Relationship between the Severity of Radiographic Features and Degree of Pain and Dysfunction in Patients with Knee Osteoarthritis

슬관절 골관절염 환자의 방사선학적 소견의 심각성과 통증 및 기능장애수준 간에 상관성

Kim, Dae-hoon;Jang, Hyun-joung;Cheon, Je-gyun;Kim, Suhn-yeop

  • Received : 2015.09.23
  • Accepted : 2015.10.28
  • Published : 2016.02.29


PURPOSE: This study aimed to assess the relationship between the severity of radiographic features and pain and function in patients with knee osteoarthritis (KOA). METHODS: Seventy-eight subjects (14 men, 64 women) with KOA, between the ages of 41 and 83 years (mean age, 61.29 years), were included. All the subjects diagnosed with KOA were scored for severity of radiographic KOA according to the Kellgren-Lawrence (K/L) grade, visual analogue scale (VAS), knee joint range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), maximum muscle power (MMP), and sit-to-stand (STS) and one-leg standing (OLS) tests. Associations among the K/L grade, diagnosis, pain, and function were examined by correlation analysis. RESULTS: There were no significant differences between the K/L grade, and the VAS, STS test time, and WOMAC scores (p>.05). There were no significant differences between the K/L grade, bilateral ROM, MMP, and left OLS test time (p>.05). However, there was a significant difference between the K/L grade and right OLS test time (p<.05). The K/L grade was negatively correlated with the left OLS test time(r=-.24, p<.05) and with the right OLS test time (r=-.307, p<.01). CONCLUSION: These results suggest that radiographic KOA was not associated with pain, knee MMP, ROM, and STS test time, but had a weak negative correlation with OLS test time.


Dysfunction;Kellgren-Lawrence scale;Knee;Osteoarthritis;Pain


  1. Anan M, Shinkoda K, Suzuki K, et al. Do patients with knee osteoarthritis perform sit-to-stand motion efficiently? Gait Posture. 2015;41(2):488-92.
  2. Andriacchi TP, Koo S, Scanlan SF. Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. J Bone Joint Surg Am. 2009;1:95-101.
  3. Bellamy N, Buchanan WW, Goldsmith CH, et al. 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 the knee. J Rheumatol. 1988;15(12):1833-40.
  4. Briggs RC, Gossman MR, Birch R, et al. Balance performance among noninstitutionalized elderly women. Phys Ther. 1989;69(9):748-56.
  5. Cicuttini FM, Baker J, Hart DJ, et al. Association of pain with radiological changes in different compartments and views of the knee joint. Osteoarthr Cartil. 1996;4(2):143-7.
  6. Creaby MW, Bennell KL, Hunt MA. Gait differs between unilateral and bilateral knee osteoarthritis. Arch Phys Med Rehabil. 2012;93(5):822-7.
  7. Cubukcu D, Sarsan A, Alkan H. Relationships between pain, function and radiographic Findings in osteoarthritis of the knee: A Cross-Sectional Study. Arthritis. 2012;2012:984060.
  8. Dawson J, Linsell L, Zondervan K, et al. Epidemiology of hip and knee pain and its impact on overall health status in older adults. Rheumatology. 2004;43(4):497-504.
  9. Dillon CF, Rasch EK, Gu Q, et al. Prevalence of knee osteoarthritis in the United States: Arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol. 2006;33:2271-9.
  10. Foley SJ, Lord SR, Srikanth V, et al. Falls risk is associated with pain and dysfunction but not radiographic osteoarthritis in older adults: Tasmanian Older Adult Cohort study. Osteoarthritis Cartilage. 2006;14(6):533-9.
  11. Franchignoni F, Tesio L, Martino MT, et al. Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging (Milano). 1998;10(1):26-31.
  12. Gauchard G, Vancon G, Meyer P, et al. On the role of knee joint in balance control and postural strategies: Effects of total knee replacement in elderly subjects with knee osteoarthritis. Gait Posture. 2010;32(2):155-60.
  13. Girish G, Lobo LG, Jacobson JA, et al. Ultrasound of the shoulder: Asymptomatic findings in men.Am J Roentgenol. 2011;197(4):W713-9.
  14. Hall M, Doherty S, Courtney P, et al. Synovial pathology detected on ultrasound correlates with the severity of radiographic knee osteoarthritis more than with symptoms. Osteoarthr Cartil. 2014;22(10):1627-33.
  15. Haugen IK, Slatkowsky-Christensen B, Boyesen P, et al. Cross-sectional and longitudinal associations between radiographic features and measures of pain and physical function in hand osteoarthritis. Osteoarthr Cartil. 2013;21(9):1191-8.
  16. Hicks GE, Fritz JM, Delitto A, et al. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84(12):1858-64.
  17. Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54(1):226-9.
  18. Hunt MA, Birmingham TB, Jones IC, et al. Effect of tibial re-alignment surgery on single leg standing balance in patients with knee osteoarthritis. Clin Biomech. 2009;24(8):693-6.
  19. Jones G, Cooley HM, Bellamy N. A cross-sectional study of the association between Heberden's nodes, radiographic osteoarthritis of the hands, grip strength, disability and pain. Osteoarthritis Cartilage. 2001;9(7):606-11.
  20. Jorgensen TS, Henriksen M, Rosager S, et al. The dynamics of the pain system is intact in patients with knee osteoarthritis: An exploratory experimental study. Scand J Pain. 2015;6:43-9.
  21. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957;16:494-502.
  22. Ko TS, Kim SY, Lee JS. Reliability and validity of the Korean Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in patients with osteoarthritis of the Knee. J Oriental Rehab Med. 2009;19(2):251-60.
  23. Lethbridge-Cejku M, Scott WW Jr, Reichle R, et al. Association of radiographic features of osteoarthritis of the knee with knee pain: Data from the Baltimore longitudinal study of aging. Arthritis Care Res. 1995;8(3):182-8.
  24. Liikavainio T, Lyytinen T, Tyrvainen E, et al. Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis. Arch Phys Med Rehabil. 2008;89(11):2185-94.
  25. Lin MR, Hwang HF, Hu MH, et al. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in communitydwelling older people. J Am Geriatr Soc. 2004;52(8):1343-8.
  26. Lord SR, Murray SM, Chapman K, et al. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol A Biol Sci Med Sci. 2002;57(8):M539-43.
  27. Macdonald K V, Sanmartin C, Langlois K, et al. Symptom onset, diagnosis and management of osteoarthritis. Health Rep. 2014;17;25(9):10-7.
  28. Martins PC, Couto TE, Gama AC. Auditory-perceptual evaluation of the degree of vocal deviation: Correlation between the visual analogue scale and numerical scale. Codas. 2015;27(3):279-84.
  29. Michael JW, Schluter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010;107(9):152-62.
  30. Oak SR, Ghodadra A, Winalski CS, et al. Radiographic joint space width is correlated with 4-year clinical outcomes in patients with knee osteoarthritis: Data from the osteoarthritis initiative. Osteoarthr Cartil. 2013;21(9):1185-90.
  31. Park HB. An economic sociological study of Korean health care system: Focusing on a comparative analysis with UK, US, and Japan. Mastrer's Degree. Hanyang University. 2010.
  32. Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting: Elbow and knee measurement. Phys Ther. 1983;63:1611-5.
  33. Szebenyi B, Hollander AP, Dieppe P, et al. Associations between pain, function, and radiographic features in osteoarthritis of the knee. Arthritis Rheum. 2006;54(1):230-5.
  34. Takacs J, Hunt MA. The effect of contralateral pelvic drop and trunk lean on frontal plane knee biomechanics during single limb standing. J Biomech. 2012;45(16):2791-6.
  35. Tarride JE, Haq M, O'Reilly DJ, et al. The excess burden of osteoarthritis in the province of Ontario, Canada. Arthritis Rheum. 2012;64:1153-61.
  36. Tiedemann A, Shimada H, Sherrington C, et al. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing. 2008;37(4):430-5.
  37. Walczak BE, McCulloch PC, Kang RW, et al. Abnormal findings on knee magnetic resonance imaging in asymptomatic NBA players. J Knee Surg. 2008;21(1):27-33.
  38. Weinstein SL, Jacobs JJ, Goldberg MJ. Osteoarthritis of the knee. N Engl J Med. 2006 Jun 8;354(23):2508-9.
  39. Whiteley R, Jacobsen P, Prior S, et al. Correlation of isokinetic and novel hand-held dynamometry measures of knee flexion and extension strength testing. J Sci Med Sport. 2012;15(5):444-50.
  40. Woollacott M.H, Shumwaycook A. Changes in posture control across the life span-a systems approach. Phys Ther. 1990;70(12):799-807.
  41. Wuang YP, Chang JJ, Wang MH, et al. Test-retest reliabilities of hand-held dynamometer for lower-limb muscle strength in intellectual disabilities. Res Dev Disabil. 2013;34(8):2281-90.

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