RESEARCH - Association of bone scintigraphic abnormalities with knee malalignment and pain

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Ann Rheum Dis. Published Online First: 3 November 2008.

doi:10.1136/ard.2008.094722

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Extended Report

Association of bone scintigraphic abnormalities with knee malalignment and pain

Virginia B Kraus 1*, Mc 1, Teddy W Worrell 2, Sheng Feng 3,

T Vail 4, Gabor Varju 5 and R 6

1 Duke University Medical Center, Department of Medicine, Durham, NC,

United States

2 Duke University Medical Center, Department of Physical Therapy,

Durham, NC, United States

3 Duke University Medical Center, Department of Bioinformatics,

Durham, NC, United States

4 Duke University Medical Center, Department of Surgery, Durham, NC,

United States

5 Department of Medicine, East Carolina University, Greenville, NC,

United States

6 Duke University Medical Center, Department of Radiology, Durham, NC,

United States

Abstract

Objective: We evaluated the information content of knee bone

scintigraphy, including pattern, localization and intensity of

retention relative to radiographic features of knee osteoarthritis

(rOA), knee alignment, and knee symptoms.

Methods: A total of 308 knees (159 subjects) with symptomatic and

radiographic knee OA (rOA) of at least one knee were assessed by late

phase technetium-99m-methylene disphosphonate bone scintigraph,

fixed-flexion knee radiograph, full limb radiograph for knee

alignment, and for self-reported knee symptom severity. Generalized

linear models were used to control for within subject correlation of

knee data.

Results: The compartmental localization (medial versus lateral) and

intensity of knee bone scan retention were associated with the pattern

(varus versus valgus) (p<0.001) and severity (p=0.0008) of knee

malalignment, and localization and severity of rOA (p<0.0001). Bone

scan agent retention in the tibiofemoral, but not patellofemoral

compartment, was associated with severity of knee symptoms (p=0.0009),

and persisted after adjusting for rOA (p=0.0012).

Conclusion: To our 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 as a sensitive and quantitative

indicator of symptomatic knee OA. Used selectively, bone scintigraphy

is a dynamic imaging modality that holds great promise as a clinical

trial screening tool and outcome measure.

http://ard.bmj.com/cgi/content/abstract/ard.2008.094722v1?papetoc

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