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-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.
-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. 
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<ref name="pmid7752134">{{cite journal |vauthors=Altman RD |title=The classification of osteoarthritis |journal=J Rheumatol Suppl |volume=43 |issue= |pages=42–3 |date=February 1995 |pmid=7752134 |doi= |url=}}</ref>
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{| class="wikitable sortable"
|+'''Classification for Subsets of Osteoarthritis'''
|+'''Classification for Subsets of Osteoarthritis'''

Revision as of 13:57, 3 June 2018

Osteoarthritis classification

Osteoarthritis Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Osteoarthritis from other Diseases

Epidemiology and Demographics

Risk Factors

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Diagnostic Criteria

History and Symptoms

Physical Examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou [2].

Overview

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:

  • Pain consisted of 5 items[1]:

-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[2]

Classification for Subsets of Osteoarthritis
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

[3][4] [5]

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, 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

[6]

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

References

  1. Menkes CJ (February 1991). "Radiographic criteria for classification of osteoarthritis". J Rheumatol Suppl. 27: 13–5. PMID 2027113.
  2. Altman RD (February 1995). "The classification of osteoarthritis". J Rheumatol Suppl. 43: 42–3. PMID 7752134.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
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