Disability for daily living is a predictor for joint replacement in patients with end-stage knee osteoarthritis
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The objective indicators which reflect the past results of end-stage knee osteoarthritis (OA) patients who have already received total knee arthroplasty (TKA) could be helpful for physicians to discuss with patients who are considering TKA. The aim of this prospective cohort study was to examine whether we could predict the knee OA patients who would receive TKA in advance based on baseline data, and to set cut-off points for receiving TKA. The two-hundred and forty end-stage medial-type knee OA patients were enrolled and followed up for 6 months while performing therapeutic exercises. Radiographic findings, visual analog scale for pain and a patient-oriented outcome measure, the Japanese Knee Osteoarthritis Measure (JKOM), were recorded at baseline. Relative risks (RRs) using the area under the curve (AUC) for a receiver operating characteristic (ROC) curve were calculated to evaluate several scores for receiving TKA. While 119 patients (55.3 %) did not undergo TKA, the remaining 96 patients (44.7 %) underwent TKA during this period. The AUCs of the ROC curve for the JKOM total score [0.71 (95 % CI 0.64–0.79)] were higher than those for radiographic parameters. Among the JKOM subcategories, JKOM category III, which indicates the condition in daily life, showed the highest AUC of 0.72 (0.65–0.80). The JKOM total score (65/100) and JKOM category III score (17/40) showed RRs of 2.20 (1.33–3.63) and 1.95 (1.18–3.22) for receiving TKA, respectively. The presence of disability in daily living was found to be an important factor determining whether the patient should undergo TKA.
KeywordsKnee osteoarthritis Japanese knee osteoarthritis measure (JKOM) Total knee arthroplasty (TKA) Disability Pain
We wish to thank for Dr. Takayuki Kawasaki for his valuable help in data collection. This study was funded in part by a High Technology Research Center Grant from the Ministry of Education, Culture, Sports, Science and Technology, Japan (to MI and KK).
Conflict of interest
All authors have no conflicts of interest.
- 10.Gossec L, Hawker G, Davis AM, Maillefert JF, Lohmander LS, Altman R, Cibere J, Conaghan PG, Hochberg MC, Jordan JM, Katz JN, March L, Mahomed N, Pavelka K, Roos EM, Suarez-Almazor ME, Zanoli G, Dougados M (2007) OMERACT/OARSI initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis. J Rheumatol 34:1432–1435PubMedGoogle Scholar
- 12.Gossec L, Paternotte S, Maillefert JF, Combescure C, Conaghan PG et al (2011) 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 19:147–154PubMedCrossRefGoogle Scholar
- 17.Dieppe P, Judge A, Williams S, Ikwueke I, Guenther KP, Floeren M, Huber J, Ingvarsson T, Learmonth I, Lohmander LS, Nilsdotter A, Puhl W, Rowley D, Thieler R, Dreinhoefer K (2009) Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres. BMC Musculoskelet Disord 10:19PubMedCentralPubMedCrossRefGoogle Scholar
- 21.Kawasaki T, Kurosawa H, Ikeda H, Kim SG, Osawa A, Takazawa Y, Kubota M, Ishijima M (2008) Additive effects of glucosamine or risedronate for the treatment of osteoarthritis of the knee combined with home exercise: a prospective randomized 18-month trial. J Bone Miner Metab 26:279–287PubMedCrossRefGoogle Scholar
- 22.Kawasaki T, Kurosawa H, Ikeda H, Takazawa Y, Ishijima M, Kubota M, Kajihara H, Maruyama Y, Kim SG, Kanazawa H, Doi T (2009) Therapeutic home exercise versus intraarticular hyaluronate injection for osteoarthritis of the knee: 6-month prospective randomized open-labeled trial. J Orthop Sci 14:182–191PubMedCrossRefGoogle Scholar
- 23.Altman R, Asch E, Bloch D, Bole G, Borenstein D et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria Committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049PubMedCrossRefGoogle Scholar
- 29.Liu L, Ishijima M, Futami I, Kaneko H, Kubota M, Kawasaki T, Matsumoto T, Kurihara H, Ning L, Xu Z, Ikeda H, Takazawa Y, Saita Y, Kimura Y, Xu S, Kaneko K, Kurosawa H (2010) Correlation between synovitis detected on enhanced-magnetic resonance imaging and a histological analysis with a patient-oriented outcome measure for japanese patients with end-stage knee osteoarthritis receiving joint replacement surgery. Clin Rheumatol 29:1185–1190PubMedCrossRefGoogle Scholar
- 30.Ishijima M, Watari T, Naito K, Kaneko H, Futami I, Yoshimura-Ishida K, Tomonaga A, Yamaguchi H, Yamamoto T, Nagaoka I, Kurosawa H, Poole RA, Kaneko K (2011) Relationships between biomarkers of cartilage, bone, synovial metabolism and knee pain provide insights into the origins of pain in early knee osteoarthritis. Arthritis Res Ther 13:R22PubMedCentralPubMedCrossRefGoogle Scholar
- 31.Pham T, Van Der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, Dougados M (2004) OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage 12:389–399PubMedCrossRefGoogle Scholar
- 35.Laslett Ll, Kingsbury Sr, Hensor Em, Bowes Ma, Conaghan Pg (2013) Effect of bisphosphonate use in patients with symptomatic and radiographic knee osteoarthritis: data from the osteoarthritis initiative. Ann Rheum Dis (Epub ahead of print)Google Scholar