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Relationship between Radiological Severity, Knee Pain and Functional Limitation in Patients with Knee Osteoarthritis at Dr. M. Djamil Padang General Hospital

Background: Osteoarthritis (OA) is a degenerative joint disease frequently affecting the elderly and the middle class due to injury or overuse of the joints. An individual with pain due to OA will experience dysfunction of joints and muscles, thus causing movement limitation, decrease of muscle strength and balance. The objective of this study is to know the association of OA radiological degree with pain intensity and limitation of physical capability in patients with knee joint OA. Methods: This study is a retrospective study on patients with knee joint OA treated at RSUP Dr. M. Djamil Padang in year 2021 from January 2021 to May 2021. Data collection was conducted in the Medical Records Department of RSUP Dr. M. Djamil Padang and questionnaire which fulfills the inclusion and exclusion criteria. Results: A total of 58 patients fulfilled the inclusion criteria of this study. Results of the study showed the mean age of the respondents was 60 years with variance of 7 years. More than a half (77.6%) of the respondents were female and most common ethnicity was Minang (82.8%). 50% of the patients were housewives. BMI of the respondents were mostly overweight obese (65.5%). Most commonly affected side of the knee joint OA was the right side (55.2%). Most common degree of OA was the fourth degree (39.7%). More than a half of the respondents (84.5%) had moderate intensity of pain and 34.5% respondents had mild physical limitation. Results of the study showed that there was an association between OA radiological degree and pain intensity in patients with knee joint OA (p value = 0.0001). Results of the study showed that there was an association between OA radiological degree and level of physical capability limitations in patients with knee joint OA (p value = 0.0001). Results of the study showed that there was an association between pain intensity and level of physical capability limitations in patients with knee joint OA (p value = 0.0001). Conclusion: There was an association between OA radiological degree and pain intensity, physical limitations in patients with knee joint OA, and there was an association between pain intensity and level of physical capability limitation in patients with knee joint OA.


Introduction
Osteoarthritis (OA) is a degenerative joint disease that often affects the elderly and the middle ages due to injury or excessive joint use. This disorder is characterized by erosion of the articular cartilage, hypertrophy of the bone at the margins (osteophytes), subchondral sclerosis and a series of biochemical and morphological changes of the synovial membrane and joint capsule 1 The clinical symptoms that can arise are joint pain, joint stiffness, swelling and redness in the joints up to limited daily activities. OA can affect various joints such as knees, hips, hands, feet, and spine. 2 The prevalence of OA increases with age increasing.
According to the World Health Organization (WHO), the prevalence of osteoarthritis sufferers in the world in 2011 reached 151.4 million people and 27.4 million people were in Southeast Asia. About 80% of people with OA will experience limitations in movement, and 25% of people with OA will be unable to carry out their main daily activities. It has been estimated that approximately 25% of the adult population, or more than 50 million people in the US, will be affected by this disease by 2020 and OA will be the leading cause of morbidity and disability among individuals over the age In Indonesia, the highest prevalence occurs at age > 75 years. 4  Based on study conducted by Asriyani (2017), it is known that there is a significant relationship between the severity of OA and the level of knee pain in OA patients. 12 Meanwhile, from study conducted by Erminawati (2017), it is known that there is a significant relationship between the severity of OA and physical activity in patients with knee OA. 13 Individual pain perception is influenced by various factors such as age, gender and socio-culture, so we are interested in seeing whether the same or different results will be obtained with previous studies conducted in different socio-cultural settings.
Therefore, in this study we were assessing the relationship between radiological degrees of OA with pain intensity and physical limitations in knee joint OA patients at Dr. M. Djamil Padang General Hospital.

Discussion
In this study, 58 patients were included in the inclusion criteria. The age of the respondents in this study had a mean of 60 years with 7 years variance.
The results of this study are in accordance with the epidemiological study conducted by Safiri, et Based on data analysis of the respondents occupations, it was found that 50% were housewives (29 patients) followed by 37.9% worked as civil servants which also found that the incidence of OA was most experienced by housewifes, which was 58% due to the burden of household work. 19 From the results of data based on BMI, the highest incidence of OA was found in the overweight -obesity group with 38 patients (65.5%). These results are consistent with a meta-analysis study conducted by Zheng et al (2015), which found that overweight or obese patients had an approximately 2.5-4.6 times risk of developing OA than the normal BMI group. The risk of OA will increase by 35% with an increase in BMI of 5kg/m2. 20 Obesity is the strongest risk factor for knee OA. The effect of obesity on the development and progression of OA is mainly through increased load on weight-bearing joints. Three to six times body weight is applied to the knee joint when the body is resting on one leg. An increase in body weight will double the burden on the knee joint when walking which causes cartilage damage. 21 From the data analysis on the knee OA side, the highest incidence of OA was found on the right knee, which was 55.2%. These results are in accordance with the research conducted by Hafizh et al in Semarang (2015), which also found that the highest incidence of knee OA occurred in the right knee. 22 This can be caused by the tendency of patients to make the right foot as the main support or the dominant foot in carrying out activities, which is also supported by study conducted by Mirjana, et al (2016), which states that this is related to dominance in one of the hemispheres of the brain that play a role in carrying out certain functions. Functionally, the brain shows laterality to both hemispheres of the brain which simultaneously play a role in carrying out an activity but one hemisphere will become more dominant in certain aspects. 23 Based on data analysis on the severity of knee OA,