Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

Tilbury, C.; Holtslag, M. J.; Tordoir, R.; Leichtenberg, Claudia S.; Verdegaal, S.H.M.; Kroon, Herman M.; Fiocco, Marta; Nelissen, Rob G H H; Vlieland, Thea Vliet

doi:10.3109/17453674.2015.1092369

Cited by 49 publications

(63 citation statements)

References 20 publications

(23 reference statements)

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“…Seven studies utilized the KSS and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. The short‐form health survey and its variations were used in five studies . Three studies used the Oxford Knee Score (OKS).…”

Section: Resultsmentioning

confidence: 99%

“…The effect of preoperative X‐ray grade of OA and postoperative pain scores was assessed in 16 studies . Six reported pain outcomes according to the KSS.…”

Section: Resultsmentioning

confidence: 99%

“…Functional outcomes were assessed in 15 studies . Six articles showed statistically significant results for various aspects of functional recovery after TKA.…”

Section: Resultsmentioning

confidence: 99%

“…However, there is a poor correlation between radiographic and clinical severity . Furthermore, the relationship between X‐ray severity and outcome post TKA varies between studies …”

Section: Introductionmentioning

confidence: 99%

“…19,20 Furthermore, the relationship between X-ray severity and outcome post TKA varies between studies. 21,22 Previous studies investigating the relationship between radiologic severity and outcome suffer from type 2 statistical error, as recruiting patients with lower radiological grades is less common. This review aims to explore the relationship between preoperative radiographic OA severity and patient reported pain, function and satisfaction in an adult population during the short and intermediate (<5 years) period after TKA.…”

Section: Introductionmentioning

confidence: 99%

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Radiographic severity of knee osteoarthritis and its relationship to outcome post total knee arthroplasty: a systematic review

Youlden

Dannaway

Enke

2019

ANZ Journal of Surgery

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Background Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA). There are many contributing factors. The relationship between preoperative osteoarthritis (OA) severity and outcome post TKA remains unclear. This review explores the relationship between preoperative OA severity with patient reported pain, function and satisfaction post TKA. Methods A pre‐registered systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Major databases were searched until September 2017. We included studies assessing adults undergoing TKA for OA. Minimum follow‐up was 6 months. Methodological quality assessment was conducted using the Newcastle‐Ottawa Scale. Results Twenty cohort studies with 7478 patients were included. There were 16 good, one fair and three poor quality studies. Knee OA was most commonly reported according to the Kellgren and Lawrence tool. Ten studies showed statistically significant pain outcomes for those with worse preoperative OA. This was supported by meta‐analysis of the Knee Society Score pain change scores to final follow‐up for those with Kellgren and Lawrence grade 4 OA. Six studies showed statistically significant results for various aspect of functional recovery, although meta‐analysis of Knee Society Score function change scores identified no difference. Meta‐analysis of final follow‐up pain and function scores alone yielded no significant difference. Patients with more severe preoperative OA were more likely to be satisfied. There were no studies demonstrating that less severe OA resulted in better pain, function or satisfaction. Conclusion Review of available research indicates that TKA for OA improves pain, function and satisfaction. Those with more severe preoperative radiological knee OA benefit most.

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Section: Resultsmentioning

confidence: 99%

“…The effect of preoperative X‐ray grade of OA and postoperative pain scores was assessed in 16 studies . Six reported pain outcomes according to the KSS.…”

Section: Resultsmentioning

confidence: 99%

“…Functional outcomes were assessed in 15 studies . Six articles showed statistically significant results for various aspects of functional recovery after TKA.…”

Section: Resultsmentioning

confidence: 99%

“…However, there is a poor correlation between radiographic and clinical severity . Furthermore, the relationship between X‐ray severity and outcome post TKA varies between studies …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiographic severity of knee osteoarthritis and its relationship to outcome post total knee arthroplasty: a systematic review

Youlden

Dannaway

Enke

2019

ANZ Journal of Surgery

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Mild radiographic osteoarthritis is associated with increased pain and dissatisfaction following total knee arthroplasty when compared with severe osteoarthritis: a systematic review and meta-analysis

Shohat

Heller

Sudya

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe association between severity of radiographic osteoarthritis with patient pain, function, and satisfaction following total knee arthroplasty has been disputed. The discrepancies in current literature prompt us to further examine this association in a systematic review and meta-analysis. Methods The OVID-Medline, Embase, and Web of Science databases were searched from their inception up to Mar 2020. The main independent variable was osteoarthritis severity as deined by preoperative radiographs. The outcomes measured were pain, function and satisfaction following total knee arthroplasty. A minimum of three studies assessing the same patient-reported outcome measures were included in the meta-analysis, as well as those separating patients by chronic pain or dissatisfaction. Results 29 studies were included in this study. Signiicant heterogeneity was seen between radiographic evaluation and reported outcomes. Patients with only mild radiographic osteoarthritis were more likely to sufer from chronic pain (odds ratio = 2.45, 95% CI = 1.80-3.34, p < 0.001) and dissatisfaction (odds ratio = 2.43, 95% CI = 1.79-3.31, p < 0.001) compared to patients with severe osteoarthritis. A signiicant association was found between mild radiographic severity and lower total Western Ontario and McMaster Universities Osteoarthritis scores (95% CI = − 0.37-0.06, p = 0.006) as well as Knee Society Scores (CI: − 0.54-0.16, p < 0.001). Conclusion Patients with mild radiographic osteoarthritis are anticipated to gain less from total knee arthroplasty compared to those with severe osteoarthritis. They are also at risk for chronic pain and dissatisfaction and should be consulted about this risk prior to surgery. Level of evidence III.

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Medial unicondylar knee arthroplasty should be reserved for patients with complete joint space collapse

Wurm

Zechling

Leitner

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To determine whether preoperative radiologic joint space width (JSW) is related to the outcome of medial unicondylar knee arthroplasty (UKA) (primary hypothesis). Methods A retrospective comparative analysis was performed. One group was comprised of UKA patients with preoperative JSW 0–1 mm. Another group was made up of patients with preoperative JSW ≥ 2 mm (range 0–4 mm). The JSW was measured from preoperative weight-bearing Schuss-view radiographs. The clinical outcome was determined with the Western Ontario and MacMaster Universities (WOMAC) Osteoarthritis Index score preoperatively and 1 year after medial UKA. Implant survival data were obtained from the arthroplasty register of Tyrol. Results There were 80 patients with a preoperative JSW 0–1 mm (age 66, BMI 27.8) and 70 patients with a preoperative JSW ≥ 2 mm (age 64, IQR 15, BMI 28.1). WOMAC total was 10 ± 10 in patients with 0–1 mm JSW and 25 ± 47 in patients with ≥ 2 mm JSW at 1 year postoperative (p = 0.052). WOMAC pain at 1 year postoperative was 7 ± 16 in patients with 0–1 mm JSW and 18 ± 46 in patients with ≥ 2 mm JSW (p = 0.047). WOMAC function at 1 year postoperative was 10 ± 9 in patients with 0–1 mm JSW and 17 ± 51 in patients with ≥ 2 mm JSW (p = 0.048). In patients with 0–1 mm JSW 5 year prosthesis survival was 92.3% and in patients with ≥ 2 mm JSW, it was 81.1% (p = 0.016). Conclusions In patients with preoperative complete joint space collapse (0–1 mm JSW), clinical outcome was superior to that of patients with incomplete joint space collapse. This was true for both 1 year postoperative WOMAC pain and WOMAC function and for 5 year implant survival rates. On the basis of our findings, it is recommended that ‘complete joint space collapse’ especially be used to achieve best clinical outcome in medial UKA surgery. Level of evidence IV.

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Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

Cited by 49 publications

References 20 publications

Radiographic severity of knee osteoarthritis and its relationship to outcome post total knee arthroplasty: a systematic review

Radiographic severity of knee osteoarthritis and its relationship to outcome post total knee arthroplasty: a systematic review

Mild radiographic osteoarthritis is associated with increased pain and dissatisfaction following total knee arthroplasty when compared with severe osteoarthritis: a systematic review and meta-analysis

Medial unicondylar knee arthroplasty should be reserved for patients with complete joint space collapse

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