Clinical and roentgenologic study of knee joints with osteophytes.
01 Mar 1970-Clinical Orthopaedics and Related Research (Clin Orthop Relat Res)-Vol. 69, Iss: 1, pp 302
About: This article is published in Clinical Orthopaedics and Related Research.The article was published on 1970-03-01. It has received 90 citations till now.
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TL;DR: In elderly persons, the new onset of knee OA is frequent and is more common in women than men, however, among the elderly, age may not affect new disease occurrence or progression.
Abstract: Objective. To determine the incidence of radiographic knee osteoarthritis (OA) and symptomatic OA (symptoms plus radiographic OA), as well as the rate of progression of preexisting radiographic OA in a population-based sample of elderly persons.
Methods. Framingham Osteoarthritis Study subjects who had knee radiographs and had answered questions about knee symptoms in 1983–1985 were reexamined in 1992–1993 (mean 8.1-year interval) using the same protocol. Subjects were defined as having new (incident) radiographic OA if they developed grade ≤2 OA (at least definite osteophytes or definite joint space narrowing). New symptomatic OA was present if subjects developed a combination of knee symptoms and grade ≤2 OA. Progressive OA was diagnosed when radiographs showing grade 2 disease at baseline showed grade ≤3 disease on followup.
Results. Of 1,438 participants in the original study, 387 (26.9%) died prior to followup. Of the 1,051 surviving subjects, 869 (82.7%) participated in the followup study (mean ± SD age 70.8 ± 5.0 at baseline). Rates of incident disease were 1.7 times higher in women than in men (95% confidence interval [CI] 1.0–2.7), and progressive disease occurred slightly more often in women (relative risk = 1.4; 95% CI 0.8–2.5) but rates did not vary by age in this sample. Among women, approximately 2% per year developed incident radiographic disease, 1% per year developed symptomatic knee OA, and about 4% per year experienced progres- sive knee OA.
Conclusion. In elderly persons, the new onset of knee OA is frequent and is more common in women than men. However, among the elederly, age may not affect new disease occurrence or progression.
711 citations
TL;DR: Study of the patterns osteoarthritis incidence and prevalence shows that it occurs frequently in the hand, foot, knee, spine and hip, but rarely in the ankle, wrist, elbow, and shoulder, and the most important universal risk factors are age, excessive joint loading, and joint injury.
Abstract: Osteoarthritis, the clinical syndrome of joint pain and dysfunction caused by joint degeneration, affects more people than any other joint disease. There are no consistently effective methods for preventing osteoarthritis or slowing its progression, and symptomatic treatments provide limited benefit for many patients. Osteoarthritis disables about 10% of people who are older than 60 years, compromises the quality of life of more than 20 million Americans, and costs the United States economy more than $60 billion per year. The incidence of osteoarthritis rises precipitously with age; as a result, the prevalence and burden of this disorder is increasing rapidly. Study of the patterns osteoarthritis incidence and prevalence shows that it occurs frequently in the hand, foot, knee, spine and hip, but rarely in the ankle, wrist, elbow, and shoulder, and the most important universal risk factors are age, excessive joint loading, and joint injury. Analysis of the impact of osteoarthritis raises questions that include: Why does the incidence increase progressively with age? Why are some joints rarely affected? How do mechanical forces cause joint degeneration? What biologic and mechanical factors slow or accelerate the rate of joint degeneration? Answering these questions could lead to effective methods of preventing osteoarthritis and slowing its progression.
664 citations
TL;DR: Methods of grading radiologic progression of osteoarthritis (OA) will be useful to the investigator in designing experimental studies and to the clinician in determining the rate of disease progression in an individual patient.
Abstract: We evaluated methods of grading radiologic progression of osteoarthritis (OA). Sets of radiographs were assessed separately by 8 readers who were blinded to the time sequence. Included were radiographs of patients with OA of the hands (24 pairs), hips (40 pairs), and knees (32 pairs). Most films were taken 12-60 months apart. The relative contribution of individual joints (such as particular interphalangeal joints), of observations (such as narrowing or spurs), and of a single joint compartment (such as the medial or lateral compartment of the knee) toward evidence of OA progression was evaluated, as well as the reliability and concordance of scoring, and the sensitivity in detecting change. In assessing OA of the hand, the greatest sensitivity was achieved by reading a single posteroanterior bilateral hand radiograph for narrowing, spurs, and erosions, and scoring 10 joints (second and third distal interphalangeal, second and third proximal interphalangeal, and trapeziometacarpal joints, bilaterally), using a scale of 0-3. In OA of the hip, a single anteroposterior radiograph assessed for joint space narrowing and cyst formation yielded the greatest sensitivity. In OA of the knee, an anteroposterior radiograph, with weight-bearing, assessed for narrowing, spurs, and sclerosis in both the medial and lateral compartments yielded the greatest sensitivity. These techniques will be useful to the investigator in designing experimental studies and to the clinician in determining the rate of disease progression in an individual patient.
396 citations
TL;DR: The natural history and prognostic factors of cartilage loss in osteoarthritis of the knee were studied in subjects from a general population survey on rheumatic diseases in 1975-8 and there was no statistically significant relation for gender, meniscectomy, injury, uric acid concentration, chondrocalcinosis, smoking, and occupation related factors.
Abstract: The natural history and prognostic factors of cartilage loss in osteoarthritis of the knee were studied in subjects from a general population survey on rheumatic diseases in 1975-8. Baseline data were collected by questionnaire, physical examination, and weightbearing anteroposterior knee radiographs. Follow up of the subjects aged 46-68 years with radiological osteoarthritis grade 2-4 (Kellgren) took place in 1988-9. Cartilage loss was assessed by two observers who scored the change in joint space width between two radiographs. Thirty four per cent had cartilage loss. Prognostic factors and adjusted odds ratios (ORs) (95% confidence intervals) were: body mass index OR = 11.1 (3.3 to 37.3) fourth v first quartile; body weight OR = 7.9 (2.6 to 24.0) third v first tertile; age OR = 3.8 (1.1 to 13.4) > 60 v < or = 49 years; Heberden's nodes OR = 6.0 (1.5 to 23.1); clinical diagnosis of generalised osteoarthritis OR = 3.3 (1.3 to 8.3); and previous bow legs or knock knees OR = 5.1 (1.1 to 23.1). The relation of age with cartilage loss was also confounded by the presence of Heberden's nodes or a diagnosis of generalised osteoarthritis. There was no statistically significant relation for gender, meniscectomy, injury, uric acid concentration, chondrocalcinosis, smoking, and occupation related factors, except possibly standing.
336 citations
TL;DR: Of 17 patients whose radiographic findings were normal by both the K/L criteria and the authors' JSN-weighted criteria, 7 had advanced tibiofemoral and/or patellofemoral compartment changes of OA seen at arthroscopy, emphasizing the insensitivity of the radiograph for detecting early articular cartilage loss.
Abstract: We examined standing knee radiographs of 92 patients who had chronic knee pain and radiographic evidence of mild or moderate osteoarthritis (OA) according to the Kellgren and Lawrence (K/L) criteria. Because the K/L criteria overemphasize osteophytosis relative to joint space narrowing (JSN), we graded OA severity also with a scoring system that placed greater emphasis on JSN than on osteophytes. In each case, the articular cartilage was visualized directly at arthroscopy. Of 17 patients whose radiographic findings were normal by both the K/L criteria and our JSN-weighted criteria, 7 had advanced tibiofemoral and/or patellofemoral compartment changes of OA seen at arthroscopy, emphasizing the insensitivity of the radiograph for detecting early articular cartilage loss. In addition, tibiofemoral JSN was common in the presence of normal articular cartilage. The JSN-weighted scale provided no advantage over the K/L criteria for assessing the severity of articular cartilage changes of OA.
278 citations