CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Extended report

Association of bone scintigraphic abnormalities with knee malalignment and pain

V B Kraus¹, G McDaniel¹, T W Worrell², S Feng⁴, T P Vail³, G Varju⁶, R E Coleman⁵

¹ Duke University Medical Center, Departments of Medicine, Durham, North Carolina, USA
² Duke University Medical Center, Departments of Physical Therapy, Durham, North Carolina, USA
³ Duke University Medical Center, Departments of Surgery, Durham, North Carolina, USA
⁴ Duke University Medical Center, Departments of Bioinformatics, Durham, North Carolina, USA
⁵ Duke University Medical Center, Departments of Radiology, Durham, North Carolina, USA
⁶ Department of Medicine, East Carolina University, Greenville, North Carolina, USA

^{Correspondence to} Dr V B Kraus, Box 3416, Duke University Medical Center, Durham, NC 27710, USA; vbk{at}acpub.duke.edu

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.

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