Gender Differences in the Correlation between Symptom and Radiographic Severity in Patients with Knee Osteoarthritis
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The effects of gender on the relationship between symptom manifestations and radiographic grades of knee osteoarthritis are not well understood.
We therefore determined the increments of symptom progression with regard to radiographic grades of knee osteoarthritis and asked if those increments differed by gender and whether symptom severity was differentially manifested by gender within the same grade.
We recruited 660 community residents; 368 (56%) women and 292 (44%) men. The mean subject age was 71.5 years (range, 65–91 years). Severity of symptoms was measured using the WOMAC and SF-36 scales, and the radiographic severity using Kellgren–Lawrence grades. Incremental changes in WOMAC and SF-36 scores were compared between adjacent Kellgren–Lawrence grades separately in men and women, and in the overall population. We compared symptom severity between men and women with the same radiographic grade.
For the entire cohort, the mean incremental change in symptom severity was not gradual between the adjacent radiographic grades but was greater between Kellgren–Lawrence Grades 1 and 2 and Grades 2 and 3 than between Grades 0 and 1 or Grades 3 and 4. The patterns of incremental changes in symptom severity differed between men and women: women had more severe symptom progression between Kellgren–Lawrence Grades 2 and 3 and Grades 3 and 4 than men. Furthermore, women had worse mean WOMAC and SF-36 scores than men with the same radiographic grade of knee osteoarthritis.
These data suggest symptom progression is not gradual between adjacent radiographic grades, and for the same radiographic grade, symptoms are worse in women.
Level of Evidence
Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Ahlbäck S, Rydberg J. X-ray classification and examination technics in gonarthrosis [in Swedish]. Läkartidningen. 1980;77:2091–2096.
- Alicea J. Scoring systems and their validation for the arthritic knee. In: Insall JN, Scott WN, eds. Surgery of the Knee. 3rd ed. New York, NY: Churchill Livingstone; 2001:1507–1515.
- Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D, Kaplan D, Koopman W, Longley S, Mankin H, McShane DJ, Medsger T, Meenan R, Mikkelsen W, Moskowitz R, Murphy W, Rothschild B, Segal M, Sokoloff L, Wolfe F. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–1049. CrossRef
- Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001;45:384–391. CrossRef
- Barker K, Lamb SE, Toye F, Jackson S, Barrington S. Association between radiographic joint space narrowing, function, pain and muscle power in severe osteoarthritis of the knee. Clin Rehabil. 2004;18:793–800. CrossRef
- Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
- Boegard T, Jonsson K. Radiography in osteoarthritis of the knee. Skeletal Radiol. 1999;28:605–615. CrossRef
- Bruyere O, Honore A, Rovati LC, Giacovelli G, Henrotin YE, Seidel L, Reginster JY. Radiologic features poorly predict clinical outcomes in knee osteoarthritis. Scand J Rheumatol. 2002;31:13–16. CrossRef
- Cicuttini FM, Baker J, Hart DJ, Spector TD. Association of pain with radiological changes in different compartments and views of the knee joint. Osteoarthritis Cartilage. 1996;4:143–147. CrossRef
- Creamer P, Lethbridge-Cejku M, Costa P, Tobin JD, Herbst JH, Hochberg MC. The relationship of anxiety and depression with self-reported knee pain in the community: data from the Baltimore Longitudinal Study of Aging. Arthritis Care Res. 1999;12:3–7. CrossRef
- Dieppe PA, Cushnaghan J, Shepstone L. The Bristol “OA500” study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint. Osteoarthritis Cartilage. 1997;5:87–97. CrossRef
- Du H, Chen SL, Bao CD, Wang XD, Lu Y, Gu YY, Xu JR, Chai WM, Chen J, Nakamura H, Nishioka K. Prevalence and risk factors of knee osteoarthritis in Huang-Pu District, Shanghai, China. Rheumatol Int. 2005;25:585–590. CrossRef
- Edwards CL, Fillingim RB, Keefe F. Race, ethnicity and pain. Pain. 2001;94:133–137. CrossRef
- Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am. 2004;42:1–9. CrossRef
- Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987;30:914–918. CrossRef
- Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998;41:1343–1355. CrossRef
- Gandhi R, Razak F, Mahomed NN. Ethnic differences in the relationship between obesity and joint pain and function in a joint arthroplasty population. J Rheumatol. 2008;35:1874–1877. CrossRef
- Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Badley EM. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med. 2000;342:1016–1022. CrossRef
- Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.
- Jordan JM, Luta G, Renner JB, Linder GF, Dragomir A, Hochberg MC, Fryer JG. Self-reported functional status in osteoarthritis of the knee in a rural southern community: the role of sociodemographic factors, obesity, and knee pain. Arthritis Care Res. 1996;9:273–278. CrossRef
- Joshy S, Datta A, Perera A, Thomas B, Gogi N, Kumar Singh B. Ethnic differences in preoperative function of patients undergoing total knee arthroplasty. Int Orthop. 2006;30:426–428. CrossRef
- Keefe FJ, Lefebvre JC, Egert JR, Affleck G, Sullivan MJ, Caldwell DS. The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain. 2000;87:325–334. CrossRef
- Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502. CrossRef
- Lanyon P, O’Reilly S, Jones A, Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis. 1998;57:595–601. CrossRef
- Lethbridge-Cejku M, Tobin JD, Scott WW, Jr., Reichle R, Plato CC, Hochberg MC. The relationship of age and gender to prevalence and pattern of radiographic changes of osteoarthritis of the knee: data from Caucasian participants in the Baltimore Longitudinal Study of Aging. Aging (Milano). 1994;6:353–357.
- Link TM, Steinbach LS, Ghosh S, Ries M, Lu Y, Lane N, Majumdar S. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology. 2003;226:373–381. CrossRef
- Macdonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH. The John Insall Award. Gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res. 2008;466:2612–2616. CrossRef
- Maly MR, Costigan PA, Olney SJ. Mechanical factors relate to pain in knee osteoarthritis. Clin Biomech (Bristol, Avon). 2008;23:796–805. CrossRef
- McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993;52:258–262. CrossRef
- O’Connor MI. Osteoarthritis of the hip and knee: sex and gender differences. Orthop Clin North Am. 2006;37:559–568. CrossRef
- Ozdemir F, Tukenmez O, Kokino S, Turan FN. How do marginal osteophytes, joint space narrowing and range of motion affect each other in patients with knee osteoarthritis. Rheumatol Int. 2006;26:516–522. CrossRef
- Park JH, Lim S, Lim J, Kim K, Han M, Yoon IY, Kim J, Chang Y, Chang CB, Chin HJ, Choi EA, Lee SB, Park YJ, Paik N, Kim TK, Jang HC, Kim KW. An overview of the Korean longitudinal study on health and aging (KLoSHA). Psychiatr Invest. 2007;4:84–95.
- Petterson SC, Raisis L, Bodenstab A, Snyder-Mackler L. Disease-specific gender differences among total knee arthroplasty candidates. J Bone Joint Surg Am. 2007;89:2327–2333. CrossRef
- Ritter MA, Wing JT, Berend ME, Davis KE, Meding JB. The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplasty. 2008;23:331–336. CrossRef
- Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, Wolinsky FD. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med. 1997;127:97–104.
- Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis Cartilage. 2005;13:769–781. CrossRef
- Summers MN, Haley WE, Reveille JD, Alarcon GS. Radiographic assessment and psychologic variables as predictors of pain and functional impairment in osteoarthritis of the knee or hip. Arthritis Rheum. 1988;31:204–209. CrossRef
- Szebenyi B, Hollander AP, Dieppe P, Quilty B, Duddy J, Clarke S, Kirwan JR. Associations between pain, function, and radiographic features in osteoarthritis of the knee. Arthritis Rheum. 2006;54:230–235. CrossRef
- Thorp LE, Sumner DR, Wimmer MA, Block JA. Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis. Arthritis Rheum. 2007;57:1254–1260. CrossRef
- Tsai YF. Gender differences in pain and depressive tendency among Chinese elders with knee osteoarthritis. Pain. 2007;130:188–194. CrossRef
- Verbrugge LM, Gates DM, Ike RW. Risk factors for disability among U.S. adults with arthritis. J Clin Epidemiol. 1991;44:167–182. CrossRef
- Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483. CrossRef
- Wright RW. Knee injury outcomes measures. J Am Acad Orthop Surg. 2009;17:31–39.
- Zhai G, Blizzard L, Srikanth V, Ding C, Cooley H, Cicuttini F, Jones G. Correlates of knee pain in older adults: Tasmanian Older Adult Cohort Study. Arthritis Rheum. 2006;55:264–271. CrossRef
- Zhang Y, Xu L, Nevitt MC, Aliabadi P, Yu W, Qin M, Lui LY, Felson DT. Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study. Arthritis Rheum. 2001;44:2065–2071. CrossRef
- Gender Differences in the Correlation between Symptom and Radiographic Severity in Patients with Knee Osteoarthritis
Clinical Orthopaedics and Related Research®
Volume 468, Issue 7 , pp 1749-1758
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Joint Reconstruction Center, Seoul National University Bundang Hospital, 300 Gumidong, Bundangu, Seongnamsi, Gyunggido, 463-707, Korea
- 2. Department of Orthopaedic Surgery, Pusan National University School of Medicine, Pusan, Korea
- 3. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- 4. Department of Orthopaedic Surgery, Kyung Hee University East-West Neo Medical Center, Seoul, Korea
- 5. Department of Statistics, Korea University, Seoul, Korea