Denuded subchondral bone and knee pain in persons with knee osteoarthritis

Authors

  • Kirsten Moisio,

    1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Felix Eckstein,

    1. Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria, and Chondrometrics, Ainring, Germany
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    • Dr. Eckstein has received consulting fees, speaking fees, and/or honoraria from Wyeth, Novo Nordisk, Novartis, and Biosyntech (less than $10,000 each) and from Pfizer, Merck Serono, and Medtronic (more than $10,000 each), and owns stock or stock options in Chondrometrics, Germany.

  • Joan S. Chmiel,

    1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Ali Guermazi,

    1. Boston University Medical Center, Boston, Massachusetts
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    • Dr. Guermazi has received consulting fees, speaking fees, and/or honoraria from Facet Solutions, Genzyme, and Stryker (less than $10,000 each) and from Merck Serono (more than $10,000), owns stock or stock options in Synarc, and is President of Boston Imaging Core Lab.

  • Pottumarthi Prasad,

    1. North Shore University Health Systems, Evanston, Illinois
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  • Orit Almagor,

    1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Jing Song,

    1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Dorothy Dunlop,

    1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Martin Hudelmaier,

    1. Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria, and Chondrometrics, Ainring, Germany
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  • Ami Kothari,

    1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Leena Sharma

    Corresponding author
    1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois
    • Division of Rheumatology, Feinberg School of Medicine, Northwestern University, 240 East Huron, M300, Chicago, IL 60611
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Abstract

Objective

It is unclear how articular cartilage loss contributes to pain in patients with knee osteoarthritis (OA). Full-thickness cartilage defects expose the subchondral bone plate. The relationship between denuded bone and pain has not been examined. The aim of this study was to investigate whether the percent of denuded bone is associated with moderate-to-severe knee pain or frequent knee pain and longitudinally with frequent knee pain 2 years after the baseline evaluation.

Methods

We studied 182 persons with knee OA (305 knees). Applying specialized magnetic resonance imaging techniques, manual segmentation was used to compute cartilage-covered and denuded bone areas for each surface. Moderate-to-severe knee pain was defined as a score of ≥40 mm on a knee-specific 100-mm visual analog scale, and frequent knee pain was defined as pain on most days during the past month. Logistic regression and generalized estimating equations were used in analyses, adjusting for age, sex, body mass index, and bone marrow lesions.

Results

Cross-sectional analyses revealed that moderate-to-severe knee pain was associated with percent denuded bone in the medial compartment (adjusted odds ratio [OR] 3.90, 95% confidence interval [95% CI] 1.33–11.47), in the medial and patellar surfaces together, and in the lateral and patellar surfaces. Frequent knee pain was associated with percent denuded bone in the patellar surface (adjusted OR 3.11, 95% CI 1.24–7.81), in the medial and patellar surfaces, and in the lateral and patellar surfaces. Longitudinal analyses (in 168 knees without frequent knee pain at baseline) revealed that percent denuded bone in the medial and patellar surfaces was associated with frequent incident knee pain (adjusted OR 4.19, 95% CI 1.56–11.22).

Conclusion

These results support a relationship between subchondral bone plate exposure and prevalent and incident knee pain in patients with knee OA.

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