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3-4). Radiographic Grading of Osteoarthritis Various grading systems of osteoarthritis have been described. It must be remembered that approximately 40% to 50% of patients with radiographic changes of osteoarthritis are asymptomatic. Joint space narrowing has been shown to correlate most strongly with clinical symptoms. A number of grading systems are presented in Table 3-2. Diagnostic Workup Algorithm The most important investigation for patients presenting with hip pain is to obtain good quality, properly exposed and oriented radiographs with the appropriate views.
Suggesting that a mechanical effect in obese patients could also result in the development of OA. Yet other studies suggest that patients who are obese suffer more hip complaints at the same radiographic stage than nonobese patients, therefore making them more likely to seek hip replacement at an earlier stage than nonobese patients. Possibly therefore, the incidence of radiographic OA is similar in obese and nonobese populations; however, obese populations are more symptomatic and seek treatment sooner for a given stage of osteoarthritis.
Further pathogenesis is discussed later. , infectious, environmental) in a genetically susceptible host. A genetic predisposition (HLA-B27) has also been shown in seronegative (defined as rheumatoid factor–negative) arthropathies; however, an infectious cause has been more closely linked to certain types. Reactive and enteric spondyloarthropathies have been associated with various gastrointestinal and genitourinary infections. Epidemiology Although mechanical abnormalities may be the etiologic factor responsible for most osteoarthritis, there are epidemiologic factors as well.