Is Indian osteoarthritis different? Emerging scenarios of disease pattern and implications for diagnosis and treatment of osteoarthritis in India
Keywords:Knee osteoarthritis, Cartogram, Radiology, Wear, Femoral, Tibial, Cartilage
Background: There are many studies to show comparative cartilage wear of medial and lateral compartment of knee. However, there are no studies in Indians that compare relative cartilage loss between femur and tibia.
Methods: 44 patients with osteoarthritic knee at our center were posted for operative intervention in the form of partial or total knee arthroplasty and included in this study. Each patient had an magnetic resonance imaging (MRI) (cartogram) and weight bearing X-rays of the same knee. Intraoperative qualitative cartilage loss both femoral and tibial surfaces was observed and confirmed with preop findings of cartilage loss on X-ray or MRI.
Results: The wear/loss of cartilage in 44 patients in femur is approximately twice that of tibia.
Conclusions: Femoral cartilage loss is significantly more than tibia in Indians. These findings carry significance of not waiting for bone on bone arthritis to consider active treatment for Indian osteoarthritis patients. Bone on bone arthritis has so far been considered the litmus test for any intervention for osteoarthritis, even in India. Specific attention should rather be given to the femoral condyle clinically and radiologically. The authors have already described “The Dervan RIM sign” for the same purpose. The wear pattern is different from Caucasians and focus cannot be on joint space narrowing which is only with equally prevalent tibial and femoral cartilage wear.
Yelin E, Callahan LF. The economic cost and social and psychological impact of musculoskeletal conditions. National Arthritis Data Work Groups. Arthritis Rheum. 1995;38:1351-62.
Creamer P, Hochberg MC. Osteoarthritis. Lancet. 1997;350:503-8.
Peterfy CG, van Dijke CF, Janzen DL, Gluer CC, Namba R, Majumdar S, et al. Quantification of articular cartilage in the knee with pulsed saturation transfer subtraction and fat-suppressed MR imaging: optimization and validation. Radiology. 1994;192:485-91.
Graichen H, Rothe ER, Vogl T, Englmeier KH, Eckstein F. Quantitative assessment of cartilage status in osteoarthritis by quantitative magnetic resonance imaging: technical validation for use in analysis of cartilage volume and further morphologic parameters. Arthritis Rheum. 2004;50:811-16.
Burgkart R, Glaser C, Durr HA, Englmeier KH, Reiser M, Eckstein F. Magnetic resonance imaging-based assessment of cartilage loss in severe osteoarthritis: accuracy, precision, and diagnostic value. Arthritis Rheum. 2001;44:2072-7.
Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman BN, Aliabadi P, et al. The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1995;38:1500-5.
Doherty M. Risk factors for progression of knee osteoarthritis. Lancet. 2001;358:775-6.
Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role ofknee alignment in disease progression and functional decline in kneeosteoarthritis. JAMA. 2001;286:188-95.
Cicuttini F, Wluka A, Hankin J, Wang Y. Longitudinal study of the relationship between knee angle and tibiofemoral cartilage volume in subjects with knee osteoarthritis. Rheumatology (Oxford). 2004;43:321-4.
Sharma L, Lou C, Cahue S, Dunlop DD. The mechanism of the effect of obesity in knee osteoarthritis: the mediating role of malalignment. Arthritis Rheum. 2000;43:568-75.
Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494-502.
Ahlback S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Stockholm. 1968;277:7-72.
Kohli P, Chavan S, Nawale A, Gulati M, Nadkarni S. Dervan Rim sign - New, Simple Radiological sign for unique Indian medial Femoral condylar Osteoarthritis. IJOS. 2018;4(4):654-7
Frobell RB, Nevitt MC, Hudelmaier M. Femorotibial subchondral bone area and regional cartilage thickness: a cross-sectional description in healthy reference cases and various radiographic stages of osteoarthritis in 1003 knees from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2010;62(1):1612-23.
Frobell RB, Graverand MPL, Buck R. The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year. Osteoarthritis Cartilage. 2009;17(2):161-7.
Eckstein F, Burstein D, Link TM. Quantitative MRI of cartilage and bone: degenerative changes in osteoarthritis. NMR in Biomedicine. 2006;19(7):822-54.
Eckstein F, Cicuttini F, Raynauld JP, Waterton JC, Peterfy C. Magnetic resonance imaging (MRI) of articular cartilage in knee osteoarthritis (OA): morphological assessment. Osteoarthritis Cartilage. 2006;14(1):46-75.
Eckstein F, Guermazi A, Roemer FW. Quantitative MR imaging of cartilage and trabecular bone in osteoarthritis. Radiologic Clin North America. 2009;47(4):655-73.
Eckstein F, Ateshian G, Burgkart R. Proposal for a nomenclature for Magnetic Resonance Imaging based measures of articular cartilage in osteoarthritis. Osteoarthritis Cartilage. 2006;14(10):974-83.
Eckstein F, Maschek S, Wirth W. One year change of knee cartilage morphology in the first release of participants from the Osteoarthritis Initiative progression sub cohort: association with sex, body mass index, symptoms and radiographic osteoarthritis status. Annals Rheumatic Dis. 2009;68(5):674-9.
Eckstein F, Wirth W, Hudelmaier M. Patterns of femorotibial cartilage loss in knees with neutral, varus, and valgus alignment. Arthritis Care Res. 2008;59(1):1563-70.
Eckstein F, Benichou O, Wirth W. Magnetic resonance imaging-based cartilage loss in painful contralateral knees with and without radiographic joint space narrowing: data from the osteoarthritis initiative. Arthritis Care Res. 2009;61(9):1218–25.
Eckstein F, Mosher T, Hunter D. Imaging of knee osteoarthritis: data beyond the beauty. Current Opinion Rheu. 2007;19(5):435-43.
Eckstein F, Hudelmaier M, Cahue S, Marshall M, Sharma L. Medial-to-lateral ratio of tibiofemoral subchondral bone area is adapted to alignment and mechanical load. Calcified Tissue Int. 2009;84(3):186-94.
Eckstein F, Wirth W, Hunter DJ. Magnitude and regional distribution of cartilage loss associated with grades of joint space narrowing in radiographic osteoarthritis: data from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage. 2010;18(6):760-8.
Eckstein F, Muller S, Faber SC, Englmeier KH, Reiser M, Putz R. Side differences of knee joint cartilage volume, thickness, and surface area, and correlation with lower limb dominance: an MRI-based study. Osteoarthritis Cartilage. 2002;10(12):914-21.
Eckstein F. Interindividual variability and correlation among morphological parameters of knee joint cartilage plate: analysis with three-dimension MR imagine. Osteoarthris Cartilage; 2001.
Seungbum K. Morphology and thickness in tibial and femoral cartilage at the knee is influenced by the mechanics of walking. Summer Bioengineering Conference. 2003; 857-8.
Hada S. The degeneration and destruction of femoral articular cartilage shows a greater degree of deterioration than that of the tibial and patellar articular cartilage in early stage knee osteoarthritis: a cross-sectional study. Osteoarthritis Cartilage. 2014;22(10):1583-9.
Valente G. Influence of weak hip abductor muscles on joint contact forces during normal walking: probabilistic modeling analysis. J Biomech. 2013;46(13):2186-93.