Is knee osteoarthritis a symmetrical disease? Analysis of a 12year prospective cohort study

Abstract

Background: The aim of this study was to document the development of bilateral knee osteoarthritis over a 12year period using a middle-aged population-based cohort with knee pain at inclusion. Methods. One hundred and forty three patients aged 35 to 54 were recruited from a population based cohort of 279 subjects who had knee pain at baseline and assessed with clinical and radiographic data, with 5 and 12year follow up. The data was analysed with regard to the development and progression of uni- and bilateral knee osteoarthritis over 12years. A definition of KL=1 was used to define radiographic disease. Results: 24 of the 30 (80%) patients with unilateral disease at baseline developed bilateral disease after 12years. At baseline 37 patients (26%) had bilateral disease, whereas that number increased to 65 (52%) at 5years and 100 (70%) at the 12year follow up. The most common pattern was medial compartment involvement in both knees. Six patients had lateral compartment disease in one knee and medial in the other whereas only two had lateral compartment disease bilaterally. Conclusions: Bilateral knee osteoarthritis is very common with time, as the majority of sufferers will eventually develop radiographic disease in both knees. Clinicians need to be aware of the joint at risk and researchers need to remember to account for both knees when assessing the relationship between physical function, pain and structural disease. The other knee should not be used for comparison, even if it appears to be normal at baseline. © 2012 Metcalfe et al.; licensee BioMed Central Ltd.