Association of bone scintigraphic abnormalities with knee malalignment and pain

• Published in: Annals of the rheumatic diseases Vol. 68; no. 11; pp. 1673 - 1679
• Main Authors: Kraus, V B, McDaniel, G, Worrell, T W, Feng, S, Vail, T P, Varju, G, Coleman, R E
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.11.2009; BMJ Publishing Group; Elsevier Limited
• Subjects: Aged; Arthritis; Biological and medical sciences; Bone Malalignment - complications; Bone Malalignment - diagnostic imaging; Cohort Studies; Diseases of the osteoarticular system; Female; Humans; Knee; Knee Joint - diagnostic imaging; Localization; Male; Medical sciences; Middle Aged; NMR; Nuclear magnetic resonance; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - etiology; Pain management; Pain Measurement; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Retention; Rheumatology; Severity of Illness Index; Technetium Tc 99m Medronate; Knee; Pain; Bone; Rheumatology
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/ard.2008.094722

Objective:The information content of knee bone scintigraphy was evaluated, including pattern, localisation and intensity of retention relative to radiographic features of knee osteoarthritis, knee alignment and knee symptoms.Methods:A total of 308 knees (159 subjects) with symptomatic and radiographic knee osteoarthritis of at least one knee was assessed by late-phase 99mTechnetium methylene disphosphonate bone scintigraph, fixed-flexion knee radiograph, full limb radiograph for knee alignment and for self-reported knee symptom severity. Generalised linear models were used to control for within-subject correlation of knee data.Results:The compartmental localisation (medial vs lateral) and intensity of knee bone scan retention were associated with the pattern (varus vs valgus) (p<0.001) and severity (p<0.001) of knee malalignment and localisation and severity of radiographic osteoarthritis (p<0.001). Bone scan agent retention in the tibiofemoral, but not patellofemoral, compartment was associated with severity of knee symptoms (p<0.001) and persisted after adjusting for radiographic osteoarthritis (p<0.001).Conclusion:To the authors’ knowledge, this is the first study describing a relationship between knee malalignment, joint symptom severity and compartment-specific abnormalities by bone scintigraphy. This work demonstrates that bone scintigraphy is a sensitive and quantitative indicator of symptomatic knee osteoarthritis. Used selectively, bone scintigraphy is a dynamic imaging modality that holds great promise as a clinical trial screening tool and outcome measure.