Radiographic systems to classify osteoarthritis vary by which
joint
A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw ...
is being investigated. In
osteoarthritis
Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...
, the choice of treatment is based on pain and decreased function, but radiography can be useful before surgery in order to prepare for the procedure.
Vertebral column
There are many grading systems for degeneration of
intervertebral disc
An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, to act as a ligament to hold t ...
s and
facet joint
The facet joints (or zygapophysial joints, zygapophyseal, apophyseal, or Z-joints) are a set of synovial, plane joints between the articular processes of two adjacent vertebrae. There are two facet joints in each spinal motion segment and e ...
s in the
cervical
In anatomy, cervical is an adjective that has two meanings:
# of or pertaining to any neck.
# of or pertaining to the female cervix: i.e., the ''neck'' of the uterus.
*Commonly used medical phrases involving the neck are
**cervical collar
**cervic ...
and
lumbar vertebrae
The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse p ...
, of which the following radiographic systems can be recommended in terms of
interobserver reliability:
*Kellgren grading of cervical disc degeneration
*Kellgren grading of cervical facet joint degeneration
*Lane grading of lumbar disc degeneration
*Thompson grading of lumbar disc degeneration (by
magnetic resonance imaging
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...
)
*Pathria grading of lumbar facet joint degeneration (by
computed tomography)
*Weishaupt grading of lumbar facet joint degeneration (by MRI and computed tomography)
The Thomson grading system is regarded to have more academic than clinical value.
Shoulder
The Samilson–Prieto classification is preferable for osteoarthritis of the
glenohumeral joint
The shoulder joint (or glenohumeral joint from Greek ''glene'', eyeball, + -''oid'', 'form of', + Latin ''humerus'', shoulder) is structurally classified as a synovial ball-and-socket joint and functionally as a diarthrosis and multiaxial joint. ...
.
Hip
![Hueftgelenk-gesund (crop)](https://upload.wikimedia.org/wikipedia/commons/b/bd/Hueftgelenk-gesund_%28crop%29.jpg)
The most commonly used radiographic classification system for osteoarthritis of the
hip joint
In vertebrate anatomy, hip (or "coxa"Latin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) in medical terminology) refers to either an anatomical region or a joint.
The hip region is ...
is the Kellgren–Lawrence system (or KL system). It uses
plain radiographs.
Osteoarthritis of the
hip joint
In vertebrate anatomy, hip (or "coxa"Latin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) in medical terminology) refers to either an anatomical region or a joint.
The hip region is ...
may also be graded by Tönnis classification. There is no consensus whether it is more or less reliable than the Kellgren-Lawrence system.
Knee
For the grading of osteoarthritis in the knee, the International Knee Documentation Committee (IKDC) system is regarded to have the most favorable combination of interobserver
precision
Precision, precise or precisely may refer to:
Science, and technology, and mathematics Mathematics and computing (general)
* Accuracy and precision, measurement deviation from true value and its scatter
* Significant figures, the number of digit ...
and correlation to knee
arthroscopy
Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the jo ...
findings.
It was formed by a group of knee surgeons from Europe and America who met in 1987 to develop a standard form to measure results of knee ligament reconstructions.
The Ahlbäck system has been found to have comparable interobserver precision and arthroscopy correlation to the IKDC system, but most of the span of the Ahlbäck system focused at various degrees of bone defect or loss, and it is therefore less useful in early osteoarthritis.
[ Systems that have been found to have lower interobserver precision and/or arthroscopy correlation are those developed by Kellgren and Lawrence, Fairbank, Brandt, and Jäger and Wirth.][
For the ]patellofemoral joint
In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the hu ...
, a classification by Merchant 1974 uses a 45° "skyline" view of the patella
The patella, also known as the kneecap, is a flat, rounded triangular bone which articulates with the femur (thigh bone) and covers and protects the anterior articular surface of the knee joint. The patella is found in many tetrapods, such as m ...
:
Other joints
*In the temporomandibular joint
In anatomy, the temporomandibular joints (TMJ) are the two joints connecting the jawbone to the skull. It is a bilateral synovial articulation between the temporal bone of the skull above and the mandible below; it is from these bones that it ...
, ''subchondral sclerosis of the mandibular condyle
The condyloid process or condylar process is the process on the human and other mammalian species' mandibles that ends in a condyle, the mandibular condyle. It is thicker than the coronoid process of the mandible and consists of two portions: the c ...
'' has been described as an early change, ''condylar flattening'' as a feature of progressive osteoarthritis, and narrowing of the temporomandibular joint space as a late stage change. A joint space of between 1.5 and 4 mm is regarded as normal.
*For the ankle
The ankle, or the talocrural region, or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular join ...
, the Kellgren–Lawrence scale, as described for the hip, has been recommended. The distances between the bones in the ankle are normally as follows:
:*Talus - medial malleolus: 1.70 ± 0.13 mm
:*Talus - tibial plafond: 2.04 ± 0.29 mm
:*Talus - lateral malleolus: 2.13 ± 0.20 mm
See also
*WOMAC
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a widely used, proprietary set of standardized questionnaires used by health professionals to evaluate the condition of patients with osteoarthritis of the knee and h ...
, a non-radiographic classification system of osteoarthritis, taking into account pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
, stiffness and functional limitation.
References
{{Reflist
Musculoskeletal radiographic signs
Arthritis
Medical scoring system