Open Access Highly Accessed Research article

Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study

Andrew J Metcalfe13*, Maria LE Andersson2, Rhian Goodfellow1 and Carina A Thorstensson2

Author Affiliations

1 School of Medicine, Cardiff University, Cardiff CF10 3XQ, UK

2 Research and Development Centre, Spenshult, Oskarström, Sweden

3 Department of Trauma and Orthopaedics, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK

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BMC Musculoskeletal Disorders 2012, 13:153  doi:10.1186/1471-2474-13-153

Published: 22 August 2012



The aim of this study was to document the development of bilateral knee osteoarthritis over a 12 year period using a middle-aged population-based cohort with knee pain at inclusion.


One hundred and forty three patients aged 35 to 54 were recruited from a population based cohort of 279 subjects who had knee pain at baseline and assessed with clinical and radiographic data, with 5 and 12 year follow up. The data was analysed with regard to the development and progression of uni- and bilateral knee osteoarthritis over 12 years. A definition of KL = 1 was used to define radiographic disease.


24 of the 30 (80%) patients with unilateral disease at baseline developed bilateral disease after 12 years. At baseline 37 patients (26%) had bilateral disease, whereas that number increased to 65 (52%) at 5 years and 100 (70%) at the 12 year follow up. The most common pattern was medial compartment involvement in both knees. Six patients had lateral compartment disease in one knee and medial in the other whereas only two had lateral compartment disease bilaterally.


Bilateral knee osteoarthritis is very common with time, as the majority of sufferers will eventually develop radiographic disease in both knees. Clinicians need to be aware of the ‘joint at risk’ and researchers need to remember to account for both knees when assessing the relationship between physical function, pain and structural disease. The other knee should not be used for comparison, even if it appears to be normal at baseline.

Osteoarthritis; Bilateral; Unilateral; Cohort