Associations between pain, function, and radiographic features in osteoarthritis of the knee

Abstract

Objective. To assess the associations between pain, loss of function, and radiographic changes in knee osteoarthritis (OA), taking into account both the patellofemoral and tibiofemoral compartments.Methods. Both knees of 167 community-based patients with OA in at least 1 of their knees were assessed. Pain was measured by visual analog scale, and function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Anteroposterior standing radiographs with the knee in extension and lateral 30°flexion were obtained and assessed for the Kellgren/Lawrence score and for individual features (osteophytes, joint space narrowing, and subchondral bone sclerosis) in each compartment.Results. Knees with structural changes in both compartments were more likely to be painful and to be associated with loss of function than were knees in which only 1 compartment was affected. The individual feature most strongly associated with pain was subchondral bone sclerosis.Conclusion. Studies exploring the associations between structural and symptomatic knee OA need to include an assessment of the patellofemoral compartment, and individual radiographic features rather than a global severity score should be considered in these studies.

Gender Differences in the Correlation between Symptom and Radiographic Severity in Patients with Knee Osteoarthritis

“…Although the relationship between radiographic findings and clinical symptoms in knee OA has been examined previously, the worsening of symptoms by radiographic grade has not been well documented, especially in the general population (Table 5) [5,8,9,11,24,26,29,31,38,44]. Female gender is a major predisposing factor of knee OA [14,16,30,36] and is reportedly associated with worse clinical manifestations of knee OA than in men [16,18,20,22,27,33,34,40].…”

“…There are other radiographic or clinical assessment tools with their own advantages such as that of Ahlbäck and Rydberg on weight-bearing radiographs [1,7] and the American Knee Society Clinical Rating System [19]. Although the evaluation tools we used were considered appropriate for our study and have been used widely in similar studies [5,8,26,29,38,44], it is possible the use of different evaluation tools would suggest differing conclusions. Third, we could not consider all factors which potentially confound the correlation between symptom and radiographic severities because this study was performed as a cross-sectional survey in a large cohort.…”

“…In addition, we believe the symptom worsening between K/L Grades 2 and 3 relates to joint space narrowing, the key feature of K/L Grade 3 and an important indicator of disease progression. Many conflicting assertions have been made about the relationship between radiographic findings and clinical symptoms (Table 5) [5,8,9,11,24,26,29,31,38,44]. Some previous studies reported the presence of osteophytes was associated with knee pain [9,24,31,38], whereas other studies found no association between them [11,44].…”

“…Many conflicting assertions have been made about the relationship between radiographic findings and clinical symptoms (Table 5) [5,8,9,11,24,26,29,31,38,44]. Some previous studies reported the presence of osteophytes was associated with knee pain [9,24,31,38], whereas other studies found no association between them [11,44]. The association between joint space narrowing and the presence of symptoms has also been debated [8,9,11,24,31,38,44], and one study concluded the presence of radiographic subchondral sclerosis is most closely associated with pain [38].…”

“…Many authors have investigated the relationship between symptom and radiographic severity [5,8,9,11,24,26,29,31,38,44], and some authors found an association between them [9,24,31,38], while others did not [5,8,11,26,29,44]. However, the previous studies had limitations including limited radiographic views that might underestimate the structural abnormalities [5,8,31,44] and unclear definitions of knee OA symptoms such as the mere presence of pain without using validated outcome scales [9,15,24,45].…”