Osteoarthritic Knee

2. University of Medical Technology
Yangon, Myanmar

3. 1. Introduction
2. Gross Anatomy of Knee Joint
3. Osteoarthritis
4. Imaging Procedure
5. Measuring Methods
6. Bony Measurements in Osteoarthritic Knee
7. Conclusion
8. References

4. Are You Suffering from Knee Pain ?
Your Parents ?
Your Relatives ?

5. • Some degenerative changes in bones and joints make the
elderly suffer for long period of time, especially knee
pain.
• Although there are numerous causes of knee pain,
Osteoarthritis becomes an increasing and highly
prevalent problem.
• Affects not only on older persons, also on everyone.
• For the patients suffering from knee pain, generally,
plain X-ray examination is the first investigation
method.
1. Introduction

6. • On the AP projection of knee joint, the standard
radiological signs of osteoarthritis;
-joint space narrowing
-sclerosis of subchondral bone
-osteophytes and
-subchondral cyst formation

7. • This presentation focuses on-
(1) the sharpening degrees of the tubercles of the
intercondylar eminence of the tibial plateau
(2) the changes in the ratios of tubercle height to width
of tibial plateau in osteoarthritic knee
• According to sex distribution, age distribution and on the
affected side in Myanmar

8.  Largest synovial joint in the body
 Kind of weight bearing joint
 Two condylar joints between femur and tibia
 A sellar (saddle) joint between patella and femur
 Major surfaces –(1)two femoral condyles
(2)the adjacent surfaces of the superior
aspect of the tibial condyles
2. Gross Anatomy of Knee Joint

9.  Upper end of the tibia consists of two large condyles with
joint surface superiorly for articulation with the femur
 Larger medial tibial condyle - superior surface is concave
in all directions
 Smaller lateral tibial condyle - convex anteroposteriorly

10. 3. Osteoarthritis @ Osteoarthrosis
 Most common degenerative disease
 Caused by cartilage breakdown and
subsequent bony changes of the joints
 A leading cause of disability among the elderly, even to
young age
 Most Common in Women

11. Joints Commonly Affected by Osteoarthritis
Ref: Francesco Priolo. (2002). Bones and Joint Imaging in Rheumatic and Orthopedic
Diseases. Italy: GPAnet,

12. Types of Osteoarthritis
Primary OA - Idiopathic Secondary OA - Posttraumatic
Some Factors:
genetic factors,
hormonal factors,
nutritional factors
biological age
•Developmental, e.g. hip dysplasia,
unequal leg lengths, etc.
•Inflammatory, e.g. rheumatoid
arthritis , spondyloarthropathies
•Infective, e.g. septic arthritis
•Metabolic, e.g. gout, pseudo-gout
•Traumatic or neuropathic
•Occupational (miners, sportsmen)
•Hypermobility syndrome
•Endocrine, e.g. acromegaly

13. OA Risk Factors
 Excess weight
 Injury
 Certain occupations (Farmers, jackhammer operators,
and mill workers)
 Congenital or developmental deformities
 Hormonal Changes

14.  Weak thigh muscles (Weak Quadriceps)
 Genetic factors
 Other diseases changing cartilage structure (RA, gout,
pseudogout, and hemochromatosis)
 Low intake of Vitamin C and D

15. Signs and Symptoms
Pain
Swelling
Decrease in motion at the joint
Stiffness
Formation of bone spurs
Loss of full knee extension

16. Standard Radiological Signs of Osteoarthritis
Joint space narrowing
Spiking of the tibial tubercles
Sclerosis of subchondral bone
Osteophytes
Subchondral cyst formation

17. Methods to Examine Knee Osteoarthritis
Physical examination
Imaging methods
 Conventional radiography
 Knee arthrography
 Ultrasound
 Radionuclide scintigraphy
 CT scan
 MRI
Laboratory tests

18. 4. Knee Joint (AP)Imaging Procedure
 Patient Position
 supine on the table, the legs fully extended
 without rotation of pelvis
 Internal Rotation 3 to 5 degrees for a true AP knee

19. Central Ray
Central ray parallel to articular facets (tibial
plateau)
Perpendicular to image receptor
Center to a point 0.5 inches (1.25 cm) distal
to apex of patella
Source to image receptor (SID)
 Minimum SID - 40 inches
Collimation
 Four-sided collimation to the area of interest

20. Shielding
Gonadal shielding over reproductive area

21. Knee Joint AP Radiographs
L

22. Criteria for Data Collection
Inclusion Criteria Exclusion Criteria
OA knee patients over
the age of 40-year
Patients with operative
knee joint and history of
trauma
Patients with knee pain
due to infection

23. 5. Measuring Methods
To measure the spiking of the tubercles of the
intercondylar eminence of tibial plateau
M° = the angle between the lines intersecting at
the tip of the medial tubercle
L° = the angle between the lines intersecting at
the tip of the lateral tubercle

24. To calculate the ratios of height of tubercle to
width of tibial plateau
Medial Ratio (MR) = MH : w
Lateral Ratio (LR) = LH : w

25. 6. Bony Measurements in OA Knee
Mean SD Minimum Median Maximum
M° 88.00 16.95 51 88 138
L° 96.07 18.58 50 95 141
Angulations of Tubercles
Ratio of Tubercle Height to Tibial Width
Mean SD Minimum Median Maximum
MR 0.15 0.10 0.01 0.14 0.90
LR 0.13 0.02 0.07 0.13 0.18
Mean Age of Osteoarthritic Knee
Mean SD Maximum Minimum
Age 55.07 12.75 90 40

26. Angulation in Age Distribution
Age Group M° L°
40-49years 90.74° 90.26°
50-59years 94.33° 101.10°
60-69years 77.07° 98.80°
70-80years 84.47° 94.94°
0
50
100
150
40-49
years
50-59
years
60-69
years
70-80
years
DegreeofTubercle
Spiking
Age Group
Angulation in Age Distribution
M°
L°

27. Ratio of Tubercle Height to Tibial Width in Age Distribution
Age Group MR LR
40-49years 0.13 0.12
50-59years 0.13 0.12
60-69years 0.15 0.13
70-80years 0.24 0.14
0.1
0.15
0.2
0.25
0.3
40-49 years 50-59 years 60-69 years 70-80 years
Ratio of Tubercle Height to Tibial Width in
Age Distribution
MR
LR

28. Osteoarthritis in Sex Distribution
Sex No of Patient Percentage
Male 20 29.9
Female 47 70.1
Total 67 100.0
Male,
29.90%
Female,
70.10%
Osteoarthritic Knee in Sex Distribution

29. Osteoarthritis in Age Distribution
Age Group No of Patient Percentage
40-49years 23 34.3
50-59years 21 31.3
60-69years 15 22.4
70-80years 8 12.0
Total 67 100.0 P=0.954
34%
31%
23%
12%
Osteoarthritis in Age Distribution
40-49years
50-59years
60-69years
70-80years

30. Affected Side in Sex Distribution
Sex Left Percentage Right Percentage
Male 11 33.33 9 26.47
Female 22 66.67 25 73.53
Total 33 100 34 100
33.33%
26.47%
66.67%
73.53%
Left Right
Affected Side in Sex Distribution
Male Female

31. 7. Conclusion
In osteoarthritic knee joint,
• Medial tubercle spike - 88.00 ± 16.95°
• Lateral tubercle spike - 96.07 ± 18.58°
• Medial ratio - 0.15
• Lateral ratio - 0.13
• Medial tubercle and Lateral Ratio is more affected by OA
changes
• Greatest incidence - 40-49 years of age
• Mean Age - 55.07 ± 12.75

32. • Disease occurrence - Higher in Female
• Affected Side - Right in Female
- Left in Male
• the sharpening of tubercles of the intercondylar eminence
of the tibial plateau
• the ratio changes of tubercle height to tibial width are
Radiological Features in Osteoarthritis of the Knee Joint

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