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

Haynes, J.; Sassoon, Adam; Nam, Denis; Schultz, Loren G.; Keeney, James A.

doi:10.1016/j.knee.2016.11.004

Cited by 30 publications

(41 citation statements)

References 22 publications

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“…in a prospective study with follow‐up ranging from 6 to 73 months demonstrated a significant inverse association ( P = 0.044). The same relationship was also demonstrated in two further studies . Conversely, Vina et al .…”

Section: Resultssupporting

confidence: 82%

“…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%

“…The relationship of these factors to outcome is complex and has not yet been established . Preoperative osteoarthritis (OA) severity may be related to outcome . This is often measured radiographically.…”

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: Resultssupporting

confidence: 82%

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%

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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“…Both young (< 50 years) and old (> 90 years) age are thought to be relative contraindications to undergoing TKA. While younger people have a higher likelihood of requiring revision surgery (both earlier and during their lifetime), and although there is some evidence that clinical results may also be inferior in younger people, youth itself is not a contraindication. Young people can still experience benefits if they satisfy the criteria above.…”

Section: Patient Characteristics Influencing Decision Makingmentioning

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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Unicompartmental bipolar osteochondral and meniscal allograft transplantation is effective for treatment of medial compartment gonarthrosis in a canine model

Schreiner

Stannard

Stoker

et al. 2020

Journal Orthopaedic Research

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Osteochondral allograft (OCA) transplantation can restore large articular defects in the knee. Bipolar OCA transplantations for partial and whole joint resurfacing often have less favorable results than single-surface transplants. This study was designed to use a large animal model to test the hypothesis that unicompartmental bipolar osteochondral and meniscal allograft transplantation (BioJoint) would be as or more effective for treatment of medial compartment osteoarthritis (OA) compared to standard-of-care nonoperative treatment. OA was induced in one knee of each research hound (n = 8) using a meniscal release model and pretreatment assessments were performed. After 3 months, dogs were randomly assigned to either the control group (n = 4, no surgical intervention, daily nonsteroidal antiinflammatory drugs [NSAIDs]) or the BioJoint group (n = 4). Clinical, radiographic, and arthroscopic assessments were performed longitudinally and histopathology was evaluated at the 6-month endpoint. At study endpoint, functional, pain, and total pressure index measures, as well as radiographic and arthroscopic grading of graft appearance and joint health, demonstrated superior outcomes for BioJoints compared to NSAID controls. Furthermore, histologic assessments showed that osteochondral and meniscal transplants maintain integrity and integrated into host tissues. Clinical significance: The results support the safety and efficacy of unicompartmental bipolar osteochondral and meniscal allograft transplantation in a preclinical model with highly functional outcomes without early OA progression.

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

Cited by 30 publications

References 22 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

Selecting and optimising patients for total knee arthroplasty

Unicompartmental bipolar osteochondral and meniscal allograft transplantation is effective for treatment of medial compartment gonarthrosis in a canine model

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