Osteoarthritis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou [2].
Overview
Since OA can affect any joint in human body. there several different classification system based on the involved joint and its location.
Classification
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is used to evaluate the pain, stiffness, and physical function among patients with hip or/and knee osteoarthritis (OA). It consists of 24 different items divided into 3 subtypes[1][2]:
- Pain consisted of 5 items:
-Staying in bed, sitting or lying, standing, walking, and using stairs.
- Stiffness consisted of 2 items:
-After waking up in morning and later in the day.
- Physical Function consisted of 17 items:
-Using stairs, sitting, rising from sitting, standing, bending, walking, getting in and/or getting out of a car, during shopping, heavy household duties, light household duties, putting on/taking off socks, lying in bed, rising from bed, getting in and/or getting out of bath, getting on/off toilet.
Osteoarthritis is radiographically classified depending on the degree of joint involvement. The Kellgren-Lawrence is a common method to classify the severity of OA in the knee using five different grades. This classification was proposed by Kellgren et al. in 1957 and then it was accepted by WHO in 1961[3].
| I: Idiopathic | |||
|---|---|---|---|
| A: Localized | |||
| 1: Hands: Heberden’s and Bouchard’s nodes (nodal), erosive interphalangeal arthritis (nonnodal), carpometacarpal joint, scaphotrapezial | |||
| 2. Feet: Hallux valgus, hallux rigidus, contracted toes (hammer/cockup toes), talonavicular | |||
| 3. Knee | a. Medial compartment
b. Lateral compartment c. Patellofemoral compartment (chondromalacia) | ||
| 4. Hip | a. Eccentric (superior)
b. Concentric (axial, medial) c. Diffuse (coxae senilis) | ||
| 5. Spine (particularly cervical and lumbar) | a. Apophyseal
b. Intervertebral (disc) c. Spondylosis (osteophytes) d. Ligamentous (hyperostosis [Forestier’s disease or DISH]) | ||
| 6. Other single sites: shoulder, temporomandibular, sacroiliac, ankle, wrist, acromioclavicular | |||
| B. Generalized: includes 3 or more areas listed above (Kellgren-Moore) | 1. Small (peripheral) and spine
2. Large (central) and spine 3. Mixed (peripheral and central) and spine |
||
| II. Secondary | |||
| A. Posttraumatic | |||
| B. Congenital or Developmental Diseases | 1. Localized | a. Hip diseases: Legg-Calve-Perthes, congenital hip dislocation, slipped capital femoral epiphysis, shallow acetabulum
b. Mechanical and local factors: obesity (7), unequal lower extremity length, extreme valgus/varus deformity, hypermobility syndromes, scoliosis | |
| 2. Generalized | a. Bone dysplasias: epiphyseal dysplasia, spondyloapophyseal dysplasia
b. Metabolic diseases: hemochromatosis, ochronosis, Gaucher’s disease, hemoglobinopathy, Ehlers-Danlos | ||
| c. Calcium Deposition Disease | 1. Calcium pyrophosphate deposition disease
2. Apatite arthropathy 3. Destructive arthropathy (shoulder, knee) |
||
| D. Other Bone and Joint Disorders: avascular necrosis, rheumatoid arthritis, gouty arthritis, septic arthritis, Paget’s disease, osteopetrosis, osteochondritis | |||
| E. Other Diseases | 1. Endocrine diseases: diabetes mellitus, acromegaly, hypothyroidism, hyperparathyroidism
2. Neuropathic arthropathy (Charcot's joints) 3. Miscellaneous: frostbite, Kashin-Beck disease, Caisson’s disease |
Knee
| Grade | Description |
|---|---|
| A | No joint space narrowing (JSN) |
| B | >4 mm joint space; small osteophytes, slight sclerosis, or femoral condyle flattening |
| C | 2-4 mm joint space |
| D | <2 mm joint space |
| Grade | Description |
|---|---|
| I (mild) | Patellofemoral joint space > 3mm |
| II (moderate) | Joint space < 3 mm but no bony contact |
| III(severe) | Bony surfaces in contact over less than one-quarter of the joint surface |
| IV (very severe) | Bony contact throughout the entire joint surface |
| Grade | Description |
|---|---|
| 0 | Normal |
| 1 | Joint space narrowing is <3 mm of the joint space or <50% of the other compartment (with or without subchondral sclerosis) |
| 2 | Obliteration of joint space |
| 3 | Bone defect/loss <5 mm |
| 4 | Bone defect and/or loss 5-10 mm |
Hip
| Grade | Description |
|---|---|
| 0 | No joint space narrowing (JSN) or reactive changes |
| I | Doubtful JSN, possible osteophytic lipping |
| II | Definite osteophytes, possible JSN |
| III | Moderate osteophytes, definite JSN, some sclerosis, possible bone-end deformity |
| IV | Large osteophytes, marked JSN, severe sclerosis, definite bone ends deformity |
| Grade | Description |
|---|---|
| 0 | No osteoarthritis signs |
| I (Mild) | Increased sclerosis, the slight narrowing of the joint space, slight loss of head sphericity or lipping at the joint margins |
| II (Moderate) | Small cysts, moderate narrowing of the joint space, moderate loss of head sphericity |
| III (Severe) | Large cysts, severe narrowing or obliteration of the joint space, severe deformity of the head |
Shoulder
| Grade | Description |
|---|---|
| I | Inferior humeral or glenoid exostosis, or both, measuring less than 3 mm in height. |
| II | Inferior humeral or glenoid exostosis, or both, between 3 and 7 mm in height, with slight glenohumeral joint irregularity. |
| III | Inferior humeral or glenoid exostosis, or both, more than 7 mm in height, with narrowing of the glenohumeral joint and sclerosis |
Vertebral column
| Grade | Description |
|---|---|
| I | Minimal anterior osteophytosis |
| II | Definite anterior osteophytosis with possible narrowing of the disc space and some sclerosis of vertebral plates |
| III | Moderate narrowing of the disc space with definite sclerosis of vertebral plates and osteophytosis |
| IV | Severe narrowing of the disc space with sclerosis of vertebral plates and multiple large osteophytes |
| Grade | Description |
|---|---|
| 1 | Doubtful osteophytes on margins of the articular facets of apophyseal joints |
| 2 | Definite osteophytes and subchondral sclerosis in apophyseal joints |
| 3 | Moderate osteophytes, subchondral sclerosis and some irregularity of articular facets |
| 4 | Many large osteophytes and severe sclerosis and irregularity of the apophyseal joints |
| Grade | Joint space narrowing | Osteophytes anterior and posterior | Sclerosis |
|---|---|---|---|
| 0 | None | None | None |
| I | Definite (mild) narrowing | Small | Present |
| II | Moderate | Moderate | – |
| III | Severe (complete loss of joint space) | Large | – |
| Grade | Nucleus | Anulus | Endplate | Vertebral body |
|---|---|---|---|---|
| I | Bulging gel | Discrete fibrous laminae | Hyaline, uniform thickness | Rounded margins |
| II | Peripheral white fibrous tissue | Mucinous material between laminae | Irregular thickness | Pointed margins |
| III | Consolidated fibrous tissue | Extensive mucinous infiltration; loss of annular-nuclear demarcation | Focal defects in cartilage | Small chondrophytes or osteophytes at margins |
| IV | Horizontal clefts parallel to endplate | Focal disruptions | Fibrocartilage extending from subchondral bone; irregularity and focal sclerosis in subchondral bone | Osteophytes smaller than 2 mm |
| V | Clefts extended through nucleus and annulus | Diffuse sclerosis | Osteophytes greater than 2 mm |
| Grade | Description |
|---|---|
| 0 | Normal |
| I | Joint space narrowing (mild degenerative disease) |
| II | Narrowing plus sclerosis or hypertrophy (moderate degenerative disease) |
| III | Severe osteoarthrosis with narrowing, sclerosis, and osteophytes (severe degenerative disease) |
| Grade | Description |
|---|---|
| 0 | Normal facet joint space (2–4 mm width) |
| I | Narrowing of the facet joint space (<2 mm) and/or small osteophytes and/or mild hypertrophy of the articular process |
| II | Narrowing of the facet joint space and/or moderate osteophytes and/or moderate hypertrophy of the articular process and/or mild subarticular bone erosions |
| III | Narrowing of the facet joint space and/or large osteophytes and/or severe hypertrophy of the articular process and/or severe subarticular bone erosions and/or subchondral cysts |
Temporomandibular joint
| flattening: common (in one series 27%) |
| osteophytes: common (27%) |
| erosions: 13% |
| sclerosis: less common (9%) |
| subchondral cysts |
Ankle
| Grade | Description |
| I | Early sclerosis and osteophyte formation, no joint space narrowing |
| II | Narrowing of medial joint space (no subchondral bone contact) |
| IIIA | Obliteration of joint space at the medial malleolus, with subchondral bone contact |
| IIIB | Obliteration of joint space over roof of talar dome, with subchondral bone contact |
| IV | Obliteration of joint space with complete bone contact |
| Grade | Description |
| 0 | Normal joint or subchondral sclerosis |
| I | Presence of osteophytes without joint-space narrowing |
| II | Joint-space narrowing with or without osteophytes |
| III | Subtotal or total disappearance or deformation of joint space |
| Grade | Description |
| 0 | No reduction of the joint space
Normal alignment |
| I | Slight reduction of the joint space
Slight formation of deposits at the joint margins Normal alignment |
| II | More pronounced change than mentioned above
Subchondral osseous sclerotic configuration Mild malalignment |
| III | Joint space reduced to about half the height of the uninjured side
Rather pronounced formation of deposits Obvious varus or valgus alignment |
| IV | Joint space has completely or practically disappeared |
| Grade | Description |
| I | Isolated ankle arthritis |
| II | Ankle arthritis with intra-articular varus or valgus deformity or a tight heel cord, or both |
| III | Ankle arthritis with hindfoot deformity, tibial malunion, midfoot abducts or adducts, supinated midfoot, plantarflexed first ray, etc |
| IV | Types 1–3 plus subtalar, calcaneocuboid, or talonavicular arthritis |
References
- ↑ Menkes CJ (February 1991). "Radiographic criteria for classification of osteoarthritis". J Rheumatol Suppl. 27: 13–5. PMID 2027113.
- ↑ Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, Carr AJ (July 2015). "Osteoarthritis". Lancet. 386 (9991): 376–87. doi:10.1016/S0140-6736(14)60802-3. PMID 25748615.
- ↑ Altman RD (February 1995). "The classification of osteoarthritis". J Rheumatol Suppl. 43: 42–3. PMID 7752134.
- ↑ Wright RW (July 2014). "Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation". J Bone Joint Surg Am. 96 (14): 1145–1151. doi:10.2106/JBJS.M.00929. PMC 4083772. PMID 25031368.
- ↑ Dell'Isola A, Steultjens M (2018). "Classification of patients with knee osteoarthritis in clinical phenotypes: Data from the osteoarthritis initiative". PLoS ONE. 13 (1): e0191045. doi:10.1371/journal.pone.0191045. PMC 5766143. PMID 29329325.
- ↑ Luyten FP, Bierma-Zeinstra S, Dell'Accio F, Kraus VB, Nakata K, Sekiya I, Arden NK, Lohmander LS (February 2018). "Toward classification criteria for early osteoarthritis of the knee". Semin. Arthritis Rheum. 47 (4): 457–463. doi:10.1016/j.semarthrit.2017.08.006. PMID 28917712.
- ↑ Falez F, Casella F, Papalia M (March 2015). "Current concepts, classification, and results in short stem hip arthroplasty". Orthopedics. 38 (3 Suppl): S6–13. doi:10.3928/01477447-20150215-50. PMID 25826635.
- ↑ Lee S, Nardo L, Kumar D, Wyatt CR, Souza RB, Lynch J, McCulloch CE, Majumdar S, Lane NE, Link TM (June 2015). "Scoring hip osteoarthritis with MRI (SHOMRI): A whole joint osteoarthritis evaluation system". J Magn Reson Imaging. 41 (6): 1549–57. doi:10.1002/jmri.24722. PMC 4336224. PMID 25139720.
- ↑ Steinhoff H, Lieutenant K, Schlitter J (1989). "Residual motion of hemoglobin-bound spin labels as a probe for protein dynamics". Z. Naturforsch., C, J. Biosci. 44 (3–4): 280–8. PMID 2545217.
- ↑ Walch G, Boulahia A, Boileau P, Kempf JF (1998). "Primary glenohumeral osteoarthritis: clinical and radiographic classification. The Aequalis Group". Acta Orthop Belg. 64 Suppl 2: 46–52. PMID 9922529.
- ↑ Lakshmanan P, Jones A, Howes J, Lyons K (February 2005). "CT evaluation of the pattern of odontoid fractures in the elderly--relationship to upper cervical spine osteoarthritis". Eur Spine J. 14 (1): 78–83. doi:10.1007/s00586-004-0743-z. PMC 3476682. PMID 15723251.
- ↑ Kanai H, Igarashi M, Yamamoto S (February 2002). "Vertebral body fracture of the lumbar spine in elderly women: more severe in osteoarthritis of the knee than in femoral neck fracture". Orthopedics. 25 (2): 163–7. PMID 11866149.
- ↑ Junker S, Krumbholz G, Frommer KW, Rehart S, Steinmeyer J, Rickert M, Schett G, Müller-Ladner U, Neumann E (January 2016). "Differentiation of osteophyte types in osteoarthritis - proposal of a histological classification". Joint Bone Spine. 83 (1): 63–7. doi:10.1016/j.jbspin.2015.04.008. PMID 26076655.
- ↑ Rutges JP, Duit RA, Kummer JA, Bekkers JE, Oner FC, Castelein RM, Dhert WJ, Creemers LB (December 2013). "A validated new histological classification for intervertebral disc degeneration". Osteoarthr. Cartil. 21 (12): 2039–47. doi:10.1016/j.joca.2013.10.001. PMID 24120397.
- ↑ Wang XD, Zhang JN, Gan YH, Zhou YH (May 2015). "Current understanding of pathogenesis and treatment of TMJ osteoarthritis". J. Dent. Res. 94 (5): 666–73. doi:10.1177/0022034515574770. PMID 25744069.
- ↑ Su N, Liu Y, Yang X, Luo Z, Shi Z (October 2014). "Correlation between bony changes measured with cone beam computed tomography and clinical dysfunction index in patients with temporomandibular joint osteoarthritis". J Craniomaxillofac Surg. 42 (7): 1402–7. doi:10.1016/j.jcms.2014.04.001. PMID 24864071.
- ↑ Nüesch C, Valderrabano V, Huber C, von Tscharner V, Pagenstert G (July 2012). "Gait patterns of asymmetric ankle osteoarthritis patients". Clin Biomech (Bristol, Avon). 27 (6): 613–8. doi:10.1016/j.clinbiomech.2011.12.016. PMID 22261013.
- ↑ Claessen FM, Meijer DT, van den Bekerom MP, Gevers Deynoot BD, Mallee WH, Doornberg JN, van Dijk CN (April 2016). "Reliability of classification for post-traumatic ankle osteoarthritis". Knee Surg Sports Traumatol Arthrosc. 24 (4): 1332–7. doi:10.1007/s00167-015-3871-6. PMC 4823329. PMID 26611896.
- ↑ Barg A, Pagenstert GI, Hügle T, Gloyer M, Wiewiorski M, Henninger HB, Valderrabano V (September 2013). "Ankle osteoarthritis: etiology, diagnostics, and classification". Foot Ankle Clin. 18 (3): 411–26. doi:10.1016/j.fcl.2013.06.001. PMID 24008208.