eMedicine Specialties > Orthopedic Surgery > Trauma

Osteoarthritis: Workup

Author: Furqan H Siddiqui, MD, Director, Research Integrity Office, University of Louisville Hospital
Coauthor(s): James Monroe Laborde, MD, MS, Clinical Assistant Professor, Department of Orthopedics, Tulane Medical School; Adjunct Assistant Professor, Department of Biomedical Engineering, Tulane University; Adjunct Assistant Professor, Department of Physical Medicine and Rehabilitation, Louisiana State University Medical School; Consulting Staff, Department of Orthopedic Surgery, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Apr 23, 2009

Workup

Laboratory Studies

  • Hematologic findings: Generally, no abnormal hematologic findings are seen in patients with osteoarthritis (OA). The erythrocyte sedimentation rate (ESR) is normal, except in those patients with the erosive inflammatory or generalized forms of the disease.
  • Synovial fluid: The viscosity is good, and the cell count is slightly increased but always less than 1000/mm3.

Imaging Studies

  • The diagnosis of osteoarthritis (OA) is usually made based on the history and physical examination findings; however, radiographic evaluation is often needed. Conventional radiographs are sensitive and cost-effective and should be the initial imaging study in the routine evaluation of OA10,11,12,13,14 .
    • Characteristic findings of degenerative arthritis are osteophytes and joint-space narrowing. When radiographic findings are normal but the pain is persistent, consider a magnetic resonance image (MRI) study, which would provide the most information about what is occurring in the affected area. An MRI could confirm the diagnosis of such conditions as avascular necrosis and/or soft-tissue meniscal changes or tearing.
    • Radiographic evidence of osteophytes, in the absence of other bony changes such as subchondral cysts or sclerosis, may be a manifestation of aging and not OA.
  • MRI is indicated whenever there is confusion regarding the diagnosis, especially if osteonecrosis of the hip, knee, or ankle may be occurring. MRI is very sensitive and is useful at times; however, it is also expensive and should never be the primary imaging study.
  • Computed tomography (CT) scanning has no advantage in the primary diagnosis of OA. The main indication for this imaging modality is the detection of the small intraarticular bodies seen in advanced cases of OA.

Diagnostic Procedures

  • Arthrocentesis is often performed for osteoarthritis (OA) to assist with the differential diagnosis of a septic or crystal-induced arthritis. This procedure also relieves the pain associated with the effusion. Samples of the joint fluid may be sent for analysis, especially if a crystalline arthritis or an infection is suspected.
  • Arthroscopy is indicated after all conservative treatments have failed. The procedure supplies a direct vision of what is going on and is often all that is necessary to relieve the patient's pain. Arthroscopy is also used for visual inspection for pathology.

Staging

Outerbridge classified articular cartilage damage based on the arthroscopic findings in patients affected with osteoarthritis (OA).7 The 4 grades are as follows:

  • Grade I - Softening and swelling
  • Grade II - Fragmentation and fissuring of less than 0.5 inches
  • Grade III - Fragmentation and fissuring of greater than 0.5 inches
  • Grade IV - Erosion down to the subchondral bone

More on Osteoarthritis

Overview: Osteoarthritis
Workup: Osteoarthritis
Treatment: Osteoarthritis
Follow-up: Osteoarthritis
Multimedia: Osteoarthritis
References
Further Reading
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References

  1. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum. Sep 2000;43(9):1905-15. [Medline].

  2. Creamer P, Hochberg MC. Osteoarthritis. Lancet. Aug 16 1997;350(9076):503-8. [Medline].

  3. Dutkowsky JP. Miscellaneous nontraumatic disorders. In: Crenshaw AH, ed: Campbell's Operative Orthopedics. 8th ed. St Louis, Mo: Mosby-Year Book; 1992:1957-2058.

  4. Schumacher HR. Osteoarthritis. In: Primer on the Rheumatic Diseases. 10th ed. Atlanta, Ga: Arthritis Foundation;1993:184-90.

  5. Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. May 1998;41(5):778-99. [Medline].

  6. Hurley MV. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am. May 1999;25(2):283-98, vi. [Medline].

  7. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. Nov 1961;43-B:752-7. [Medline]. [Full Text].

  8. Zgoda M, Paczek L, Bartlomiejczyk I, et al. Age-related decrease in the activity of collagenase in the femoral head in patients with hip osteoarthritis. Clin Rheumatol. Feb 2007;26(2):240-1. [Medline].

  9. Daras M, Macaulay W. Total hip arthroplasty in young patients with osteoarthritis. Am J Orthop. Mar 2009;38(3):125-9. [Medline].

  10. Bellamy N, Bell MJ, Pericak D, et al. BLISS index for analyzing knee osteoarthritis trials data. J Clin Epidemiol. Feb 2007;60(2):124-32. [Medline].

  11. Boniatis I, Costaridou L, Cavouras D, et al. Assessing hip osteoarthritis severity utilizing a probabilistic neural network based classification scheme. Med Eng Phys. Mar 2007;29(2):227-37. [Medline].

  12. Gabriel SE, Crowson CS, Campion ME, O'Fallon WM. Indirect and nonmedical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol. Jan 1997;24(1):43-8. [Medline].

  13. Lanes SF, Lanza LL, Radensky PW, et al. Resource utilization and cost of care for rheumatoid arthritis and osteoarthritis in a managed care setting: the importance of drug and surgery costs. Arthritis Rheum. Aug 1997;40(8):1475-81. [Medline].

  14. Keen HI, Wakefield RJ, Conaghan PG. A systematic review of ultrasonography in osteoarthritis. Ann Rheum Dis. May 2009;68(5):611-9. [Medline].

  15. Hathcock JN, Shao A. Risk assessment for glucosamine and chondroitin sulfate. Regul Toxicol Pharmacol. Feb 2007;47(1):78-83. [Medline].

  16. Cibulka MT, White DM, Woehrle J, Harris-Hayes M, Enseki KR, Fagerson TL, et al. Hip pain and mobility deficits-hip osteoarthritis. J Orthop Sports Phys Ther. Apr 2009;39(4):A1-A25. [Medline].

  17. [Best Evidence] Chaipinyo K, Karoonsupcharoen O. No difference between home-based strength training and home-based balance training on pain in patients with knee osteoarthritis: a randomised trial. Aust J Physiother. 2009;55(1):25-30. [Medline].

  18. Kirkley A, Birmingham TB, Litchfield RB, et al. A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine. Available at http://content.nejm.org/cgi/content/short/359/11/1097?query=TOC. Accessed September 11, 2008.

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  21. Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. Sep 11 2008;359(11):1097-107. [Medline].

  22. Pagenstert G, Knupp M, Valderrabano V, Hintermann B. Realignment surgery for valgus ankle osteoarthritis. Oper Orthop Traumatol. Mar 2009;21(1):77-87. [Medline].

  23. Kuo A, Ezzet KA, Patil S, Colwell CW Jr. Total Hip Arthroplasty in Rapidly Destructive Osteoarthritis of the Hip: A Case Series. HSS J. Mar 24 2009;[Medline].

  24. Nemirovskiy OV, Dufield DR, Sunyer T, et al. Discovery and development of a type II collagen neoepitope (TIINE) biomarker for matrix metalloproteinase activity: from in vitro to in vivo. Anal Biochem. Feb 1 2007;361(1):93-101. [Medline].

  25. Weiker GG, Villis JD. The degenerative knee. In: Garrett WE Jr, Speer KP, Kirkendall DT, eds. Principles and Practice of Orthopaedic Sports Medicine. Phladelphia, Pa: Lippincott Williams & Wilkins;2000:845-62.

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Keywords

osteoarthritis, OA, degenerative joint disease, degenerative arthritis, osteoarthrosis, arthritis

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Contributor Information and Disclosures

Author

Furqan H Siddiqui, MD, Director, Research Integrity Office, University of Louisville Hospital
Furqan H Siddiqui, MD is a member of the following medical societies: American Federation for Clinical Research
Disclosure: Nothing to disclose.

Coauthor(s)

James Monroe Laborde, MD, MS, Clinical Assistant Professor, Department of Orthopedics, Tulane Medical School; Adjunct Assistant Professor, Department of Biomedical Engineering, Tulane University; Adjunct Assistant Professor, Department of Physical Medicine and Rehabilitation, Louisiana State University Medical School; Consulting Staff, Department of Orthopedic Surgery, Louisiana State University Health Sciences Center
James Monroe Laborde, MD, MS is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Phillip J Marone, MD, MSPH, Clinical Professor, Department of Orthopedic Surgery, Jefferson Medical College
Phillip J Marone, MD, MSPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Samuel Agnew, MD, FACS, Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center
Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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