Association of bone scintigraphic abnormalities with knee malalignment and pain

Ann Rheum Dis. 2009 Nov;68(11):1673-9. doi: 10.1136/ard.2008.094722. Epub 2008 Nov 3.


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 (99m)Technetium 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bone Malalignment / complications*
  • Bone Malalignment / diagnostic imaging
  • Cohort Studies
  • Female
  • Humans
  • Knee Joint* / diagnostic imaging
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / etiology*
  • Pain Measurement
  • Radiography
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Severity of Illness Index
  • Technetium Tc 99m Medronate


  • Radiopharmaceuticals
  • Technetium Tc 99m Medronate