Concordance between clinical and radiographic evaluations of knee osteoarthritis

Abstract

BackgroundSignificant correlation has been previously demonstrated between radiographic and clinical diagnoses of knee osteoarthritis (OA); however, the specific findings on clinical examination that relate best to a radiographic diagnosis have not been fully elicited.AimsWe aimed to explore the relationship between clinical symptoms and physical findings with radiographic diagnoses of tibiofemoral and patellofemoral OA.MethodsThis study was based on 409 individuals from the Hertfordshire Cohort Study, born between 1931 and 1939. Antero-posterior and lateral radiographs were taken of both knees. The presence of tibiofemoral and patellofemoral OA was defined according to the Kellgren and Lawrence score. Clinical symptoms, assessed using WOMAC, and physical findings were ascertained by examination. Relationships were assessed using multilevel univariate logistic regression.ResultsIn the 775 knees studied, the prevalence of physical findings was crepitus (25%), tibiofemoral tenderness (15%), bony swelling (12%), and pain on flexion (10%). Thirty-one percent (n = 238) knees demonstrated tibiofemoral OA, 28% (n = 220) showed patellofemoral OA, and 16% demonstrated OA in both locations. A global clinical symptom score was associated with increased risk of tibiofemoral OA (OR 12.5, 95% CI 5.4–29.0) and patellofemoral OA (OR 5.1, 95% CI 2.3–13.1). On clinical examination, the presence of crepitus, tibiofemoral tenderness, bony swelling, and pain on flexion was associated with increased risk of tibiofemoral OA; however, only tenderness was found to be associated with patellofemoral OA.ConclusionGlobal clinical symptom score was associated with radiographic tibiofemoral and patellofemoral OA. However, individual clinical signs were more strongly associated with tibiofemoral than patellofemoral OA.

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

“…Therefore, for clinically “certain” knees, diagnostic abilities based on clinical data only should be considered as good enough, in contrast to clinically “uncertain” knees. Our results support expert recommendations and the results of previous studies [ 3 , 4 , 6 , 7 , 8 ], where diagnoses based on clinical findings were found to be reliable and where radiographs were deemed unnecessary for diagnosing typical KOA.…”

“…The European League Against Rheumatism Recommendations (EULAR) reported that three symptoms (knee pain, morning stiffness less than 30 min and functional limitation) combined with three clinical signs (crepitus, restricted range of motion and bone enlargement) could predict 99% radiographic KOA [ 3 ]. Similarly, recent studies showed that clinical manifestations, such as knee pain, crepitus, joint line tenderness, bony swelling and pain on flexion/extension could be used for identifying radiographic KOA [ 4 , 5 , 6 ]. Current recommendations advise not to use imaging in patients with typical OA presentations, but these were mainly based on expert opinion [ 7 , 8 ].…”

Osteoarthritis year in review 2018: imaging

“…Several studies have reported a poor correlation between radiographic signs of knee OA and joint symptoms, which are relevant for the clinical diagnosis. In contrast with those findings, a general elderly population study showed positive association of radiographic knee OA with physical findings as determined by clinical examination, including tenderness, crepitus, pain on flexion, and bony swelling 40 . Radiographic OA was also found to be positively associated with knee pain, knee stiffness, and functional limitation.…”

Jumping Joints: The Complex Relationship Between Osteoarthritis and Jumping Mechanography

“…An alternative explanation could be that osteoarthritic joint damage could lead to overstimulation of mechanoreceptors, perhaps in the absence of clinical symptoms, as in the proposed AMI mechanism, eventually leading to reduced neural stimulation of muscle, alterations in muscle innervation, composition, and weakness. This mechanism is supported by the widely reported poor correlation of radiographic osteoarthritis with clinical symptoms, meaning that joint damage can occur in the absence of pain, and vice versa [29,30], though concordance has also been demonstrated [31].…”