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Cartilage survival of the knee strongly depends on malalignment: a survival analysis from the Osteoarthritis Initiative (OAI)

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Progression of osteoarthritis over time is poorly understood. The aim of the current study was to establish a timeline of “cartilage survival rate” per subregion of the knee in relation to mechanical alignment of the lower extremity. The study hypothesized that there are differences in progression of osteoarthritis between varus, valgus and physiologic lower extremity alignment.

Methods

Based on hip-knee-ankle standing radiographs at baseline, 234 knees had physiologic (180° ± 3°, mean 179.7°), 158 knees had varus (< 177°; mean 174.5°) and 66 knees valgus (> 183°; mean 185.2°) alignment (consecutive knees of the OAI “Index Knee” group, n = 458; mean age 61.7; 264 females). The Osteoarthritis Initiative (OAI; a multi-center, longitudinal, prospective observational study of knee osteoarthritis [30] using MRIs) defines progressive OA as a mean decrease of cartilage thickness of 136 µm/year and a mean decrease of cartilage volume by 5% over 1 year (DESS sequences, MRI). A Kaplan–Meier curve was generated for osteoarthritis progression based on OAI criteria.

Results

Osteoarthritis progression based on volume decrease of 5% in varus knees occurred after 30.8 months (medial femoral condyle), after 37 months (medial tibia), after 42.9 months (lateral femoral condyle) and 43.4 months (lateral tibia), respectively. In a valgus alignment progression was detectable after 31.5 months (lateral tibia), after 36.2 months (lateral femoral condyle), after 40.4 months (medial femoral condyle) and 43.8 months (medial tibia), respectively. The physiological alignment shows a progression after 37.8 months (medial femoral condyle), after 41.6 months (lateral tibia), after 41.7 months (medial tibia) and after 43 months (lateral femoral condyle), respectively.

Conclusion

Based on data from the OAI, the rate and location (subregion) of osteoarthritis progression of the knee is strongly associated with lower extremity mechanical alignment.

Level of evidence

Level I (prognostic study).

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Funding

No funding was used to conducting this study. Outside the submitted work Dr. Boettner reports personal fees from Smith & Nephew, personal fees from Ortho Development Corporation, personal fees from Depuy and Dr. Faschingbauer reports personal fees from Deutsche Forschungsgemeinschaft (Research Fellowship, FA 1271/1-1, www.dfg.de).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, RKU, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany

    Martin Faschingbauer & H. Reichel

  2. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    F. Boettner

  3. Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria

    M. Kasparek & W. Waldstein

  4. Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria

    P. Schadler

Authors
  1. Martin Faschingbauer
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  2. M. Kasparek
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  3. W. Waldstein
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  4. P. Schadler
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  5. H. Reichel
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  6. F. Boettner
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Contributions

FM: planning/conception of the study, collection of data, analysis and interpretation, statistical analysis, writing and revising article; (orthopedic surgeon). KM: collection of data, analysis and interpretation, statistical analysis; (resident). SP, WW: collection of data, critical revision of the article; (resident, orthopedic surgeon). RH, BF: critical revision of the article, final approval of the article, overall responsibility; (surgeon in chief University of Ulm; orthopedic surgeon, attending at HSS).

Corresponding author

Correspondence to Martin Faschingbauer.

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Conflict of interest

We certify that we have not signed any agreement with commercial interest related to this study, which would in any way limit publication of any and all data generated for the study or to delay publication for any reason. Dr. Boettner reports personal fees from Smith & Nephew, personal fees from Ortho Development Corporation, personal fees from Depuy, outside the submitted work. Dr. Faschingbauer reports personal fees from Deutsche Forschungsgemeinschaft (Research Fellowship, FA 1271/1-1, http://www.dfg.de), during the conduct of the study.

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The authors’ institutional review board approved this study.

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Faschingbauer, M., Kasparek, M., Waldstein, W. et al. Cartilage survival of the knee strongly depends on malalignment: a survival analysis from the Osteoarthritis Initiative (OAI). Knee Surg Sports Traumatol Arthrosc 28, 1346–1355 (2020). https://doi.org/10.1007/s00167-019-05434-1

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