Search tips
Search criteria 


Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 1993 April; 52(4): 258–262.
PMCID: PMC1005622

Determinants of disability in osteoarthritis of the knee.


OBJECTIVES: To evaluate the influences of radiographic severity, quadriceps strength, knee pain, age, and gender on functional ability in patients with osteoarthritis of the knee. METHODS: Equal numbers of knee pain positive and negative respondents to a survey of registrants aged more than 55 years at a general practice were invited to attend for knee radiographs and quadriceps femoris isometric strength estimations. Disability was measured using the Stanford Health Assessment Questionnaire. RESULTS: Complete data were available on 70 men (mean age 72.7 years) and 89 women (mean age 68.1 years); 44% reported knee pain, 48% had radiographic features of osteoarthritis, and 32% reported some degree of disability. Significant correlations were observed between disability and radiographic score, quadriceps strength, and knee pain. Logistic regression analysis, however, showed significant independent contributions from quadriceps strength (odds ratio 0.84 kgF), knee pain (odds ratio 1.67), and age (odds ratio 1.06 per year) only; the radiographic score had no influence on the model. These results were not influenced by confining the analysis to the group with radiographic features of osteoarthritis. CONCLUSIONS: Quadriceps strength, knee pain, and age are more important determinants of functional impairment in elderly subjects than the severity of knee osteoarthritis as assessed radiographically. Strategies designed to optimise muscle strength may have the potential to reduce a vast burden of disability, dependency, and cost.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (930K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Knee pain and disability in the community. Br J Rheumatol. 1992 Mar;31(3):189–192. [PubMed]
  • van Saase JL, van Romunde LK, Cats A, Vandenbroucke JP, Valkenburg HA. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis. 1989 Apr;48(4):271–280. [PMC free article] [PubMed]
  • Hochberg MC, Lawrence RC, Everett DF, Cornoni-Huntley J. Epidemiologic associations of pain in osteoarthritis of the knee: data from the National Health and Nutrition Examination Survey and the National Health and Nutrition Examination-I Epidemiologic Follow-up Survey. Semin Arthritis Rheum. 1989 May;18(4 Suppl 2):4–9. [PubMed]
  • Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis. Prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis. 1966 Jan;25(1):1–24. [PMC free article] [PubMed]
  • Claessens AA, Schouten JS, van den Ouweland FA, Valkenburg HA. Do clinical findings associate with radiographic osteoarthritis of the knee? Ann Rheum Dis. 1990 Oct;49(10):771–774. [PMC free article] [PubMed]
  • McAlindon TE, Snow S, Cooper C, Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis. 1992 Jul;51(7):844–849. [PMC free article] [PubMed]
  • Summers MN, Haley WE, Reveille JD, Alarcón GS. Radiographic assessment and psychologic variables as predictors of pain and functional impairment in osteoarthritis of the knee or hip. Arthritis Rheum. 1988 Feb;31(2):204–209. [PubMed]
  • Rudd E. Physiatric management of osteoarthritis. Clin Rheum Dis. 1985 Aug;11(2):433–445. [PubMed]
  • Young A. Exercise physiology in geriatric practice. Acta Med Scand Suppl. 1986;711:227–232. [PubMed]
  • Aniansson A, Sperling L, Rundgren A, Lehnberg E. Muscle function in 75-year-old men and women. A longitudinal study. Scand J Rehabil Med Suppl. 1983;9:92–102. [PubMed]
  • Kirwan JR, Reeback JS. Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol. 1986 May;25(2):206–209. [PubMed]
  • Edwards RH, Young A, Hosking GP, Jones DA. Human skeletal muscle function: description of tests and normal values. Clin Sci Mol Med. 1977 Mar;52(3):283–290. [PubMed]
  • Young A, Stokes M, Crowe M. Size and strength of the quadriceps muscles of old and young women. Eur J Clin Invest. 1984 Aug;14(4):282–287. [PubMed]
  • Young A, Stokes M, Crowe M. The size and strength of the quadriceps muscles of old and young men. Clin Physiol. 1985 Apr;5(2):145–154. [PubMed]
  • KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502. [PMC free article] [PubMed]
  • Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914–918. [PubMed]
  • Hernborg J, Nilsson BE. Age and sex incidence of osteophytes in the knee joint. Acta Orthop Scand. 1973;44(1):66–68. [PubMed]
  • Fife RS, Brandt KD, Braunstein EM, Katz BP, Shelbourne KD, Kalasinski LA, Ryan S. Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee. Arthritis Rheum. 1991 Apr;34(4):377–382. [PubMed]
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. [PubMed]
  • Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982 Sep-Oct;9(5):789–793. [PubMed]
  • Thompson PW, Pegley FS. A comparison of disability measured by the Stanford Health Assessment Questionnaire disability scales (HAQ) in male and female rheumatoid outpatients. Br J Rheumatol. 1991 Aug;30(4):298–300. [PubMed]
  • Asmussen E, Fruensgaard K, Norgaard S. A follow-up longitudinal study of selected physiologic functions in former physical education students-after forty years. J Am Geriatr Soc. 1975 Oct;23(10):442–450. [PubMed]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group