Extent of Tibiofemoral Osteoarthritis Before Knee Arthroplasty: Multicenter Data from the Osteoarthritis Initiative
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Knee arthroplasty traditionally is recommended for persons with substantial disability and disabling pain attributable to moderate or severe osteoarthritis (OA). Pain and functional status after arthroplasty may be influenced by the extent of knee OA before surgery and recent evidence suggests persons with less severe knee OA before undergoing TKA have greater pain levels and worse function than persons with more severe knee OA.
We determined the proportion of patients undergoing knee arthroplasty who had less than moderate knee OA before surgery and who had either a radiographically normal medial or lateral joint space before surgery.
One hundred sixteen persons in the Osteoarthritis Initiative underwent knee arthroplasty during a 3-year period. Ninety-seven of the 116 patients (84%) had radiographs available less than 1 year before surgery and were included. We used Z-tests to determine whether the proportion of patients with a modified Kellgren-Lawrence (KL) grade of 3 or higher differed from literature-based estimates. In addition, we described the proportion of patients with medial and lateral joint space narrowing.
The proportion of patients with a modified KL grade of 3 or higher was 0.81 (95% CI, 0.73–0.89) and was less than the 0.95 estimated population proportion. Of the patients who underwent knee arthroplasty, 85% (82 of 97 knee arthroplasties) had at least one tibiofemoral joint compartment that had no joint space narrowing. One in six patients with OA who underwent knee arthroplasty had a KL grade of 2 or lower.
Variation in the extent of tibiofemoral OA in patients preparing for joint arthroplasty is greater than previously described. A greater percentage of patients undergoing knee arthroplasty may be at risk for increased pain and poorer function than previously assumed after surgery because of less severe knee OA before surgery.
Level of Evidence
Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage. 2007;15(suppl A):A1–A56. CrossRef
- Altman RD, Hochberg M, Murphy WA Jr, Wolfe F, Lequesne M. Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage. 1995;3(suppl A):3–70.
- Barker K, Lamb SE, Toye F, Jackson S, Barrington S. Association between radiographic joint space narrowing, function, pain and muscle power in severe osteoarthritis of the knee. Clin Rehabil. 2004;18:793–800. CrossRef
- Benichou OD, Hunter DJ, Nelson DR, Guermazi A, Eckstein F, Kwoh K, Myers SL, Wirth W, Duryea J; Osteoarthritis Initiative Investigators. One-year change in radiographic joint space width in patients with unilateral joint space narrowing: data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2010;62:924–931. CrossRef
- Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg. 2008;16:9–18.
- Brandt KD, Mazzuca SA, Conrozier T, Dacre JE, Peterfy CG, Provvedini D, Ravaud P, Taccoen A, Vignon E. Which is the best radiographic protocol for a clinical trial of a structure modifying drug in patients with knee osteoarthritis? J Rheumatol. 2002;29:1308–1320.
- Cross WW 3rd, Saleh KJ, Wilt TJ, Kane RL. Agreement about indications for total knee arthroplasty. Clin Orthop Relat Res. 2006;446:34–39. CrossRef
- Cushnaghan J, Bennett J, Reading I, Croft P, Byng P, Cox K, Dieppe P, Coggon D, Cooper C. Long-term outcome following total knee arthroplasty: a controlled longitudinal study. Ann Rheum Dis. 2009;68:642–647. CrossRef
- Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86:963–974.
- Gossec L, Paternotte S, Bingham CO 3rd, Clegg DO, Coste P, Conaghan PG, Davis AM, Giacovelli G, Gunther KP, Hawker G, Hochberg MC, Jordan JM, Katz JN, Kloppenburg M, Lanzarotti A, Lim K, Lohmander LS, Mahomed NN, Maillefert JF, Manno RL, March LM, Mazzuca SA, Pavelka K, Punzi L, Roos EM, Rovati LC, Shi H, Singh JA, Suarez-Almazor ME, Tajana-Messi E, Dougados M; OARSI-OMERACT Task Force Total Articular Replacement as Outcome Measure in OA. OARSI/OMERACT initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis. An OMERACT 10 Special Interest Group. J Rheumatol. 2011;38:1765–1769.
- Gossec L, Paternotte S, Maillefert JF, Combescure C, Conaghan PG, Davis AM, Gunther KP, Hawker G, Hochberg M, Katz JN, Kloppenburg M, Lim K, Lohmander LS, Mahomed NN, March L, Pavelka K, Punzi L, Roos EM, Sanchez-Riera L, Singh JA, Suarez-Almazor ME, Dougados M; OARSI-OMERACT Task Force “total articular replacement as outcome measure in OA”. The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement. Osteoarthritis Cartilage. 2011;19:147–154.
- Guermazi A, Hunter DJ, Roemer FW. Plain radiography and magnetic resonance imaging diagnostics in osteoarthritis: validated staging and scoring. J Bone Joint Surg Am. 2009;91(suppl 1):54–62. CrossRef
- Kauppila AM, Kyllonen E, Mikkonen P, Ohtonen P, Laine V, Siira P, Niinimaki J, Arokoski JP. Disability in end-stage knee osteoarthritis. Disabil Rehabil. 2009;31:370–380. CrossRef
- Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502. CrossRef
- Kim HA, Kim S, Seo YI, Choi HJ, Seong SC, Song YW, Hunter D, Zhang Y. The epidemiology of total knee replacement in South Korea: national registry data. Rheumatology (Oxford). 2008;47:88–91. CrossRef
- Kothari M, Guermazi A, von Ingersleben G, Miaux Y, Sieffert M, Block JE, Stevens R, Peterfy CG. Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol. 2004;14:1568–1573. CrossRef
- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174. CrossRef
- NIH Consensus Panel. NIH Consensus Statement on total knee replacement December 8–10, 2003. J Bone Joint Surg Am. 2004;86:1328–1335.
- Norwegian Arthroplasty Register. Annual Report June 2010. Available at: http://nrlweb.ihelse.net/eng/Report_2010.pdf. Accessed January 4, 2012.
- Peterfy C, Li J, Zaim S, Duryea J, Lynch J, Miaux Y, Yu W, Genant HK. Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: test-retest reproducibility. Skeletal Radiol. 2003;32:128–132. CrossRef
- Riddle DL, Jiranek WA, McGlynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States. J Arthroplasty. 2008;23:408–412. CrossRef
- Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85:257–268.
- Valdes AM, Doherty SA, Zhang W, Muir KR, Maciewicz RA, Doherty M. Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. Semin Arthritis Rheum. 2012;41:568–575. CrossRef
- Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee. 2009;16:473–478. CrossRef
- Wise BL, Felson DT, Clancy M, Niu J, Neogi T, Lane NE, Hietpas J, Curtis JR, Bradley LA, Torner JC, Zhang Y. Consistency of knee pain and risk of knee replacement: the Multicenter Osteoarthritis Study. J Rheumatol. 2011;38:1390–1395. CrossRef
- Woolson ST, Shu B, Giori NJ. Incidence of radiographic unicompartmental arthritis in patients undergoing knee arthroplasty. Orthopedics. 2010;33:798.
- Wright JG, Coyte P, Hawker G, Bombardier C, Cooke D, Heck D, Dittus R, Freund D. Variation in orthopedic surgeons’ perceptions of the indications for and outcomes of knee replacement. CMAJ. 1995;152:687–697.
- Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Rheum Dis Clin North Am. 2008;34:515–529. CrossRef
- Extent of Tibiofemoral Osteoarthritis Before Knee Arthroplasty: Multicenter Data from the Osteoarthritis Initiative
Clinical Orthopaedics and Related Research®
Volume 470, Issue 10 , pp 2836-2842
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Physical Therapy, Virginia Commonwealth University, P.O. Box 980224, Richmond, VA, 23298, USA
- 2. Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA