The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease

Abstract

Objective. Varus and valgus malalignment increase the risk of medial and lateral osteoarthritis (OA) progression, respectively. The impact of a mechanical factor such as alignment depends not only on the factor itself, but also on the state of the joint. The lessdamaged joint of mild OA may be less vulnerable to malalignment effects than the more-damaged joint of moderate OA. Our goal was to explore the impact of alignment on subsequent progression of knee OA according to the baseline stage of disease.Methods. Two hundred thirty patients with knee OA (defined by the presence of osteophytes and symptoms) recruited from the community underwent assessment of both lower limbs at baseline and at an 18-month followup. Alignment was measured on a full-limb radiograph as the angle made by the intersection of the femoral and tibial mechanical axes. Compartmentspecific progression was defined as an increase between baseline and 18 months in the grade of severity of joint space narrowing on radiographs of semiflexed knees taken after fluoroscopic confirmation of position. Knees were grouped according to their baseline stage of OA as Kellgren/Lawrence (K/L) grades 0-1, 2, or 3. Progression odds ratios were estimated from logistic regression using generalized estimating equations.Results. There were 377 K/L grade 0-3 knees in 230 subjects (173 women and 57 men, mean age 64.0 years, mean body mass index 30.4 kg/m 2 ) in this longitudinal study. In knees with mild OA (K/L grade 2), the odds of 18-month progression in the medial compartment were significantly increased 4-fold by varus alignment at baseline. In K/L grade 2 knees, the odds of lateral progression were increased 2-fold by valgus alignment (approaching significance). In knees with moderate OA (K/L grade 3), the risk of progression was comparably increased by varus or valgus alignment (10-fold).Conclusion. While some effect of malalignment was suggested at almost all stages of knee OA examined, the impact of varus or valgus malalignment on the odds of OA progression over the ensuing 18 months was greater in knees with moderate (K/L grade 3) OA at baseline, possibly due to greater joint vulnerability with some contribution from slightly more severe malalignment.

Prognostic factors of progression of osteoarthritis of the knee: A systematic review of observational studies

“…Three studies (10,14,22) reported a statistically significant association between varus alignment and progression of OA measured by a decrease in JSW. A nonsignificant relationship between the varus alignment and progression of OA was only found in the analysis of the K/L grade 0 -1 group in the study by Cerejo et al (10).…”

“…Three studies (10,14,22) reported a statistically significant association between varus alignment and progression of OA measured by a decrease in JSW. A nonsignificant relationship between the varus alignment and progression of OA was only found in the analysis of the K/L grade 0 -1 group in the study by Cerejo et al (10). In the study by Miyazaki et al (22), a statistically significant OR was found for the univariate analysis of varus alignment and progression of knee OA (OR 3.10, 95% CI 1.07-9.12), but not in the multivariate analysis.…”

“…In the study by Miyazaki et al (22), a statistically significant OR was found for the univariate analysis of varus alignment and progression of knee OA (OR 3.10, 95% CI 1.07-9.12), but not in the multivariate analysis. Cerejo et al (10) and Sharma et al (14) also investigated the relationship between valgus alignment and progression of Bruyere (42) Yes vs no (22) also investigated the association between the adduction moment and progression of OA. For the adduction moment, a statistically significant association was reported.…”

Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes

“…In our study, the loss of cartilage volume in the TWO-YEAR PROGRESSION OF KNEE OA ASSESSED BY QUANTITATIVE MRImedial compartment of the knee were even more striking and reflected a more rapid disease progression in this region. This may be explained in part by the higher weight-bearing pressure in this compartment or by baseline varus-valgus misalignment (61).…”

Constitutional Varus Does Not Affect Joint Line Orientation in the Coronal Plane

“…stress, obesity, genetic predisposition, kinematic alterations, and lower limb malalignment [3][4][5][6]. Current knowledge of the morphological bases of knee osteoarthritis onset and progression is mainly limited to lower limb alignment in the coronal plane [3-6, 25, 26].…”