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The clinical symptom profile of early radiographic knee arthritis: a pain and function comparison with advanced disease

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Early knee OA is a significant problem that can be disabling. The purpose of this study was to understand the symptomatic profile of patients with early knee OA when compared to those with end-stage knee OA.

Methods

A cross-sectional case control study design was used to compare those with early structural change to those with advanced structural change. In total, 100 consecutive patients with early radiographic knee OA presenting to the knee service outpatient clinic from December 2010 to August 2011 were prospectively identified on the basis of their radiographic changes. All met the symptomatic and radiological diagnostic criteria of early knee OA as defined by Luyten et al. They were compared with 200 knees with full thickness anteromedial knee OA and 200 knees with full thickness tricompartmental knee OA for their demographic, pain and functional profile.

Results

Patients with early knee OA were younger than those with full thickness disease. However, 78 % of individual patients with early radiographic OA had pain and function scores equal to individual patients presenting for UKA, whilst 74 % of individual patients with early radiographic OA had pain and function scores that are equal to or worse than individual patients presenting for TKA.

Conclusions

Patients with early radiographic knee OA demonstrate considerable overlap in the severity of their symptoms with those demonstrating end-stage structural changes within the knee. Patients with early structural changes of arthritis should not be assumed by clinicians to have mild disease. In many cases, their symptoms are as bad as those with end-stage structural changes. This work will help clinicians to identify and categorise those with early arthritis and thereby assist in guiding appropriate treatments.

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References

  1. Beard DJ, Pandit H, Price AJ, Butler-Manuel PA, Dodd CAF, Murray DW, Goodfellow JW (2007) Introduction of a new mobile-bearing total knee prosthesis: minimum three year follow-up of an RCT comparing it with a fixed-bearing device. Knee 14:448–451

    Article  PubMed  CAS  Google Scholar 

  2. Bedson J, Croft PR (2008) The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord 9:116–127

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bewick V, Cheek L, Ball J (2004) Statistics review 9: one-way analysis of variance. Crit Care BioMed Cent 8:130–136

    Article  Google Scholar 

  4. Bollars P, Bosquet M, Vandekerckhove B, Hardeman F, Bellemans J (2012) Prosthetic inlay resurfacing for the treatment of focal, full thickness cartilage defects of the femoral condyle: a bridge between biologics and conventional arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:1753–1759

    Article  PubMed  Google Scholar 

  5. Brouwer RW, Jakma TSC, Bierma-Zeinstra SMA, Verhagen AP, Verhaar J (2005) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev CD004019

  6. Flores R, Hochberg M (1998) Definition and Classification of Osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS (eds) Osteoarthritis. Oxford University Press, New York, pp 1–12

    Google Scholar 

  7. Guermazi A, Roemer FW, Burstein D, Hayashi D (2011) Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis. Arthritis Res Ther 13:247–258

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38:1125–1133

    Article  PubMed  Google Scholar 

  9. Harris K, Dawson J, Doll H, Field RE, Murray DW, Fitzpatrick R, Jenkinson C, Price AJ, Beard DJ (2013) Can pain and function be distinguished in the Oxford Knee Score in a meaningful way? An exploratory and confirmatory factor analysis. Qual Life Res 22:2561–2568

    Article  PubMed  Google Scholar 

  10. Harris KK, Dawson J, Jones LD, Beard DJ, Price AJ (2013) Extending the use of PROMs in the NHS-using the Oxford Knee Score in patients undergoing non-operative management for knee osteoarthritis: a validation study. BMJ Open 3:e003365

    PubMed  PubMed Central  Google Scholar 

  11. Heir S, Nerhus TK, Røtterud JH, Løken S, Ekeland A, Engebretsen L, Arøen A (2010) Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 38:231–237

    Article  PubMed  Google Scholar 

  12. Hernigou P, Medeville D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. J Bone Joint Surg 69-A:332–354

    Google Scholar 

  13. Jinks C, Jordan K, Ong BN, Croft P (2004) A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over. Rheumatology 43:55–61

    Article  PubMed  CAS  Google Scholar 

  14. Jones LD, Grammatopoulos G, Kambouroglou G (2014) Titanium elastic nails, open reduction internal fixation and non-operative management for middle third clavicle fractures: a comparative study. Eur J Orthop Surg Traumatol 24:323–329

    Article  PubMed  Google Scholar 

  15. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Levene H (1960) Contributions to probability and statistics: essays in honor of Harold Hotelling. Stanford University Press, California, USA, pp 278–292

  17. Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Predicting the outcome of total knee arthroplasty. J Bone Joint Surg 86-A:2179–2186

    PubMed  Google Scholar 

  18. London NJ, Miller LE, Block JE (2011) Clinical and economic consequences of the treatment gap in knee osteoarthritis management. Med Hypotheses 76:887–892

    Article  PubMed  Google Scholar 

  19. Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L (2012) Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20:401–406

    Article  PubMed  Google Scholar 

  20. Marcacci M, Kon E, Zaffagnini S, Filardo G, Delcogliano M, Neri MP, Iacono F, Hollander AP (2007) Arthroscopic second generation autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 15:610–619

    Article  PubMed  Google Scholar 

  21. Michael JW, Schlüter-Brust KU, Eysel P (2010) The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int 107:152–162

    PubMed  PubMed Central  Google Scholar 

  22. Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, Dragomir A, Kalsbeek WD, Luta G, Jordan JM (2008) Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum 59:1207–1213

    Article  PubMed  PubMed Central  Google Scholar 

  23. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg (Br) 89:1010–1014

    Article  CAS  Google Scholar 

  24. Murray DW, Goodfellow JW, O’Connor JJ (1998) The Oxford unicompartmental knee arthroplasty. J Bone Joint Surg (Br) 80:983–989

    Article  CAS  Google Scholar 

  25. Pandit H, Gulati A, Jenkins C, Barker K, Price AJ, Dodd CAF, Murray DW (2011) Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Knee 18:168–171

    Article  PubMed  CAS  Google Scholar 

  26. Pandit H, Jenkins C, Gill HS, Barker K, Dodd CAF, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg (Br) 93:198–204

    Article  CAS  Google Scholar 

  27. Pill SG, Huffman RG, Garino JP, Lee G-C (2009) Knee osteotomy for unicompartmental knee arthritis. Curr Orthop Pract 20:682–686

    Article  Google Scholar 

  28. Porter M, Tucker K, Beaumont R, Young E, Forsyth O, Swanson M (2012) National Joint Registry for England and Wales 9th Annual Report. Natl Jt Regist 1–212

  29. Ruhdorfer A, Dannhauer T, Wirth W, Hitzl W, Kwoh CK, Guermazi A, Hunter DJ, Benichou O, Eckstein F (2013) Thigh muscle cross-sectional areas and strength in advanced versus early painful osteoarthritis: an exploratory between-knee, within-person comparison in osteoarthritis initiative participants. Arthritis Care Res (Hoboken) 65:1034–1042

    Article  Google Scholar 

  30. Sofat N, Ejindu V, Kiely P (2011) What makes osteoarthritis painful? The evidence for local and central pain processing. Rheumatology 50:2157–2165

    Article  PubMed  Google Scholar 

  31. Szebenyi B, Hollander AP, Dieppe P, Quilty B, Duddy J, Clarke S, Kirwan JR (2006) Associations between pain, function, and radiographic features in osteoarthritis of the knee. Arthritis Rheum 54:230–235

    Article  PubMed  Google Scholar 

  32. Thorstensson CA, Andersson MLE, Jönsson H, Saxne T, Petersson IF (2009) Natural course of knee osteoarthritis in middle-aged subjects with knee pain: 12-year follow-up using clinical and radiographic criteria. Ann Rheum Dis 68:1890–1893

    Article  PubMed  CAS  Google Scholar 

  33. Torres L, Dunlop DD, Peterfy C, Guermazi A, Prasad P, Hayes KW, Song J, Cahue S, Chang A, Marshall M, Sharma L (2006) The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthr Cartil 14:1033–1040

    Article  PubMed  CAS  Google Scholar 

  34. Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37(Suppl 1):105–111

    Article  Google Scholar 

  35. White DK, Zhang Y, Niu J, Keysor JJ, Nevitt MC, Lewis CE, Torner JC, Neogi T (2010) Do worsening knee radiographs mean greater chances of severe functional limitation? Arthritis Care Res (Hoboken) 62:1433–1439

    Article  Google Scholar 

  36. White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. J Bone Joint Surg (Br) 73:582–586

    CAS  Google Scholar 

  37. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2008) OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16:137–162

    Article  PubMed  CAS  Google Scholar 

  38. Zhang Y, Jordan J (2011) Epidemiology of osteoarthritis. Clin Geriatr Med 26:355–369

    Article  Google Scholar 

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Jones, L.D., Bottomley, N., Harris, K. et al. The clinical symptom profile of early radiographic knee arthritis: a pain and function comparison with advanced disease. Knee Surg Sports Traumatol Arthrosc 24, 161–168 (2016). https://doi.org/10.1007/s00167-014-3356-z

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  • DOI: https://doi.org/10.1007/s00167-014-3356-z

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