Greater Lateral Femorotibial Cartilage Loss in Osteoarthritis Initiative Participants With Incident Total Knee Arthroplasty: A Prospective Cohort Study

Hitzl, Wolfgang; Wirth, W.; Maschek, S.; Cotofana, Sebastian; Nevitt, Michael C.; John, Markus R.; Ladel, Christoph; Eckstein, F.

doi:10.1002/acr.22608

Cited by 8 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 45 The study design and the fact that the imaging data were restricted to X-rays may have been important limiting factors of this report. The observation of the association of TKA with the progression of valgus malalignment and cartilage loss in the global knee and lateral compartment in women extends the existing knowledge from previous studies 36 , 37 and could be an explanation for the association between BML and TKA being found only in women.…”

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

Risk factors associated with the occurrence of total knee arthroplasty in patients with knee osteoarthritis: a nested case–control study

Pelletier

Dorais²,

Paiement³

et al. 2022

Therapeutic Advances in Musculoskeletal

View full text Add to dashboard Cite

Objectives: The aim of this study was to investigate changes over time in osteoarthritis risk factors most closely associated with the occurrence of total knee arthroplasty (TKA). We hypothesize that the robustness of a longitudinal case–control study will provide new information on the association between changes in various clinical and structural parameters in different time frames before TKA. Methods: Cases (195; TKA after cohort entry) and controls (468) matched for age, gender, income, WOMAC pain, Kellgren–Lawrence grade and follow-up duration were from the Osteoarthritis Initiative cohort. Associations between changes in sociodemographic, clinical, imaging and osteoarthritis therapies with the occurrence of TKA were performed using conditional logistic regression analyses. Results: Worsening of WOMAC scores (cOR 1.02–1.20, p ⩽ 0.012), KOOS (1.02–1.04, p ⩽ 0.014), knee injuries sustained in the previous 30–40 years (women 2.70, p = 0.034) and valgus alignment (1.10, p = 0.052) were associated with the occurrence of TKA. Also associated with TKA was cartilage volume loss in the lateral (overall 1.76, p = 0.025; women 1.93, p = 0.047) and medial compartments (⩾10%, overall 1.54, p = 0.027; men 2.34, p = 0.008), occurrence of medial meniscal extrusion (overall 1.77, p = 0.046; men 2.86, p = 0.028), and increase in bone marrow lesions (BMLs) for women (1.09, p = 0.048). The association of risk factors with TKA was reinforced when both an increase in WOMAC pain and cartilage volume loss (1.85, p = 0.001) were combined. Pain medication usage, mainly narcotics and intra-articular steroid injections (IASI), was also associated with TKA, with no impact on changes in cartilage loss or structure. Conclusion: This study provides new information about gender differences in risk factors associated with the occurrence of TKA. Worsening of valgus alignment, cartilage volume loss in the lateral compartment, BMLs and older injuries are important risk factors in women, while medial compartment cartilage loss and meniscal extrusion are in men. The use of pain medication and IASI although associated was found not causal with TKA.

show abstract

Section: Discussionsupporting

confidence: 83%

“…As malalignment is a well-known factor associated with cartilage loss, it could provide a possible explanation for the higher incidence of TKA. 7 , 16 , 17 , 36 , 37 …”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with the occurrence of total knee arthroplasty in patients with knee osteoarthritis: a nested case–control study

Pelletier

Dorais²,

Paiement³

et al. 2022

Therapeutic Advances in Musculoskeletal

View full text Add to dashboard Cite

show abstract

“…A previous report from 2003 by Escobar et al tried to identify factors for the appropriateness of the indication for TKR in patients with osteoarthritis by using a modified Delphi panel judgment based on outcome measures and confirmed that symptomatology and radiology explained most of the variability in the appropriateness of indication [14]. A previous study by Hitzl et al [15] revealed that individuals receiving a TKR within a period of 4 years displayed a significantly reduced cartilage thickness at base-line when compared to controls, indicating a change in structure; here, the magnetic resonance imaging (MRI) parameter is a predicting factor that can guide a surgeon's decision for performing TKR surgery.…”

Section: Introductionmentioning

confidence: 94%

Predicting Total Knee Replacement from Symptomology and Radiographic Structural Change Using Artificial Neural Networks—Data from the Osteoarthritis Initiative (OAI)

Heisinger

Hitzl

Hobusch

et al. 2020

JCM

Self Cite

View full text Add to dashboard Cite

The aim of the study was to longitudinally investigate symptomatic and structural factors prior to total knee replacement (TKR) surgery in order to identify influential factors that can predict a patient’s need for TKR surgery. In total, 165 participants (60% females; 64.5 ± 8.4 years; 29.7 ± 4.7 kg/m2) receiving a TKR in any of both knees within a four-year period were analyzed. Radiographic change, knee pain, knee function and quality of life were annually assessed prior to the TKR procedure. Self-learning artificial neural networks were applied to identify driving factors for the surgical procedure. Significant worsening of radiographic structural change was observed prior to TKR (p ≤ 0.0046), whereas knee symptoms (pain, function, quality of life) worsened significantly only in the year prior to the TKR procedure. By using our prediction model, we were able to predict correctly 80% of the classified individuals to undergo TKR surgery with a positive predictive value of 84% and a negative predictive value of 73%. Our prediction model offers the opportunity to assess a patient’s need for TKR surgery two years in advance based on easily available patient data and could therefore be used in a primary care setting.

show abstract

“…Notably, the results of one study showed that patients who had been treated with intra-articular glucocorticoids (40 mg triamcinolone) had significantly greater cartilage volume loss than those who had been given intra-articular saline over a 2 year period (between group difference −0.11mm; 95% CI −0.20 to −0.03mm) 55 . This result is concerning because a 1% increase in the rate of tibial cartilage loss between baseline and 2 years corresponds to an ~20% increase in the risk of undergoing knee replacement surgery at 4 years 56 and because high rates of cartilage loss have been directly associated with an increased risk of undergoing arthroplasty 57 .…”

Section: Standard Intra-articular Treatmentsmentioning

confidence: 99%

Intra-articular treatment options for knee osteoarthritis

et al. 2018

View full text Add to dashboard Cite

Intra-articular drug delivery has a number of advantages over systemic administration; however, for the past 20 years, intra-articular treatment options for the management of knee osteoarthritis (OA) have been limited to analgesics, glucocorticoids, hyaluronic acid (HA) and a small number of unproven alternative therapies. Although HA and glucocorticoids can provide clinically meaningful benefits to an appreciable number of patients, emerging evidence indicates that the apparent effectiveness of these treatments is largely a result of other factors, including the placebo effect. Biologic drugs that target inflammatory processes are used to manage rheumatoid arthritis, but have failed to translate to OA. A lack of high-level evidence and methodological limitations hinder our understanding of so called ‘stem’ cell therapies and, although the off-label administration of intra-articular cell therapies (such as platelet-rich plasma and bone marrow aspirate concentrate) is common, high-quality clinical data is needed before these treatments can be recommended. A number of promising intra-articular treatments are currently in clinical development in the United States, including small-molecule and biologic therapies, devices, and gene therapies. Although the prospect of new, non-surgical treatments for OA is exciting, the benefits new treatments must be carefully weighed against their costs and potential risks.

show abstract

Greater Lateral Femorotibial Cartilage Loss in Osteoarthritis Initiative Participants With Incident Total Knee Arthroplasty: A Prospective Cohort Study

Cited by 8 publications

References 16 publications

Risk factors associated with the occurrence of total knee arthroplasty in patients with knee osteoarthritis: a nested case–control study

Risk factors associated with the occurrence of total knee arthroplasty in patients with knee osteoarthritis: a nested case–control study

Predicting Total Knee Replacement from Symptomology and Radiographic Structural Change Using Artificial Neural Networks—Data from the Osteoarthritis Initiative (OAI)

Intra-articular treatment options for knee osteoarthritis

Contact Info

Product

Resources

About