Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 1, pp 161–168 | Cite as

The clinical symptom profile of early radiographic knee arthritis: a pain and function comparison with advanced disease

  • L. D. Jones
  • N. Bottomley
  • K. Harris
  • W. Jackson
  • A. J. Price
  • D. J. Beard



Early knee OA is a significant problem that can be disabling. The purpose of this study was to understand the symptomatic profile of patients with early knee OA when compared to those with end-stage knee OA.


A cross-sectional case control study design was used to compare those with early structural change to those with advanced structural change. In total, 100 consecutive patients with early radiographic knee OA presenting to the knee service outpatient clinic from December 2010 to August 2011 were prospectively identified on the basis of their radiographic changes. All met the symptomatic and radiological diagnostic criteria of early knee OA as defined by Luyten et al. They were compared with 200 knees with full thickness anteromedial knee OA and 200 knees with full thickness tricompartmental knee OA for their demographic, pain and functional profile.


Patients with early knee OA were younger than those with full thickness disease. However, 78 % of individual patients with early radiographic OA had pain and function scores equal to individual patients presenting for UKA, whilst 74 % of individual patients with early radiographic OA had pain and function scores that are equal to or worse than individual patients presenting for TKA.


Patients with early radiographic knee OA demonstrate considerable overlap in the severity of their symptoms with those demonstrating end-stage structural changes within the knee. Patients with early structural changes of arthritis should not be assumed by clinicians to have mild disease. In many cases, their symptoms are as bad as those with end-stage structural changes. This work will help clinicians to identify and categorise those with early arthritis and thereby assist in guiding appropriate treatments.


Early osteoarthritis Symptoms 


  1. 1.
    Beard DJ, Pandit H, Price AJ, Butler-Manuel PA, Dodd CAF, Murray DW, Goodfellow JW (2007) Introduction of a new mobile-bearing total knee prosthesis: minimum three year follow-up of an RCT comparing it with a fixed-bearing device. Knee 14:448–451PubMedCrossRefGoogle Scholar
  2. 2.
    Bedson J, Croft PR (2008) The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord 9:116–127PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Bewick V, Cheek L, Ball J (2004) Statistics review 9: one-way analysis of variance. Crit Care BioMed Cent 8:130–136CrossRefGoogle Scholar
  4. 4.
    Bollars P, Bosquet M, Vandekerckhove B, Hardeman F, Bellemans J (2012) Prosthetic inlay resurfacing for the treatment of focal, full thickness cartilage defects of the femoral condyle: a bridge between biologics and conventional arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:1753–1759PubMedCrossRefGoogle Scholar
  5. 5.
    Brouwer RW, Jakma TSC, Bierma-Zeinstra SMA, Verhagen AP, Verhaar J (2005) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev CD004019Google Scholar
  6. 6.
    Flores R, Hochberg M (1998) Definition and Classification of Osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS (eds) Osteoarthritis. Oxford University Press, New York, pp 1–12Google Scholar
  7. 7.
    Guermazi A, Roemer FW, Burstein D, Hayashi D (2011) Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis. Arthritis Res Ther 13:247–258PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38:1125–1133PubMedCrossRefGoogle Scholar
  9. 9.
    Harris K, Dawson J, Doll H, Field RE, Murray DW, Fitzpatrick R, Jenkinson C, Price AJ, Beard DJ (2013) Can pain and function be distinguished in the Oxford Knee Score in a meaningful way? An exploratory and confirmatory factor analysis. Qual Life Res 22:2561–2568PubMedCrossRefGoogle Scholar
  10. 10.
    Harris KK, Dawson J, Jones LD, Beard DJ, Price AJ (2013) Extending the use of PROMs in the NHS-using the Oxford Knee Score in patients undergoing non-operative management for knee osteoarthritis: a validation study. BMJ Open 3:e003365PubMedPubMedCentralGoogle Scholar
  11. 11.
    Heir S, Nerhus TK, Røtterud JH, Løken S, Ekeland A, Engebretsen L, Arøen A (2010) Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 38:231–237PubMedCrossRefGoogle Scholar
  12. 12.
    Hernigou P, Medeville D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. J Bone Joint Surg 69-A:332–354Google Scholar
  13. 13.
    Jinks C, Jordan K, Ong BN, Croft P (2004) A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over. Rheumatology 43:55–61PubMedCrossRefGoogle Scholar
  14. 14.
    Jones LD, Grammatopoulos G, Kambouroglou G (2014) Titanium elastic nails, open reduction internal fixation and non-operative management for middle third clavicle fractures: a comparative study. Eur J Orthop Surg Traumatol 24:323–329PubMedCrossRefGoogle Scholar
  15. 15.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Levene H (1960) Contributions to probability and statistics: essays in honor of Harold Hotelling. Stanford University Press, California, USA, pp 278–292Google Scholar
  17. 17.
    Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Predicting the outcome of total knee arthroplasty. J Bone Joint Surg 86-A:2179–2186PubMedGoogle Scholar
  18. 18.
    London NJ, Miller LE, Block JE (2011) Clinical and economic consequences of the treatment gap in knee osteoarthritis management. Med Hypotheses 76:887–892PubMedCrossRefGoogle Scholar
  19. 19.
    Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L (2012) Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20:401–406PubMedCrossRefGoogle Scholar
  20. 20.
    Marcacci M, Kon E, Zaffagnini S, Filardo G, Delcogliano M, Neri MP, Iacono F, Hollander AP (2007) Arthroscopic second generation autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 15:610–619PubMedCrossRefGoogle Scholar
  21. 21.
    Michael JW, Schlüter-Brust KU, Eysel P (2010) The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int 107:152–162PubMedPubMedCentralGoogle Scholar
  22. 22.
    Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, Dragomir A, Kalsbeek WD, Luta G, Jordan JM (2008) Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum 59:1207–1213PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg (Br) 89:1010–1014CrossRefGoogle Scholar
  24. 24.
    Murray DW, Goodfellow JW, O’Connor JJ (1998) The Oxford unicompartmental knee arthroplasty. J Bone Joint Surg (Br) 80:983–989CrossRefGoogle Scholar
  25. 25.
    Pandit H, Gulati A, Jenkins C, Barker K, Price AJ, Dodd CAF, Murray DW (2011) Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee 18:168–171PubMedCrossRefGoogle Scholar
  26. 26.
    Pandit H, Jenkins C, Gill HS, Barker K, Dodd CAF, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg (Br) 93:198–204CrossRefGoogle Scholar
  27. 27.
    Pill SG, Huffman RG, Garino JP, Lee G-C (2009) Knee osteotomy for unicompartmental knee arthritis. Curr Orthop Pract 20:682–686CrossRefGoogle Scholar
  28. 28.
    Porter M, Tucker K, Beaumont R, Young E, Forsyth O, Swanson M (2012) National Joint Registry for England and Wales 9th Annual Report. Natl Jt Regist 1–212Google Scholar
  29. 29.
    Ruhdorfer A, Dannhauer T, Wirth W, Hitzl W, Kwoh CK, Guermazi A, Hunter DJ, Benichou O, Eckstein F (2013) Thigh muscle cross-sectional areas and strength in advanced versus early painful osteoarthritis: an exploratory between-knee, within-person comparison in osteoarthritis initiative participants. Arthritis Care Res (Hoboken) 65:1034–1042CrossRefGoogle Scholar
  30. 30.
    Sofat N, Ejindu V, Kiely P (2011) What makes osteoarthritis painful? The evidence for local and central pain processing. Rheumatology 50:2157–2165PubMedCrossRefGoogle Scholar
  31. 31.
    Szebenyi B, Hollander AP, Dieppe P, Quilty B, Duddy J, Clarke S, Kirwan JR (2006) Associations between pain, function, and radiographic features in osteoarthritis of the knee. Arthritis Rheum 54:230–235PubMedCrossRefGoogle Scholar
  32. 32.
    Thorstensson CA, Andersson MLE, Jönsson H, Saxne T, Petersson IF (2009) Natural course of knee osteoarthritis in middle-aged subjects with knee pain: 12-year follow-up using clinical and radiographic criteria. Ann Rheum Dis 68:1890–1893PubMedCrossRefGoogle Scholar
  33. 33.
    Torres L, Dunlop DD, Peterfy C, Guermazi A, Prasad P, Hayes KW, Song J, Cahue S, Chang A, Marshall M, Sharma L (2006) The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthr Cartil 14:1033–1040PubMedCrossRefGoogle Scholar
  34. 34.
    Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37(Suppl 1):105–111CrossRefGoogle Scholar
  35. 35.
    White DK, Zhang Y, Niu J, Keysor JJ, Nevitt MC, Lewis CE, Torner JC, Neogi T (2010) Do worsening knee radiographs mean greater chances of severe functional limitation? Arthritis Care Res (Hoboken) 62:1433–1439CrossRefGoogle Scholar
  36. 36.
    White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. J Bone Joint Surg (Br) 73:582–586Google Scholar
  37. 37.
    Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2008) OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16:137–162PubMedCrossRefGoogle Scholar
  38. 38.
    Zhang Y, Jordan J (2011) Epidemiology of osteoarthritis. Clin Geriatr Med 26:355–369CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • L. D. Jones
    • 1
  • N. Bottomley
    • 1
  • K. Harris
    • 1
  • W. Jackson
    • 1
  • A. J. Price
    • 1
  • D. J. Beard
    • 1
  1. 1.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK

Personalised recommendations