The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis

Dowsey, Michelle M.; Dieppe, Paul; Lohmander, L. Stefan; Castle, David; Liew, Danny; Choong, Peter F. M.

doi:10.1016/j.knee.2012.02.007

Cited by 36 publications

(46 citation statements)

References 57 publications

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“…Just as with preoperative PROMs, this could be the result of simply more function to gain for patients with more severe knee OA initially, especially since lateral compartment involvement is generally related to later progression of OA. 24 Furthermore, when the KL grades were combined from each compartment, the results showed significant negative correlations for WOMAC disability and pain scores as well as stronger positive associations between KL grades and overall change in WOMAC total and disability, indicating that patients with more severe preoperative radiographic OA had greater overall improvement as measured by PROMs.…”

Section: Discussionmentioning

confidence: 90%

“…As Dowsey et al showed with their work comparing preoperative PROMs to radiographic measures of OA severity, there is surprisingly little association between radiographic assessments of OA and symptoms reported by the patient. 24 Therefore, it seems possible that the relationship between radiographic OA severity (as determined by KL grading) and postoperative outcomes might be relatively unrelated to the relationship seen between preoperative PROMs and postoperative outcomes. Further work is needed to more fully understand this relationship.…”

Section: Discussionmentioning

confidence: 99%

“…Many recent studies have sought to predict patient outcomes based on various preoperative patient characteristics, including radiographic findings, knee function scores, mental health, and socioeconomic status. 14,[17][18][19][20][21][22][23][24] Each of these variables has shown to have some predictive value but each has significant limitations. The situation is further complicated by the relatively weak association between symptoms of patients with OA and radiographic findings.…”

Section: Introductionmentioning

confidence: 99%

“…The situation is further complicated by the relatively weak association between symptoms of patients with OA and radiographic findings. [24][25][26] Therefore, it is all the more important to determine which of these patient characteristics are comparatively most predictive of patient outcome to help develop clinical pathways to improve patient care and ultimate outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Total Knee Arthroplasty in Relation to Preoperative Patient-Reported and Radiographic Measures

Kahn

Soheili

Schwarzkopf

2013

Geriatr Orthop Surg Rehabil

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Introduction: Total knee arthroplasty (TKA) is the preferred surgical treatment for end-stage osteoarthritis. However, substantial numbers of patients still experience poor outcomes. Consequently, it is important to identify which patient characteristics are predictive of outcomes in order to guide clinical decisions. Our hypothesis is that preoperative patient-reported outcome measures and radiographic measures may help to predict TKA outcomes. Methods: Using cohort data from the Osteoarthritis Initiative, we studied 172 patients who underwent TKA. For each patient, we compiled pre-and postoperative Western Ontario and McMaster University Arthritis Index (WOMAC) scores. Radiographs were measured for knee joint angles, femorotibial angles, anatomical lateral distal femoral angles, and anatomical medial proximal tibial angles; Kellgren and Lawrence (KL) grades were assigned to each compartment of the knee. All studied measurements were compared to WOMAC outcomes. Results: Preoperative WOMAC disability, pain, and total scores were positively associated with postoperative WOMAC total scores (P ¼ .010, P ¼ .010, and P ¼ .009, respectively) and were associated with improvement in WOMAC total scores (P < .001, P < .001, and P < .001, respectively). For radiographic measurements, preoperative joint angles were positively associated with improvements in postoperative WOMAC total scores (P ¼ .044). Combined KL grades (medial and lateral compartments) were negatively correlated with postoperative WOMAC disability and pain scores (P ¼ .045 and P ¼ .044) and were positively correlated with improvements in WOMAC total scores (P ¼ .001). Conclusions: All preoperative WOMAC scores demonstrated positive associations with postoperative WOMAC scores, while among the preoperative radiographic measurements only combined KL grades and joint angles showed any correlation with postoperative WOMAC scores. Higher preoperative KL grades and joint angles were associated with better (lower) postoperative WOMAC scores, demonstrating an inverse correlation.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes of Total Knee Arthroplasty in Relation to Preoperative Patient-Reported and Radiographic Measures

Kahn

Soheili

Schwarzkopf

2013

Geriatr Orthop Surg Rehabil

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“…Polkowski et al have noted that as many as 50% of patients who present for assessment of a painful TKA with acceptable postoperative radiographs had only mild or moderate preoperative radiographic disease at the time of their primary TKA procedure [19]. While several published studies have suggested a relationship between preoperative malalignment and obesity on the progression of knee osteoarthritis and postoperative TKA clinical outcome scores, these studies have not specifically reported on the radiographic disease severity of patients related to patient age at the time of TKA surgery [4][5][6]8,11,22]. We performed this study to assess the radiographic disease severity of younger patients (≤55 years old) at the time of TKA surgery and the relationship between radiographic disease severity, patient demographic features, and preoperative patient reported outcome measures.…”

Section: Introductionmentioning

confidence: 99%

Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty

et al. 2017

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Previous cartilage surgery is associated with inferior patient‐reported outcomes after knee arthroplasty

Birkenes,

Furnes,

Lygre

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe hypothesis of the present study assumed that a history of focal cartilage lesions would not affect Knee Injury and Osteoarthritis Outcome scores (KOOSs) following knee arthroplasty compared to a matched national cohort of knee arthroplasty patients.MethodsFifty‐eight knee arthroplasty patients with previous surgery for focal cartilage lesions (cartilage cohort) were compared to a matched cohort of 116 knee arthroplasty patients from the Norwegian Arthroplasty Register (control group). Age, sex, primary or revision arthroplasty, type of arthroplasty (total, unicondylar or patellofemoral), year of arthroplasty surgery and arthroplasty brand were used as matching criteria. Demographic data and KOOS were obtained through questionnaires. Regression models were employed to adjust for confounding factors.ResultsMean follow‐up post knee arthroplasty surgery was 7.6 years (range 1.2–20.3) in the cartilage cohort and 8.1 (range 1.0–20.9) in the control group. The responding patients were at the time of surgery 54.3 versus 59.0 years in the cartilage and control group, respectively. At follow‐up the control group demonstrated higher adjusted Knee Injury and Osteoarthritis Outcome subscores than the previous focal cartilage patients with a mean adjusted difference (95% confidence interval in parentheses): Symptoms 8.4 (0.3, 16.4), Pain 11.8 (2.2, 21.4), Activities of daily living (ADL) 9.3 (−1.2, 18.6), Sport and recreation 8.9 (−1.6, 19.4) and Quality of Life (QoL) 10.6 (0.2, 21.1). The control group also demonstrated higher odds of reaching the patient‐acceptable symptom state threshold for the Knee Injury and Osteoarthritis Outcome subscores with odds ratio: Symptoms 2.7 (1.2, 6.4), Pain 3.0 (1.3, 7.0), ADL 2.1 (0.9, 4.6) and QoL 2.4 (1.0, 5.5).ConclusionPrevious cartilage surgery was associated with inferior patient‐reported outcomes after knee arthroplasty. These patients also exhibited significantly lower odds of reaching the patient‐acceptable symptom state threshold for the Knee Injury and Osteoarthritis Outcome subscores.Level of EvidenceLevel III.

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The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis

Cited by 36 publications

References 57 publications

Outcomes of Total Knee Arthroplasty in Relation to Preoperative Patient-Reported and Radiographic Measures

Outcomes of Total Knee Arthroplasty in Relation to Preoperative Patient-Reported and Radiographic Measures

Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty

Previous cartilage surgery is associated with inferior patient‐reported outcomes after knee arthroplasty

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