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Recursive Partitioning Tree of Altman for the Diagnosis of Osteoarthritis of the Knee Using Clinical, Laboratory and X-Ray Data

Purpose: To evaluate a patient for idiopathic osteoarthritis of the knee using the recursive partitioning model of Altman with clinical, laboratory and X-ray data.

Description

Altman used recursive partitioning in the diagnosis of idiopathic osteoarthritis of the knee. The diagnosis can be made based on clinical, laboratory and radiological data. The author is from the University of Miami and Miami Veterans Administration Medical Center.


NOTE: The recursive partitioning is similar to CART (classification and regression tree) analysis.

 

Patient selection:

(1) presence of knee pain

(2) absence of a condition predisposing to degenerative arthritis (see Table I, page 33)

 

Parameters:

(1) osteophytes on joint X-ray

(2) synovial fluid (SF) findings

(3) duration of morning stiffness

(4) crepitus

 

Synovial fluid (SF) findings seen in osteoarthritis

(1) clear

(2) viscous

(3) WBC count < 2,000 per µL.

 

Osteophytes

SF Findings

Morning Stiffness

Crepitus

Group

N

0 or 1

 

 

A

N

2 or 3

> 30 minutes

 

B

N

2 or 3

<= 30 minutes

N

C

N

2 or 3

<= 30 minutes

Y

D

Y

 

 

 

E

 

 

Group

Diagnosis

A

no osteoarthritis

B

no osteoarthritis

C

no osteoarthritis

D

osteoarthritis

E

osteoarthritis

 

Performance:

• The sensitivity is 94% and the specificity is 88% (page 37, text).

 

Age can be used as a surrogate marker if synovial fluid data is not available.

 

Osteophytes

Age in Years

Morning Stiffness

Crepitus

Group

N

<= 39 years

 

 

A

N

<= 39 years

> 30 minutes

 

B

N

>= 40 years

<= 30 minutes

N

C

N

>= 40 years

<= 30 minutes

Y

D

Y

 

 

 

E

 


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Specialty

Objective

ICD-10