Knee osteoarthritis is a disease characterized by deterioration and inflammation of the knee joint.6 Knee OA can be identified with radiographic evidence or by symptomology. The Kellgren-Lawrence (KL) grading scheme is the radiographic reference standard for defining knee OA.6 The severity of osteoarthritis is determined by the presence of osteophytes on the knee joint, joint space narrowing, sclerosis of the subchondral bone, and deformity of the femoral head.7 Scoring of the KL grading scheme ranges from 0 to 4. Minimal, but definitive, knee OA is defined by the presence of an osteophyte, equating to a KL grade of 2 or higher.6,7,10 Symptomatic knee OA is characterized by radiographic evidence of OA accompanied by pain, aching, or stiffness in the affected joint.
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Pain occurring on most days of a recent month is representative of symptomatic knee OA.2,6,8
Data from the 2011-2012 National Health Interview Survey (NHIS) indicates that 15.1 million United States (U.S.) adults have symptomatic knee OA. An additional 8.6 million adults are classified with KL grade 3 or 4 advanced symptomatic knee OA.1 The prevalence of knee OA has dramatically increased in the past one hundred years. Wallace et al. compared the prevalence of knee OA among American adults from the early industrial and postindustrial periods. The prevalence of knee OA (16%, 95% CI: 14-19%) was 2.6 times higher among the postindustrial sample (95% CI: 2.1-3.4) compared to the early industrial sample (6%, 95% CI: 5-7%). 10
Prevalence data for knee OA differs across studies depending on the definition of osteoarthritis. Studies using the radiographic definition of osteoarthritis trend towards higher prevalence as compared to the symptomatic definition.4,11,12 In the Framingham Osteoarthritis study, 27.4% of adults over sixty-three had radiographic knee OA. However, only 7% of adults within this sample had symptomatic OA.9,13 Similarly,
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