Radiographic severity,extent and pattern of cartilage loss are not associated with patient reported outcomes before or after total knee arthroplasty in end-stage knee osteoarthritis |
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| Affiliation: | 1. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom;2. Department of Orthopaedics, The University of Edinburgh, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom;1. Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States;2. Department of Medicine, Division of Infectious Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States;1. Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA;2. Johns Hopkins Department of Orthopaedic Surgery, Adult Reconstruction Division, Columbia, MD, USA;3. Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA;1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA;2. Department of Neurological Surgery, University of California at San Francisco Fresno, Fresno, California, USA;3. Department of Surgery, University of Toronto, Toronto, Ontario, Canada;1. University Hospital Plymouth, United Kingdom;2. Royal Devon &Exeter Hospital, United Kingdom;3. Southwest Orthopaedic Research Division, United Kingdom |
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| Abstract: | BackgroundThe aim of this study was to determine if radiographic severity, extent or pattern of knee osteoarthritis was associated with pain and function before total knee arthroplasty (TKA) or improvement therein one year after TKA.MethodsA prospective study of 259 patients undergoing unilateral TKA for Kellgren-Lawrence (KL) grade ≥ 3 knee osteoarthritis was conducted: mean age 69.8 ± 9.7 (44–91); mean BMI 31.0 ± 5.8 (17–52); 152/259 (58.7%) female. Preoperative radiographs were assessed using the KL and Ahlback systems. Preoperatively and 1 year postoperatively patients completed Oxford Knee Scores, VAS-Pain and EQ-5D scores. Full thickness cartilage loss was recorded intraoperatively.ResultsMedian radiographic severity was Ahlback 2, KL 4: 51/259 (19.7%) hypertrophic; 23/259 (8.8%) atrophic. Neither Ahlback nor Kellgren-Lawrence OA grade was associated with OKS, VAS Pain or EQ-5D prior to TKA (p > 0.05). The extent and pattern of cartilage loss did not affect preoperative PROMs. Radiographic OA severity, compartment involvement, and pattern of cartilage loss were not significantly associated with PROMs or improvements therein following TKA (p > 0.05). Hypertrophic OA was associated with less pain before TKA (difference 6.8, 0.23–13.9 95%CI, p = 0.044), and worse improvement in OKS following TKA (difference −3.41, −6.8 to −0.05 95%CI, p = 0.047). Better preoperative OKS and hypertrophic OA were independently associated with poorer improvement in OKS 1 year following TKA (R2 = 0.208).ConclusionProvided at least one compartment has KL grade ≥ 3 changes, further radiographic severity, pattern or extent of cartilage loss did not affect PROMs before or after TKA: multicompartmental was no worse than unicompartmental disease. |
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| Keywords: | Kellgren-Lawrence Ahlback Knee osteoarthritis Patient reported outcomes Total knee arthroplasty |
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