee OA, the majority of them was diagnosed with OA grade 1. In 57% of cases, radiographic OA was based on the presence of osteophytes alone versus 13% on JSN. More than 1/3 of subjects had isolated PF joint involvement. Knee OA progression rate over 6 years was 56% (71/128). During 6 years, a non-linear course of radiographic OA progression with intermittent periods of progression and stabilization was observed. Individual course of OA revealed distinct subsets of radiographic progression. Osteophytosis is an important early radiographic sign of OA and its progression. Isolated PF joint involvement is a frequent expression of knee OA. In middle-aged subjects, the progression rate of knee OA over 6 years was 56%. A non-linear course of radiographic OA progression was observed. Several radiographic subsets refer to the heterogeneity of the OA process.
Journal of King Abdulaziz University - Medical Sciences
Several studies have suggested that there is a high discrepancy between clinical and radiographic knee osteoarthritis. The objectives of this study were to examine association between radiographic classification and clinical manifestations of knee osteoarthritis, and to determine if the assessment of individual radiographic features was superior to the general radiographic scale in establishing such a relationship. A total of 125 patients with knee osteoarthritis were enrolled in this study. Radiographic features were assessed with the Kellgren-Lawrence grade scale for general radiographic grading, and a line-drawing atlas for detailed radiographic analysis. The severity of knee pain, stiff ness, and disability were measured using the Western Ontario and McMaster Universities Osteoarthritis Index. Patients' age and pain duration were found to correlate significantly with knee pain, stiff ness, and disability. No association between general radiographic grading scale and clinical...
BMC Musculoskeletal Disorders, 2008
Background: Studies have suggested that the symptoms of knee osteoarthritis (OA) are rather weakly associated with radiographic findings and vice versa. Our objectives were to identify estimates of the prevalence of radiographic knee OA in adults with knee pain and of knee pain in adults with radiographic knee OA, and determine if the definitions of x ray osteoarthritis and symptoms, and variation in demographic factors influence these estimates.
Annals of the Rheumatic Diseases, 1993
Objectives-To investigate differing patterns and associations of osteoarthritis of the knee in patients referred to hospital. Methods-Two hundred and fifty two consecutive patients (161 women, 91 men; mean age 70 years, range 34-91 years) referred to hospital with osteoarthritis of the knee underwent clinical, radiographic, and synovial fluid screening. Results-Radiographic changes of osteoarthritis of the knee (definite narrowing with or without osteoarthritic features) were bilateral in 85% of patients. Of 470 knees affected, 277 (59%) were affected in two compartments and 28 (6%) in three compartments. Unilateral and isolated medial tibiofemoral osteoarthritis were more common in men. Calcium pyrophosphate crystal deposition was common (synovial fluid identification in 132 (28%) knees; knee chondrocalcinosis in 76 (30%) patients) and associated with disability, bilateral, multicompartmental and severe radiographic osteoarthritis, marked osteophytosis, attrition, and cysts. Multiple clinical nodes (58 (23%) patients) and radiographic polyarticular interphalangeal osteoarthritis (66 (26%) patients) were associated with a higher frequency of inactivity pain, disability, multicompartmental and severe radiographic change. Forestier's disease predominated in men but showed no other associations. Conclusions-In a group of patients referred to hospital osteoarthritis of the knee is usually bilateral and affects more than one compartment. Severe and multicompartmental radiographic changes are associated with calcium pyrophosphate crystal deposition, nodal change, and polyarticular interphalangeal osteoarthritis.
Development of radiological knee osteoarthritis in patients with knee complaints
Annals of the Rheumatic Diseases, 2012
Objectives It is currently impossible to identify which patients with knee complaints presenting to the general practitioner will develop knee osteoarthritis (OA) pathology at a later stage. This study examines the determinants for developing OA pathology on x-ray in patients with knee complaints but no radiological OA at baseline in the painful knee. Methods Data from the prospective Rotterdam cohort study (including subjects aged ≥55 years) were used. Analysis was performed on 623 subjects with knee complaints at baseline and their data at 6-year follow-up (T1; n=607) and at 11-year follow-up (T2; n=457). At baseline, none had radiological OA (rOA=Kellgren and Lawrence (KL) grade ≥2) in the painful joint. At follow-up, predictors for rOA were determined using multivariate ordinal logistic regression analysis. Results At T1, 8.5% of the group had developed knee rOA and, by T2, this had increased to 23%. Determinants remaining signifi cant in the multivariate analysis were female gender (OR 1.95, 95% CI 1.15 to 3.36), other joint complaints (OR 2.22, 95% CI 1.12 to 4.35) and KL grade 1 at baseline in the painful knee joint (OR 7.14, 95% CI 4.55 to 11.1). All outcomes are adjusted for all included determinants. Conclusion The best predictors of development of knee rOA are a combination of female gender, other joint complaints and KL grade 1 in the painful joint. KL grade 1 in combination with knee pain should be considered as early OA in patient management.
Osteoarthritis year 2011 in review: imaging in OA – a radiologists’ perspective
Osteoarthritis and Cartilage, 2012
With major technological advances and application of magnetic resonance imaging (MRI) to large longitudinal osteoarthritis (OA) studies the role of imaging has become increasingly important for OA research over the last years. Currently, radiography, MRI and ultrasound are the most established imaging tools applied in a research setting. MRI assessment of OA features can be morphologic, compositional and can be applied in non-loaded and loaded conditions. Morphologic assessment includes semiquantitative and quantitative analyses. Novel semiquantitative scoring methods for knee, hip and hand OA using MRI were introduced. A series of key reports were published this year, reviewing the importance of radiography and MRI as a research tool. Although radiography is insensitive for the detection of OA-related structural pathology when compared to MRI, it still has been widely used for subject inclusion in observational and interventional studies due also to a straight forward disease definition that was established more than 50 years ago. In an attempt to generate an MRI-based definition of structural disease, a Delphi exercise was performed to develop a testable MRI definition of structural OA. This presentation reviews publications related to imaging of OA, published in English between September 2010 and October 2011, excluding animal studies or in vitro data. This is not a systematic or comprehensive review and the selection of papers included is based on the expert opinions of the presenter, from a musculoskeletal radiologist's perspective.
Knee osteoarthritis diagnosis, treatment and associated factors of progression: part II
Caspian journal of internal medicine, 2011
Diagnosis of knee osteoarthritis can be confirmed based on clinical and/or radiological features. The potential of a progressive disease can be prevented or decreased by earlier recognition and correction of associated factors. Obesity and alignment especially varus malalignment are recognized factors of a progressive disease. Both nonpharmalogical as well as pharmacological modalities of treatment are useful in managing the symptoms of knee osteoarthritis. Surgery should be considered only in patients who do not respond to medical therapy. The prevalence and risk factors of knee osteoarthritis have been described in the first part of this review. In this issue, the diagnosis progressive factors and management of knee osteoarthritis are discussed.
Assessment of radiographic findings in patients with osteoarthritis of knee
National Journal of Clinical Orthopaedics, 2021
Background: Osteoarthritis (OA) is one of the most prevalent conditions resulting to disability particularly in elderly population. Plain radiography remains a mainstay in the diagnosis of OA. Hence; under the light of above mentioned data, the present study was undertaken for assessing radiographic findings in patients with osteoarthritis of knee. Materials and Methods: Present study was conducted on 20 patients with presenting with knee pain and clinical suspicion of osteoarthritis. Detailed radiographic and MR imaging was be done in all subjects. Radiographic examination was done. All radiographs were assigned scores by using the Kellgren-Lawrence scoring system. This summary Kellgren-Lawrence score was based on osteophyte formation, joint space narrowing, sclerosis, and joint deformity characteristics according to the five-level scale defined as follows: grade 0, normal; grade 1, doubtful osteoarthritis; grade 2, minimal osteoarthritis; grade 3, moderate osteoarthritis; or grade 4, severe osteoarthritis. Radiographic findings were compiled as per performa and subjected to analysis using appropriate statistical tests. Results: 20 percent of the patients each showed doubtful and minimal osteoarthritis while the remaining 10 percent of the patients showed moderate osteoarthritis. On MRI examination, no meniscal abnormalities were seen in 25 percent of the patients while Globular intrasubstance abnormalities were seen in 35 percent of the patients. Linear intrasubstance meniscal abnormality was seen in 25 percent of the patients while Tear (displaced/ undisplaced/ complex/ macerated) was seen in 15 percent of the patients. Conclusion: The pathologic changes of pre-radiographic OA can be detected at an earlier stage of the disease through radiographic examination.
A new approach yields high rates of radiographic progression in knee osteoarthritis
The Journal of Rheumatology, 2008
Progression of knee osteoarthritis (OA) has typically been assessed in the medial tibiofemoral (TF) compartment on the anteroposterior (AP) or posteroanterior (PA) view. We propose a new approach using multiple views and compartments that is likely to be more sensitive to change and reveals progression throughout the knee. Methods. We tested our approach in the Multicenter Osteoarthritis Study, a study of persons with OA or at high risk of disease. At baseline and 30 months, subjects provided PA (fixed flexion without fluoro) and lateral weight-bearing knee radiographs. Paired radiographs were read by 2 readers who scored joint space (JS) using a 0-3 atlas-based scale. When JS narrowed but narrowing did not reach a full grade on the scale, readers used half-grades. Change was scored in medial and lateral TF compartments on both PA and lateral views and in the patellofemoral (PF) joint on lateral view. A knee showed progression when there was at least a half-grade worsening in JS width in any compartment at followup. Disagreements were adjudicated by a panel of 3 readers. To validate progression, we tested definitions for TF progression to see if malalignment on long-limb radiographs at baseline (≥ 3°malaligned in any direction with nonmalaligned knees being reference) increased risk of progression. A valid definition of progression would show that malalignment strongly predicted progression. Results. We studied 842 knees with either Kellgren-Lawrence grade ≥ 2 or PF OA at baseline in 606 subjects (age range 50-79 yrs, mean 63.9 yrs; 66.6% women). Mean body mass index was 31.9, and 32.8% of knees had frequent knee pain at baseline. Of these, 500 knees (59.4%) showed progression. Of the 500, 75 (15%) had progression only in the PF joint, while the remainder had progression in the TF joint. Malalignment increased the risk of overall progression in TF joint and increased the risk of half-grade progression, suggesting that half-grade progression had validity. Conclusion. PA and lateral views obtained in persons at high risk of OA progression can produce a cumulative incidence of progression above 50% at 30 months. Keys to increasing the yield include imaging PF and lateral compartments, using semiquantitative scales designed to detect change, and examining more than one radiographic view.