Can Structural Joint Damage Measured with MR Imaging Be Used to Predict Knee Replacement in the Following Year?

Abstract

).q RSNA, 2014 Purpose:To assess whether magnetic resonance (MR) imagingbased cross-sectional measures of structural joint damage can be used to predict knee replacement during the following year. Materials and Methods:Participants were drawn from the Osteoarthritis Initiative, a longitudinal observational study that includes 4796 participants who have knee osteoarthritis or are at risk. The HIPAA-compliant protocol was approved by the institutional review boards of all participating centers, and written informed consent was obtained from all participants. During the 5 years of follow-up, 199 knees underwent knee replacement and were matched with 199 control knees that did not undergo knee replacement. Knees were matched according to radiographic disease stage and patient sex and age. All knees that underwent knee replacement and had MR images available from the year before surgery were included. MR images were assessed for cartilage damage, bone marrow lesions, meniscal damage, meniscal extrusion, synovitis, and effusion prior to reported knee replacement. Conditional logistic regression was applied to assess the risk of knee replacement. Analyses were performed on a compartmental and knee level. Results:Participants had a mean age 6 standard deviation of 64.2 years 6 8. Conclusion:Apart from meniscal extrusion, all features of tissue abnormalities at MR imaging were related to clinical prognosis and could be used to predict knee replacement in the following year.q RSNA, 2014

Measuring Disease Progression in Osteoarthritis

“…BMLs are strong and independent predictors of knee cartilage loss, especially site-specific cartilage loss [67,68,69••], and progression of knee cartilage lesions [24,28,67,68,[70][71][72]. BMLs also predict total knee replacement over periods of up to 4 years [49,50,[73][74][75]. In some studies, BMLs predicted knee replacements more strongly than other predictors assessed in the same cohort [49,74].…”

“…Interestingly, associations between synovial inflammation/effusion and cartilage alterations could be the 'chicken or the egg' dilemma in that, although synovial inflammation could lead to cartilage damage [87], the reverse is also possible [87,88]. The presence of MRI-detected effusion or synovitis predicts knee replacement [75]. Data also showed that chondroitin sulphate, a symptomatic slow acting drug for osteoarthritis (SYSADOA) with DMOAD activity, at 6 months in patients concomitantly taking NSAIDs, significantly reduced the synovial membrane thickness (as assessed by MRI without contrast agent [84]) compared to the placebo group, in addition to decreasing cartilage volume loss [53].…”

“…Meniscal extrusion independently predicts knee cartilage volume loss at about 2 years [54,91], as do meniscal tears [92]. Both meniscal extrusion [75] and tears [49] predict knee replacement surgery [49]. Meniscal tears also demonstrate effect modification through changes in weight, with increase in weight associated with increased cartilage loss over 2 years in those with meniscal tears; this effect was absent in those without meniscal tears [93•].…”

Predictive value of semi-quantitative MRI-based scoring systems for future knee replacement: data from the osteoarthritis initiative

“…For each cartilage, bone marrow or meniscus score, the average of all locations' scores was calculated as the determinant variable ( Table 1). The risk [defined as the hazard ratio (HR) of the subsequent KR] was determined to be contributed by all compartmental scores [20]. BLOKS scorings included full thickness and lesion extent scores for the cartilage (femoral, trochlear, tibial and patellar locations), bone marrow (adjacency, percent edema and size of lesions in the mentioned compartments) and meniscus [lateral/medial; tear (anterior/ posterior/body) and extrusion (medially/laterally)].…”

“…In a recent investigation, Roemer et al utilized the OAI data sets to demonstrate the value of semiquantitative MRI scorings (MRI Osteoarthritis Knee Score: MOAKS; MOAKS shares some of the scoring features present in either BLOKS or WORMS) in the prediction of KR [20]. They included cases and controls that were matched for gender, age group and radiographic Kellgren-Lawrence (KL) score.…”