Knee Osteoarthritis has high incidence in the population over 60 years reaching a rate of 10% in several studies. However, not all arthritic knee joints are actively causing patient discomfort or pain. There is only a limited correlation between patient radio graphs and symptoms leading to high rates of false positive and false negative of knee OA. Consequently, patients may have bilateral knee arthritis when the more arthritic knee per x-ray is less symptomatic. On the other hand knee MRI and bone scan maybe oversensitive for diagnosis knee arthritis with a high rate of false positive.