The Influence of the Contralateral Knee Prior to Knee Arthroplasty on Post-Arthroplasty Function: The Multicenter Osteoarthritis Study

Maxwell, Jessica; Niu, Jingbo; Singh, Jasvinder A.; Nevitt, Michael C.; Law, Laura Frey; Felson, David T.

doi:10.2106/jbjs.l.00267

Cited by 34 publications

(28 citation statements)

References 19 publications

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“…For example, instruments designed to quantify pain catastrophizing, anxiety and depressive symptom severity may provide more granular and therefore more stable and more predictive measures of psychological health [23]. Contralateral knee OA and pain status [24] as well as index knee quadriceps strength[25], fibromyalgia symptoms[26] and overall bodily pain also have been associated with poor outcome following KA and may add to the power of a prognostic model. Finally, greater comorbidity[27] and African American race[28] also are associated with poor outcome.…”

Section: Discussionmentioning

confidence: 99%

External Validation of a Prognostic Model for Predicting Nonresponse Following Knee Arthroplasty

Riddle

Golladay

Jiranek

et al. 2017

The Journal of Arthroplasty

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Background Instruments designed to predict extent of pain and function following knee arthroplasty (KA) recovery have strong potential to guide patients and clinicians in shared decision-making. Our purpose was to test the external validity of a recently developed prognostic instrument designed to estimate the probability of nonresponse following knee arthroplasty. Methods We used data from the Osteoarthritis Initiative (OAI), a nine-year multi-site National Institutes of Health study designed to examine the natural history of knee osteoarthritis in 4,796 subjects. A total of 427 subjects underwent KA over the study period. Dowsey and colleagues examined the prognostic role of obesity, general mental health, pain and function, and Kellgren and Lawrence knee osteoarthritis (OA) grades. Calibration of the prognostic model was determined using a calibration curve. The c-statistic was used to indicate discrimination of the model. Results In the primary analysis 63 (19.3%) of 326 subjects in OAI were classified as non-responders. The calibration curve generated from OAI data indicated poor calibration relative to the recently developed instrument. Discrimination as measured by the c-statistic was 0.76. Conclusion The external validity of the prognostic instrument was partially supported. While discrimination of the model was very similar to the recently developed instrument, calibration was poor indicating poor agreement between actual versus predicted probabilities of nonresponse. WOMAC and Kellgren and Lawrence grades show strong potential for use in future prognostic model development. Measurements of general mental health and obesity were not prognostic for nonresponse.

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Section: Discussionmentioning

confidence: 99%

External Validation of a Prognostic Model for Predicting Nonresponse Following Knee Arthroplasty

Riddle

Golladay

Jiranek

et al. 2017

The Journal of Arthroplasty

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“…Presence of contralateral knee pain: 4.1 times risk (95% CI, 1.5–11.5) of poor self‐reported function post‐TKA…”

Section: Optimising Pre‐operative Status To Maximise Recovery and Attmentioning

confidence: 99%

“…There is good evidence that non‐operative treatment of mild to moderate osteoarthritis may yield benefits, and it would appear intuitive that interventions designed to improve the functional status of TKA patients pre‐operatively may enhance post‐operative recovery. Many TKA recipients suffer from other lower limb joint disease, so these interventions may also be helpful beyond the index joint.…”

Section: Optimising Pre‐operative Status To Maximise Recovery and Attmentioning

confidence: 99%

Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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Summary The minimum requirements for total knee arthroplasty (TKA) are significant, prolonged symptoms with supporting clinical and radiological signs. Despite interest in screening tools, there is limited evidence for a specific symptom threshold that justifies surgery. Non‐operative treatments including medications, exercise and weight loss are unlikely to reverse radiographic changes, but they may improve symptoms and delay the need for surgery. Many patient factors such as mental health and obesity affect both the level of symptomatic improvement after surgery and risks of surgery, but none have been identified as contraindications for the procedure as significant health gains can still be achieved. Although age and sex are associated with patient‐reported outcomes and risk of revision, these factors cannot be used to restrict access to TKA, and age cut‐offs are not recommended. Evidence regarding pre‐operative optimisation of patients to improve post‐operative TKA outcomes is limited by the few interventional trials available, particularly in the areas of patient expectation, diabetes, obesity and vascular disease. There is good evidence from randomised controlled trials that pre‐operative rehabilitation primarily focusing on exercises for the joint or limb has minimal effect on post‐operative TKA outcomes, and there is some evidence from randomised controlled trials that an intensive smoking cessation program before surgery may improve post‐operative outcomes. Detailed international guidelines exist on the optimisation of the cardiorespiratory status of surgical patients, and these should be followed for TKA surgery.

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“…Naugle and Riley showed that self‐reported physical activity levels in healthy individuals predicted lower pain sensitivity showing an interaction between function and pain sensitivity. Further, preoperative contralateral knee pain is associated with poor function after TKA: people reporting the highest pain severity had 4.1 times higher risk of poor function . Thus, enhanced pain sensitivity and widespread pain predict worse pain and function after TKA.…”

Section: Discussionmentioning

confidence: 98%

Predictors of multidimensional functional outcomes after total knee arthroplasty

Cooper

Rakel

Zimmerman

et al. 2017

Journal Orthopaedic Research

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Multiple assessments are used clinically after total knee arthroplasty (TKA) including self-report, performance tasks, and physical activity levels. It is unclear if these different functional assessments are interchangeable or if they measure different constructs. The objective of this study was to characterize different functional measures before and after TKA. We characterized function before and after TKA using perceived function (KOOS ADL), physical performance (gait speed), and daily activity (steps/day via accelerometry); compared function in people undergoing TKA to age-matched healthy controls; and examined characteristics of those undergoing TKA for potential predictors of postoperative function. Prior to TKA, all three functional assessments were significantly lower for participants than those of healthy controls and each measure remained lower for participants than for controls postoperatively. All three functional assessments developed differently over time postoperatively. Each functional outcome had a unique set of predictors. Perceived function was predicted primarily by anxiety and depression, physical performance was most strongly predicted by age, and daily activity was chiefly predicted by BMI. Pressure pain threshold was a common predictor across all models. Functional limitations exist preoperatively and persist postoperatively across different measures in people undergoing TKA when compared to those measures in healthy controls. Functional outcomes after TKA are different depending on the functional measure utilized, implying that different constructs underlie each measure. Multiple functional measures should be assessed to provide a more comprehensive assessment of function after TKA. Further work should assess the impact of interventions designed to treat modifiable predictors of postoperative TKA function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2790-2798, 2017.

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The Influence of the Contralateral Knee Prior to Knee Arthroplasty on Post-Arthroplasty Function: The Multicenter Osteoarthritis Study

Cited by 34 publications

References 19 publications

External Validation of a Prognostic Model for Predicting Nonresponse Following Knee Arthroplasty

External Validation of a Prognostic Model for Predicting Nonresponse Following Knee Arthroplasty

Selecting and optimising patients for total knee arthroplasty

Predictors of multidimensional functional outcomes after total knee arthroplasty

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