Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis

Abstract

BackgroundArthritis is a leading cause of disability in the United States. Total knee arthroplasty (TKA) has become the gold standard to manage the pain and disability associated with knee osteoarthritis (OA). Although more than 400 000 primary TKA surgeries are performed each year in the United States, not all individuals with knee OA elect to undergo the procedure. No clear consensus exists on criteria to determine who should undergo TKA. The purpose of this study was to determine which clinical factors will predict the decision to undergo TKA in individuals with end-stage knee OA. Knowledge of these factors will aid in clinical decision making for the timing of TKA.MethodsFunctional data from one hundred twenty persons with end-stage knee OA were obtained through a database. All of the individuals complained of knee pain during daily activities and had radiographic evidence of OA. Functional and clinical tests, collectively referred to as the Delaware Osteoarthritis Profile, were completed by a physical therapist. This profile consisted of measuring height, weight, quadriceps strength and active knee range of motion, while functional mobility was assessed using the Timed Up and Go (TUG) test and the Stair Climbing Task (SCT). Self-perceived functional ability was measured using the activities of daily living subscale of the Knee Outcome Survey (KOS-ADLS). A logistic regression model was used to identify variables predictive of TKA use.ResultsForty subjects (33%) underwent TKA within two years of evaluation. These subjects were significantly older and had significantly slower TUG and SCT times (p < 0.05). Persons that underwent TKA were also significantly weaker, had lower self-reported function and had less knee extension than persons who did not undergo TKA. No differences between groups were seen for BMI, gender, knee flexion ROM and unilateral versus bilateral joint disease. Using backward regression, age, knee extension ROM and KOS-ADLS together significantly predicted whether or not a person would undergo TKA (p ≤ 0.001, R2 = 0.403).ConclusionsYounger patients with full knee ROM who have a higher self-perception of function are less likely to undergo TKA. Physicians and clinicians should be aware that potentially modifiable factors, such as knee ROM can be addressed to potentially postpone the need for TKA.

Joint Space Predicts THA After Hip Arthroscopy in Patients 50 Years and Older

“…Prior studies [2,3,20,21,26] have demonstrated an association between K-L grade and the presence and severity of chondral damage and symptoms of OA in the knee on MR images. A few studies [7,23] have used the K-L grading system to evaluate hips.…”

GP referral of patients with osteoarthritis for consideration of total joint replacement: a longitudinal study

“…13 Studies have found that women are less likely to undergo TJR than men, 14 and younger individuals with a full knee range of motion are less likely to undergo total knee replacement (TKR). 15 There is little published research investigating the biomedical and psychosocial differences between patients who are referred in primary care by the GP and those who are considered candidates for a TJR. This study set out to investigate differences between individuals with OA newly referred to an orthopaedic surgeon for consideration for TJR; to identify differences in individuals who were put on the waiting list for TJR; and to identify the predictors of having a THR or TKR.…”

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

“…BLOKS and WORMS scoring systems were presented with their three separate scores for the cartilage, bone marrow and meniscus. As mentioned above, following previous studies [18][19][20], the risk of (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) are also similarly used in Tables 3, 4 and 5 for further analysis subsequent KR was calculated per every one unit increase in the average scores of all locations (Table 1).…”

“…The chronic and often progressive clinical course of knee OA emphasizes the role for possible preventive strategies in early detection and secondary prevention of endstage joint destruction requiring KR. Recent studies have focused on extracting the predictors of the development and progression of OA for accurate outcome prediction of painful knee OA with possible ensuing joint replacement [4,[7][8][9]. Several well-defined cohorts have been initiated for this purpose, such as osteoarthritis initiatives (OAIs), the Multicentric Osteoarthritis Study (MOST) and Framingham Osteoarthritis Study [10][11][12][13].…”