Osteoarthritis Clinical Presentation

  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Jan 18, 2012
 

History

The disease progression of osteoarthritis (OA) is characteristically slow, occurring over several years or decades. The patient can become progressively less active, leading to morbidities related to decreasing physical activity (including potential weight gain).

Early in the disease process of osteoarthritis, the joints may appear normal, and the patient’s gait may be antalgic if weight-bearing joints are involved.

Pain is usually the initial source of morbidity in osteoarthritis, with the disease’s primary symptom being deep, achy joint pain exacerbated by extensive use. Also, reduced range of motion and crepitus are frequently present.

Stiffness during rest (gelling) may develop, with morning joint stiffness usually lasting for less than 30 minutes.

Initially, pain can be relieved by rest and may respond to simple analgesics. However, joints may become unstable as the osteoarthritis progresses; therefore, the pain may become more prominent (even during rest) and may not respond to medications.

Next

Physical Examination

Physical examination findings in patients with the disease are mostly limited to the affected joints.[36, 37, 38]

A deep, achy joint pain, presumably arising from a combination of mechanisms, is the main presenting symptom of osteoarthritis. Also, reduced range of motion and crepitus are frequently present (see Pathophysiology).

Malalignment with a bony enlargement (depending on the disease’s severity) may occur. Most cases of osteoarthritis do not involve erythema or warmth over the affected joint(s); however, an effusion may be present. Limitation of joint motion or muscle atrophy around a more severely affected joint may occur.

Heberden nodes, which represent palpable osteophytes in the DIP joints, are characteristic in women but not in men. Inflammatory changes are typically absent or at least not pronounced.

Previous
Next

Progression of Osteoarthritis

The etiopathogenesis of osteoarthritis has been divided into 3 stages. In stage 1, proteolytic breakdown of the cartilage matrix occurs. Stage 2 involves the fibrillation and erosion of the cartilage surface, with a subsequent release of proteoglycan and collagen fragments into the synovial fluid. In stage 3, the breakdown products of cartilage induce a chronic inflammatory response in the synovium.

Certain diseases are often categorized as subsets of primary osteoarthritis. These include primary generalized osteoarthritis (PGOA), erosive osteoarthritis, and chondromalacia patellae.

Several systems have been advocated for use in the grading of focal cartilage change; however, a simple description of the extent of disease (ie, surface, partial-thickness, or full-thickness irregularity with or without underlying subchondral bone change) is generally sufficient and prevents confusion that occurs with numeric grading systems.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Carlos J Lozada, MD  Director of Rheumatology Fellowship Program, Professor, Department of Medicine, Division of Rheumatology and Immunology, University of Miami, Leonard M Miller School of Medicine

Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Pfizer Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching

Coauthor(s)

Samuel Agnew, MD, FACS  Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; 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.

B Sonny Bal, MD  Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Pat Auveek Basu, MD, MBA  Staff Physician, Department of Radiology, Stanford University Hospitals

Pat Auveek Basu, MD, MBA is a member of the following medical societies: American Medical Association, American Roentgen Ray Society, California Medical Association, Chicago Medical Society, Illinois State Medical Society, Radiological Society of North America, and Society of Interventional Radiology

Disclosure: Nothing to disclose.

Howard A Chansky, MD  Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center

Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Irim Ciolino, MD  Resident Physician, Department of Physical Medicine and Rehabilitation, Georgetown University Hospital-NRH

Irim Ciolino, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Michael S Clarke, MD  Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Jaimie A Clodfelter, DO  Resident Physician, Department of Physical Medicine and Rehabilitation, Louisiana State University Health Science Center

Jaimie A Clodfelter, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Mervyn J Cross, MBBS, FRACS  Director of the Australian Institute of Musculoskeletal Research, Department of Orthopedic Surgery, North Sydney Orthopedic/Sports Medicine Center, Crows Nest, Australia

Mervyn J Cross, MBBS, FRACS is a member of the following medical societies: American Orthopaedic Society for Sports Medicine, Australasian College of Sports Physicians, Australian Association of Surgeons, Australian Medical Association, Australian Orthopaedic Association, Hughston Society, and Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

Thomas M DeBerardino, MD  Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Carlos A Garcia-Moral, MD  Clinical Professor, Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Services Center

Carlos A Garcia-Moral, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, and Oklahoma State Medical Association

Disclosure: Nothing to disclose.

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

Amilcare Gentili, MD  Professor of Clinical Radiology, University of California, San Diego, School of Medicine; Consulting Staff, Department of Radiology, Thornton Hospital; Chief of Radiology, San Diego Veterans Affairs Healthcare System

Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology

Disclosure: Nothing to disclose.

Dennis P Grogan, MD  Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa

Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: Nothing to disclose.

Kathleen A Hogan, MD  Fellow in Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital

Kathleen A Hogan, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Thomas R Hunt III, MD  John D Sherrill Professor and Director of Orthopedic Surgery, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham School of Medicine; Surgeon-in-Chief, UAB Highlands Hospital

Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association

Disclosure: Tornier Royalty Independent contractor; Tornier Ownership interest None; Lippincott Royalty Independent contractor

Stephen Kishner, MD, MHA  Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Nanne P Kort, MD, PhD  Consulting Staff, Department of Orthopedic Surgery, Orbis Medical Park Sittard, The Netherlands

Nanne P Kort, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

James Monroe Laborde, MD, MS  Clinical Assistant Professor, Department of Orthopedics, Louisiana State University Health Sciences Center and 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

James Monroe Laborde, MD, MS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth)  Consultant Spinal Surgeon, Department of Trauma and Orthopaedics, Sunderland Royal Hospital, UK

Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth) is a member of the following medical societies: AO Spine International and British Orthopaedic Association

Disclosure: Nothing to disclose.

Cato T Laurencin, MD, PhD  Vice President for Health Affairs, Dean of the School of Medicine, Van Dusen Endowed Chair and Professor in Academic Medicine, Distinguished Professor of Orthopedic Surgery, and Chemical, Materials, and Biomolecular Engineering, University of Connecticut School of Medicine

Cato T Laurencin, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Mark D Lazarus, MD  Associate Professor of Orthopedic Surgery, Medical College of Pennsylvania-Hahnemann University, Chief of Shoulder and Elbow Service, Department of Orthopedic Surgery, Hahnemann University Hospital

Disclosure: Nothing to disclose.

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.

Scott E Marwin, MD  Assistant Professor of Orthopedic Surgery, Albert Einstein College of Medicine; Associate Chair, Department of Orthopedic Surgery, Long Island Jewish Medical Center

Scott E Marwin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Charles T Mehlman, DO, MPH  Professor of Pediatrics and Pediatric Orthopedic Surgery, Division of Pediatric Orthopedic Surgery, Director, Musculoskeletal Outcomes Research, Cincinnati Children's Hospital Medical Center

Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: Nothing to disclose.

Pekka A Mooar, MD  Professor, Department of Orthopedic Surgery, Temple University School of Medicine

Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Peter M Murray, MD  Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research, Jacksonville; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital

Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Robert J Nowinski, DO  Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Ohio Osteopathic Association, and Ohio State Medical Association

Disclosure: Tornier Grant/research funds Other; Tornier Honoraria Speaking and teaching

Simon H Palmer, MD  Consultant Surgeon, Department of Orthopedics and Trauma, Worthing and Southlands NHS trust, Sussex

Disclosure: Nothing to disclose.

Albert W Pearsall IV, MD  Associate Professor, Department of Orthopedic Surgery, University of South Alabama College of Medicine; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center

Disclosure: Nothing to disclose.

Marcus Romanowski, MD  Chief, Department of Orthopedic Surgery, Kenmore Mercy Hospital; Director, Knee and Hip Center, Kenmore Mercy Hospital; Partner, Joint Reconstruction Orthopedics

Marcus Romanowski, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Arthritis Foundation

Disclosure: Nothing to disclose.

Brett J Rothaermel, MD, PT  Clinical Instructor, Department of Physical Medicine and Rehabilitation, Louisiana State University School of Medicine in New Orleans; Staff Physician in Occupational Medicine, East Jefferson Occupational Medicine Clinic; Staff Physician PRN in Urgent Care, East Jefferson After Hours

Brett J Rothaermel, MD, PT is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Occupational and Environmental Medicine, Louisiana State Medical Society, and Orleans Parish Medical Society

Disclosure: Nothing to disclose.

Richard Salcido, MD  Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

H Del Schutte, Jr, MD  Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Medical University of South Carolina

H Del Schutte, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, American Medical Association, American Orthopaedic Association, California Medical Association, Orthopaedic Research Society, South Carolina Medical Association, Southern Medical Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Lester Sher, MBBCh, FRCS  Honorary Clinical Lecturer, Department of Orthopedics, Wansbeck Hospital, UK

Disclosure: Nothing to disclose.

Furqan H Siddiqui  MD, Assistant Professor of Medicine and Research, Louisiana State University Medical Center, New Orleans

Furqan H Siddiqui is a member of the following medical societies: American Federation for Clinical Research

Disclosure: Nothing to disclose.

Dev Sinha, MD  Resident Physician, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Health Systems

Disclosure: Nothing to disclose.

Curtis W Slipman, MD  Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center

Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society

Disclosure: Nothing to disclose.

Gregory Scott Stacy, MD  Associate Professor, Department of Radiology, University of Chicago Hospitals

Gregory Scott Stacy, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society of Skeletal Radiology

Disclosure: Nothing to disclose.

Lynne S Steinbach, MD  Professor, Department of Radiology, University of California, San Francisco, School of Medicine

Lynne S Steinbach, MD is a member of the following medical societies: American College of Radiology, International Skeletal Society, and Radiological Society of North America

Disclosure: Nothing to disclose.

Todd P Stitik, MD  Professor, Department of Physical Medicine and Rehabilitation, Director, Outpatient Occupational/Musculoskeletal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Ashish Upadhyay, MD, MBMS, MRCS (Edinburgh)  Resident, Department of Orthopedics, University of Illinois at Chicago

Ashish Upadhyay, MD, MBMS, MRCS (Edinburgh) is a member of the following medical societies: Royal College of Surgeons of Edinburgh and Royal Society of Medicine

Disclosure: Nothing to disclose.

Jos van Raay, PhD  Associate Chair, Residency Director, Department of Orthopedic Surgery, Martini Hospital Groningen, Netherlands

Disclosure: Nothing to disclose.

Specialty Editor Board

Felix S Chew, MD, MBA, EdM  Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington School of Medicine

Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Elliot Goldberg, MD  Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

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.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Eli Steigelfest, MD, Alex Minh Nguyet Tran, MD, Kevin Trapp, MD, Siriporn Janchai, MD, to the development and writing of the source articles.

References

  1. 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].

  2. Kellgren JH. Osteoarthritis in patients and populations. Br Med J. 1961;Vol 2.:1-6.

  3. Loughlin J. The genetic epidemiology of human primary osteoarthritis: current status. Expert Rev Mol Med. May 24 2005;7(9):1-12. [Medline].

  4. Cheung EV, Adams R, Morrey BF. Primary osteoarthritis of the elbow: current treatment options. J Am Acad Orthop Surg. Feb 2008;16(2):77-87. [Medline].

  5. Dagenais S, Garbedian S, Wai EK. Systematic review of the prevalence of radiographic primary hip osteoarthritis. Clin Orthop Relat Res. Mar 2009;467(3):623-37. [Medline]. [Full Text].

  6. Lee P, Rooney PJ, Sturrock RD, Kennedy AC, Dick WC. The etiology and pathogenesis of osteoarthrosis: a review. Semin Arthritis Rheum. Spring 1974;3(3):189-218. [Medline].

  7. Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. Nov 1965;38(455):810-24. [Medline].

  8. Radin ER, Paul IL, Rose RM. Pathogenesis of primary osteoarthritis. Lancet. Jun 24 1972;1(7765):1395-6. [Medline].

  9. Sharma L. Epidemiology of osteoarthritis. In: Moskowitz RW, Howell DS, Altman, RD, et al, eds. Osteoarthritis. 3rd ed. 2001:3-27.

  10. Veys E, Verbruggen G. Evolution and prognosis of osteoarthritis. In: Reginster JY, Pelletier JP, Martel-Pelletier J, et al, eds. Osteoarthritis. 1999:312-3.

  11. Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. Jul 2009;467(7):1800-6. [Medline]. [Full Text].

  12. Buckland-Wright C, Verbruggen G, Haraoui PB. Imaging: radiological assessment of hand osteoarthritis. In: Osteoarthritis Cartilage. 2000:55-6.

  13. Jewell FM, Watt I, Doherty M. Plain radiographic features of osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS, eds. Osteoarthritis. New York, NY: Oxford University Press; 1998:217-37.

  14. Mankin HJ. The reaction of articular cartilage to injury and osteoarthritis (first of two parts). N Engl J Med. Dec 12 1974;291(24):1285-92. [Medline].

  15. Miller EJ, Van der Korst JK, Sokoloff L. Collagen of human articular and costal cartilage. Arthritis Rheum. Feb 1969;12(1):21-9. [Medline].

  16. Phadke K. Regulation of metabolism of the chondrocytes in articular cartilage--an hypothesis. J Rheumatol. Dec 1983;10(6):852-60. [Medline].

  17. Resnick D, Niwayama G. Degenerative disease of extraspinal locations. In: Resnick D, ed. Diagnosis of Bone and Joint Disorders. 3rd ed. 1995:1263-1371.

  18. Poole AR. An introduction to the pathophysiology of osteoarthritis. Front Biosci. Oct 15 1999;4:D662-70. [Medline].

  19. Radin EL, Paul IL. Response of joints to impact loading. I. In vitro wear. Arthritis Rheum. May-Jun 1971;14(3):356-62. [Medline].

  20. Burkitt HG, Stevens A, Lowe JS. Skeletal system. In: Basic Histopathology. 3rd ed. New York, NY: Churchill Livingstone; 1996:260.

  21. Hamerman D. The biology of osteoarthritis. N Engl J Med. May 18 1989;320(20):1322-30. [Medline].

  22. Hartmann C, De Buyser J, Henry Y, Morère-Le Paven MC, Dyer TA, Rode A. Nuclear genes control changes in the organization of the mitochondrial genome in tissue cultures derived from immature embryos of wheat. Curr Genet. May 1992;21(6):515-20. [Medline].

  23. Howell DS. Pathogenesis of osteoarthritis. Am J Med. Apr 28 1986;80(4B):24-8. [Medline].

  24. Bullough PG. The geometry of diarthrodial joints, its physiologic maintenance, and the possible significance of age-related changes in geometry-to-load distribution and the development of osteoarthritis. Clin Orthop Relat Res. May 1981;61-6. [Medline].

  25. Aigner T, Rose J, Martin J, Buckwalter J. Aging theories of primary osteoarthritis: from epidemiology to molecular biology. Rejuvenation Res. Summer 2004;7(2):134-45. [Medline].

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

  27. Zgoda M, Paczek L, Bartlomiejczyk I, Sieminska J, Chmielewski D, Górecki A. 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].

  28. Felson DT. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev. 1988;10:1-28. [Medline].

  29. Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF. Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med. Jul 1 1988;109(1):18-24. [Medline].

  30. Goulston LM, Kiran A, Javaid MK, et al. Does obesity predict knee pain over fourteen years in women, independently of radiographic changes?. Arthritis Care Res (Hoboken). Oct 2011;63(10):1398-406. [Medline].

  31. 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].

  32. Felson DT. Risk factors for osteoarthritis: understanding joint vulnerability. Clin Orthop Relat Res. Oct 2004;S16-21. [Medline].

  33. Hoaglund FT, Yau AC, Wong WL. Osteoarthritis of the hip and other joints in southern Chinese in Hong Kong. J Bone Joint Surg Am. Apr 1973;55(3):545-57. [Medline].

  34. Roberts J, Burch TA. Osteoarthritis prevalence in adults by age, sex, race, and geographic area. Vital Health Stat 11. Jun 1966;1-27. [Medline].

  35. Chapple CM, Nicholson H, Baxter GD, Abbott JH. Patient characteristics that predict progression of knee osteoarthritis: A systematic review of prognostic studies. Arthritis Care Res (Hoboken). Aug 2011;63(8):1115-25. [Medline].

  36. [Guideline] Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum. Nov 1990;33(11):1601-10. [Medline].

  37. [Guideline] Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. May 1991;34(5):505-14. [Medline].

  38. [Guideline] Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. 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. Aug 1986;29(8):1039-49. [Medline].

  39. Brandt KD. A pessimistic view of serologic markers for diagnosis and management of osteoarthritis. Biochemical, immunologic and clinicopathologic barriers. J Rheumatol Suppl. Aug 1989;18:39-42. [Medline].

  40. Recht MP, Kramer J, Marcelis S, Pathria MN, Trudell D, Haghighi P, et al. Abnormalities of articular cartilage in the knee: analysis of available MR techniques. Radiology. May 1993;187(2):473-8. [Medline].

  41. Recht MP, Goodwin DW, Winalski CS, White LM. MRI of articular cartilage: revisiting current status and future directions. AJR Am J Roentgenol. Oct 2005;185(4):899-914. [Medline].

  42. Jewell FM, Watt I, Doherty M. Plain radiographic features of osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS, eds. Osteoarthritis. New York, NY: Oxford University Press; 1998:217-37.

  43. Hunter DJ. Advanced imaging in osteoarthritis. Bull NYU Hosp Jt Dis. 2008;66(3):251-60. [Medline].

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

  45. Kraus VB, McDaniel G, Worrell TW, Feng S, Vail TP, Varju G, et al. Association of bone scintigraphic abnormalities with knee malalignment and pain. Ann Rheum Dis. Nov 2009;68(11):1673-9. [Medline].

  46. [Guideline] Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. Feb 2008;16(2):137-62. [Medline].

  47. Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med. Apr 1 1992;116(7):535-9. [Medline].

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

  49. Neustadt DH. Intra-articular therapy. In: Moskowitz RW, Howell DS, Altman RD, et al, eds. Osteoarthritis. 3rd ed. 2001:393-409.

  50. Lineker SC, Bell MJ, Boyle J, Badley EM, Flakstad L, Fleming J, et al. Implementing arthritis clinical practice guidelines in primary care. Med Teach. Mar 2009;31(3):230-7. [Medline].

  51. Godwin M, Dawes M. Intra-articular steroid injections for painful knees. Systematic review with meta-analysis. Can Fam Physician. Feb 2004;50:241-8. [Medline]. [Full Text].

  52. Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP. Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. Jul 2007;56(7):2278-87. [Medline].

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

  54. Roddy E, Doherty M. Changing life-styles and osteoarthritis: what is the evidence?. Best Pract Res Clin Rheumatol. Feb 2006;20(1):81-97. [Medline].

  55. Perrot S, Poiraudeau S, Kabir M, Bertin P, Sichere P, Serrie A, et al. Active or passive pain coping strategies in hip and knee osteoarthritis? Results of a national survey of 4,719 patients in a primary care setting. Arthritis Rheum. Nov 15 2008;59(11):1555-62. [Medline].

  56. Anandacoomarasamy A, Leibman S, Smith G, et al. Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. Jan 2012;71(1):26-32. [Medline].

  57. McCarthy GM, McCarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol. Apr 1992;19(4):604-7. [Medline].

  58. [Best Evidence] Jan MH, Lin CH, Lin YF, Lin JJ, Lin DH. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil. Jun 2009;90(6):897-904. [Medline].

  59. [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].

  60. [Best Evidence] Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum. Nov 15 2009;61(11):1545-53. [Medline].

  61. Marks R, Allegrante JP. Chronic osteoarthritis and adherence to exercise: a review of the literature. J Aging Phys Act. Oct 2005;13(4):434-60. [Medline].

  62. Goldberg VM, Buckwalter JA. Hyaluronans in the treatment of osteoarthritis of the knee: evidence for disease-modifying activity. Osteoarthritis Cartilage. Mar 2005;13(3):216-24. [Medline].

  63. Stitik TP, Levy JA. Viscosupplementation (biosupplementation) for osteoarthritis. Am J Phys Med Rehabil. Nov 2006;85(11 Suppl):S32-50. [Medline].

  64. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. Apr 19 2006;CD005321. [Medline].

  65. Altman RD, Moskowitz R. Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatol. Nov 1998;25(11):2203-12. [Medline].

  66. Stitik TP, Blacksin MF, Stiskal DM, Kim JH, Foye PM, Schoenherr L, et al. Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain. Arch Phys Med Rehabil. Feb 2007;88(2):135-41. [Medline].

  67. Waddell DD, Kolomytkin OV, Dunn S, Marino AA. Hyaluronan suppresses IL-1beta-induced metalloproteinase activity from synovial tissue. Clin Orthop Relat Res. Dec 2007;465:241-8. [Medline].

  68. Liu H, Abbott J, Bee JA. Pulsed electromagnetic fields influence hyaline cartilage extracellular matrix composition without affecting molecular structure. Osteoarthritis Cartilage. Mar 1996;4(1):63-76. [Medline].

  69. Zizic TM, Hoffman KC, Holt PA, Hungerford DS, O'Dell JR, Jacobs MA, et al. The treatment of osteoarthritis of the knee with pulsed electrical stimulation. J Rheumatol. Sep 1995;22(9):1757-61. [Medline].

  70. Fukuda TY, Alves da Cunha R, Fukuda VO, et al. Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial. Phys Ther. Jul 2011;91(7):1009-17. [Medline].

  71. Ying KN, While A. Pain relief in osteoarthritis and rheumatoid arthritis: TENS. Br J Community Nurs. Aug 2007;12(8):364-71. [Medline].

  72. Selfe TK, Taylor AG. Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials. Fam Community Health. Jul-Sep 2008;31(3):247-54. [Medline]. [Full Text].

  73. Marx RG. Arthroscopic Surgery for Osteoarthritis of the Knee?. New England Journal of Medicine. 2008;Vol. 359:1169-1170. [Full Text].

  74. Barclay L, Nghiem HT. Arthroscopic Surgery May Not Be Helpful for Knee Osteoarthritis. Medscape. Available at http://www.medscape.com/viewarticle/580300. Accessed September 29, 2010.

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

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

  77. Kuo A, Ezzet KA, Patil S, Colwell CW Jr. Total hip arthroplasty in rapidly destructive osteoarthritis of the hip: a case series. HSS J. Sep 2009;5(2):117-9. [Medline]. [Full Text].

  78. Miller M, Stürmer T, Azrael D, Levin R, Solomon DH. Opioid analgesics and the risk of fractures in older adults with arthritis. J Am Geriatr Soc. Mar 2011;59(3):430-8. [Medline].

  79. Belhorn LR, Hess EV. Erosive osteoarthritis. Semin Arthritis Rheum. Apr 1993;22(5):298-306. [Medline].

  80. Kellgren JH, Moore R. Generalized osteoarthritis and Heberden's nodes. Br Med J. 1952;Vol 1:181-7.

  81. Zanetti M, Bruder E, Romero J, Hodler J. Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology. Jun 2000;215(3):835-40. [Medline].

 
Previous
Next
 
This radiograph demonstrates osteoarthritis of the right hip, including the finding of sclerosis at the superior aspect of the acetabulum. Frequently, osteoarthritis at the hip is a bilateral finding, but it may occur unilaterally in an individual who has a previous history of hip trauma that was confined to that one side.
Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.
This radiograph demonstrates osteoarthritis of the right hip, including the finding of sclerosis at the superior aspect of the acetabulum. Frequently, osteoarthritis at the hip is a bilateral finding, but it may occur unilaterally in an individual who has a previous history of hip trauma that was confined to that one side.
Arthroscopic view of a torn meniscus before (top) and after (bottom) removal of loose meniscal fragments.
Arthroscopic view of an arthritic knee.
Arthroscopic view of a knee after the removal of loose fragments of articular and meniscal cartilage.
Arthroscopic view of the removal of cartilaginous loose body.
Anteroposterior radiograph shows knee replacement in 1 knee and arthritis in the other, with medial joint-space narrowing and subchondral sclerosis.
Anteroposterior radiograph of the pelvis and hips shows an arthritic hip not treated surgically and a total hip replacement.
Anteroposterior radiograph obtained after knee replacement.
Lateral radiograph obtained after knee replacement (same patient as in the above image).
Oblique projection demonstrates gradual narrowing and sclerosis of the facet joints as one progresses down the lumbar spine.
Standing radiograph of the knee reveals narrowing of the medial and lateral femorotibial compartments with marginal osteophytes.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.