Osteoarthritis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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) and it is consists of 24 different items divided into 3 subtypes:

• Pain consisted of 5 items: staying in bed, sitting or lying, and standing. during 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 degree of joint involvement. The Kellgren-Lawrence is a common method to classify the severity of OA in knee using five different grades. This classification was proposed by Kellgren et al. in 1957 and then it was accepted by WHO in 1961. 

Classification for Subsets of Osteoarthritis

I: Idiopathic
	A: Localized
		1: Hands: Heberden’s and Bouchard’s nodes (nodal), erosive interphalangeai arthritis (nonnodal), scaphometacarpal 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: hemachromatosis, ochronosis, Gaucher’s disease, hemoglobinopathy, Ehlers-Danlos
	c. Calcium Deposition Disease	1. Calcium pyrophosphate deposition disease 2. Apatite atthropathy 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 joints) 3. Miscellaneous: frostbite, Kashin-Beck disease, Caisson’s disease

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) and it is consists of 24 different items divided into 3 subtypes:

• Pain consisted of 5 items: staying in bed, sitting or lying, and standing. during 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.

Knee

International Knee Documentation Committee (IKDC Questionnaire)

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

Merchant system: a 45° "skyline" view for the Patellofemoral join

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

Ahlbäck classification of osteoarthritis of the knee joint

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

Kellgren-Lawrence system

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

Tönnis classification

Grade	Description
0	No osteoarthritis signs
I (Mild)	Increased sclerosis, slight narrowing of the joint space, no or 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

Samilson-Prieto classification

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

Kellgren grading of cervical disc degeneration

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

Kellgren grading of cervical facet joint degeneration

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

Lane grading of lumbar disc degeneration

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	–

Thompson macroscopic grading of lumbar disc degeneration on sagittal sections using MRI

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

Pathria grading of lumbar facet joint degeneration

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)

Weishaupt Grading of lumbar facet joint degeneration using CT and MRI

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

Radiographic features Changes are usually more evident on the condylar side of the TMJ joint

flattening: common (in one series 27%)

osteophytes: common (27%)

erosions: 13%

sclerosis: less common (9%)

subchondral cysts

Ankle 

 Takakura Classification

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

Giannini Classification

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

Cheng Classification

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

Canadian Orthopedic Foot and Ankle Society (COFAS) classification

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 abductus or adductus, supinated midfoot, plantarflexed first ray, etc
IV	Types 1–3 plus subtalar, calcaneocuboid, or talonavicular arthritis

References

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References