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What is the predictive value of MRI for the occurrence of knee replacement surgery in knee osteoarthritis?
  1. J-P Pelletier1,
  2. C Cooper2,3,
  3. C Peterfy4,
  4. J-Y Reginster5,
  5. M-L Brandi6,
  6. O Bruyère5,
  7. R Chapurlat7,
  8. F Cicuttini8,
  9. P G Conaghan9,
  10. M Doherty10,
  11. H Genant11,
  12. G Giacovelli12,
  13. M C Hochberg13,
  14. D J Hunter14,
  15. J A Kanis15,
  16. M Kloppenburg16,
  17. J-D Laredo17,
  18. T McAlindon18,
  19. M Nevitt19,
  20. J-P Raynauld1,
  21. R Rizzoli20,
  22. C Zilkens21,
  23. F W Roemer22,23,
  24. J Martel-Pelletier1,
  25. A Guermazi23
  1. 1Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
  2. 2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  3. 3NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
  4. 4Spire Sciences, LLC, San Francisco, California, USA
  5. 5Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
  6. 6Metabolic Bone Unit, Department of Internal Medicine, University of Florence, Florence, Italy
  7. 7Service de Rhumatologie et Pathologie Osseuse, INSERM UMR 1033 and Université de Lyon, Hôpital Edouard Herriot, Lyon, France
  8. 8School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  9. 9Division of Musculoskeletal Disease, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
  10. 10Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK
  11. 11Departments of Radiology, Medicine, Epidemiology and Orthopedic Surgery, University of California, San Francisco, California, USA
  12. 12Clinical Research Unit, Rottapharm|Madaus Group, Monza, Italy
  13. 13Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
  14. 14Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
  15. 15WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
  16. 16Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  17. 17Department of Radiology, Bone and Joint Imaging Unit, Lariboisière Hospital, Assistance publique des hôpitaux de Paris and Université Paris-Diderot, Paris, France
  18. 18Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA
  19. 19Department of Epidemiology and Biostatistics, OAI Coordinating Center, University of California, San Francisco, California, USA
  20. 20Division of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
  21. 21Medical Faculty, Department of Orthopaedic Surgery, University of Dusseldorf, Dusseldorf, Germany
  22. 22Department of Radiology, University of Erlangen, Erlangen, Germany
  23. 23Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Professor J-P Pelletier, Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, 1560 Sherbrooke Street East, Montreal, Quebec, Canada H2L 4M1; dr{at}


Knee osteoarthritis is associated with structural changes in the joint. Despite its many drawbacks, radiography is the current standard for evaluating joint structure in trials of potential disease-modifying osteoarthritis drugs. MRI is a non-invasive alternative that provides comprehensive imaging of the whole joint. Frequently used MRI measurements in knee osteoarthritis are cartilage volume and thickness; others include synovitis, synovial fluid effusions, bone marrow lesions (BML) and meniscal damage. Joint replacement is considered a clinically relevant outcome in knee osteoarthritis; however, its utility in clinical trials is limited. An alternative is virtual knee replacement on the basis of symptoms and structural damage. MRI may prove to be a good alternative to radiography in definitions of knee replacement. One of the MRI parameters that predicts knee replacement is medial compartment cartilage volume/thickness, which correlates with radiographic joint space width, is sensitive to change, and predicts outcomes in a continuous manner. Other MRI parameters include BML and meniscal lesions. MRI appears to be a viable alternative to radiography for the evaluation of structural changes in knee osteoarthritis and prediction of joint replacement.

  • Knee Osteoarthritis
  • Magnetic Resonance Imaging
  • Outcomes research

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