Clinico-radiological correlation of osteoarthritis knee using Western Ontario and McMaster Universities score and Kellegren and Lawrance grading

Manish Singh Rajpoot, Digember Peepra, Krishna Kumar Pandey, H. S. Varma


Background: Diagnosis OA is basically based upon clinical and radiological features. In our study we have used a clinical scoring system of OA called as WOMAC (Western Ontario and McMaster Universities) score and a radiological staging system KL staging (Kellegren and Lawrance) OA radiological staging system and correlation between them.

Methods: There were total 66 patients with 102 knees. X ray of bilateral knee was taken in weight bearing position (standing) and WOMAC score was calculated. X-rays were assessed with KL grading. WOMAC score a clinical scoring was correlated with a radiological KL grading for the OA of knee.

Results: Range of WOMAC score was 11.5-67.7. Mean WOMAC score were 18.75, 31.31, 52.57 and 67.2 in patients of KL grade 1, 2, 3 and 4 respectively. Correlation between KL grading and WOMAC scoring were found to be significant; there were rise in the WOMAC scoring when KL grading increases.

Conclusions: Both the KL grading and WOMAC score are directly proportional to each other, and hence, WOMAC scoring can be used to diagnose, assess the progression of the disease and the response to treatment of osteoarthritis.


KL grading, Osteoarthritis knee, WOMAC score

Full Text:



National Collaborating Centre for Chronic Conditions (UK). "Osteoarthritis - National clinical guideline for care and management in adults". London: Royal College of Physicians (UK). 2008.

Davis MA. Epidemiology of osteoarthritis. Clin Geriatr Med. 1988;4:241-55.

Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998;4:1343-55.

Keuttner KE, Golderg VM. Osteoarthritic disorders. In: Keuttner KE, Golderg VM, eds. A Book. 2nd ed. Rosemont: AAOS. 1995:95-101.

Villanueva I, del Mar Guzman M, Javier Toyos F, Ariza- Ariza R, Navarro F. Relative efficiency and validity properties of a visual analogue v/s a categorical scaled version of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index: Spanish versions. Osteoarthritis Cartilage. 2004;12(3):225-31.

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis Ann. Rheum. Dis. 1957;16:494.

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis knee. Arthritis Rheum. 1986;29:1039-49.

Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994;84:351-8.

Yelin E. The economics of osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS, Eds. Osteoarthritis. New York: Oxford University Press. 1998;23-30.

Meenan RF, Callahan LF, Helmick CG. The National Arthritis Action Plan: a public health strategy for a looming epidemic Editorial. Arthritis Care Res. 1999;12:79-81.

Leardini G, Salaffi F, Montanelli R, Gertzeli S, Colangelo I, Canesi B. A multicentric study of annual costs of knee osteoarthritis in Italy. Arthritis Rheum. 2001;44:S313.

Gabriel SE, Crowson CS, O’Fallon WM. Costs of osteoarthritis: estimates from a geographically defined population. J Rheumatol. 1995;43:23-5.

Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care 1989;27:S217-32.

Testa MA, Simonson DC. Assessment of quality of life outcomes. N Engl J Med. 1996;334:835-40.

Salaffi F, Piva S, Barreca C, Cacace E, Ciancio G. Leardini Gon behalf of Gonarthrosis and Quality of Life (GOQUOLA) Study Group. Validation of an Italian version of the arthritis impact measurement scales 2 (ITALIAN-AIMS2) for patients with osteoarthritis of the knee. Rheumatology. 2000;39:720-6.

Creamer P, Lethbridge-Cejku M, Hochberg MC. Determinants of pain severity in knee osteoarthritis: effect of demographic and psychosocial variables using 3 pain measures. J Rheumatol. 1999;26:1785-92.