Skip to main content

Low grade of radiographic osteoarthritis predicts unsatisfactory response of the contralateral knee replacement in two-stage bilateral total knee arthroplasty

Abstract

Purpose

It is difficult to counsel patients with bilateral osteoarthritis who are unsatisfied with their first knee replacement as to whether they are likely to have a better outcome after the contralateral knee is replaced. The purpose of this study was to determine whether predictive factors can be found to prognosticate outcome of the second-side knee replacement when a patient has an unsatisfactory response to the first, with the hypothesis that predictors, such as prosthetic factors and radiographic level of osteoarthritis, may be able to predict a satisfactory response to the contralateral knee replacement.

Materials and methods

An analysis of staged bilateral knee replacements performed at a tertiary arthroplasty centre from 2012 to 2018 was undertaken. A total of 550 knee replacements in 275 patients were included in this study. The primary variable measured was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Satisfactory response to surgery was defined as a WOMAC score improved by 17 points or more, and 56 or greater. Patients who did not achieve a satisfactory response with their first knee replacement were further analysed for predictive factors (age, sex, pre-operative score, mental score, socioeconomic status, type of prosthesis, use of navigation, patella resurfacing and radiographic osteoarthritis) of an unsatisfactory response for their contralateral knee replacement.

Results

Overall, 44 (16%) patients failed to achieve a satisfactory response from both their first and contralateral knee replacements. The factor most predictive of an unsatisfactory response to their first knee replacement was pre-operative mental health score. However, in patients who did not achieve a satisfactory response with their first knee replacement, radiographic osteoarthritis, as measured by the Kellgren-Lawrence (KL) score was the main predictor of satisfactory response for their contralateral knee replacement. Only patients with KL grade 4 osteoarthritis were likely to have a satisfactory response with their contralateral knee replacements (KL4 versus KL3, Odds ratio 3.57 (CI 1.26—10.03) p = 0.016*). Patients with KL grade 3 osteoarthritis were unlikely to have a satisfactory response, and in this series, no patient with KL grade 2 osteoarthritis had a satisfactory response.

Conclusion

In a patient who has an unsatisfactory response to their first knee replacement, the best predictor of achieving a satisfactory response to his/her contralateral knee replacement is the level of radiographic osteoarthritis in that knee.

Level of evidence

IV: Retrospective Cohort study.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. B P (2008) Socio-Economic Indexes for Areas (SEIFA) - Technical Paper. Australia: Australian Bureau of Statistics. Commonwealth of Australia.

  2. Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ (2018) What is the minimum clinically important difference for the WOMAC index after TKA? Clin Orthop Relat Res 476:2005–2014

    Article  Google Scholar 

  3. Clement ND, Merrie KL, Weir DJ, Holland JP, Deehan DJ (2019) Asynchronous bilateral total knee arthroplasty: predictors of the functional outcome and patient satisfaction for the second knee replacement. J Arthroplasty 34:2950–2956

    Article  Google Scholar 

  4. Dowsey MM, Nikpour M, Dieppe P, Choong PF (2012) Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthritis Cartilage 20:1095–1102

    CAS  Article  Google Scholar 

  5. Dowsey MM, Smith AJ, Choong PFM (2015) Latent Class Growth Analysis predicts long term pain and function trajectories in total knee arthroplasty: a study of 689 patients. Osteoarthritis Cartilage 23:2141–2149

    CAS  Article  Google Scholar 

  6. Gabr A, Withers D, Pope J, Santini A (2011) Functional outcome of staged bilateral knee replacements. Ann R Coll Surg Engl 93:537–541

    CAS  Article  Google Scholar 

  7. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE et al (1998) Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51:1171–1178

    CAS  Article  Google Scholar 

  8. Hoorntje A, Witjes S, Koenraadt KLM, Aarts R, Weert T, van Geenen RCI (2019) More severe preoperative Kellgren-Lawrence grades of knee osteoarthritis were partially associated with better postoperative patient-reported outcomes in TKA patients. J Knee Surg 32:211–217

    Article  Google Scholar 

  9. Horst PK, Barrett AA, Huddleston JI 3rd, Maloney WJ, Goodman SB, Amanatullah DF (2020) Total knee arthroplasty has a positive effect on patients with low mental health scores. J Arthroplasty 35:112–115

    Article  Google Scholar 

  10. Huo T, Guo Y, Shenkman E, Muller K (2018) Assessing the reliability of the short form 12 (SF-12) health survey in adults with mental health conditions: a report from the wellness incentive and navigation (WIN) study. Health Qual Life Outcomes 16:34

    Article  Google Scholar 

  11. Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE (2018) Patient satisfaction after total knee replacement: a systematic review. HSS J 14:192–201

    Article  Google Scholar 

  12. Keurentjes JC, Fiocco M, So-Osman C, Onstenk R, Koopman-Van Gemert AW, Poll RG et al (2013) Patients with severe radiographic osteoarthritis have a better prognosis in physical functioning after hip and knee replacement: a cohort-study. PLoS ONE 8:e59500

    CAS  Article  Google Scholar 

  13. Kohn MD, Sassoon AA, Fernando ND (2016) Classifications in brief: kellgren-lawrence classification of osteoarthritis. Clin Orthop Relat Res 474:1886–1893

    Article  Google Scholar 

  14. Liebensteiner M, Wurm A, Gamper D, Oberaigner W, Dammerer D, Krismer M (2019) Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse. Int Orthop 43:1841–1847

    Article  Google Scholar 

  15. Lizaur-Utrilla A, Serna-Berna R, Vizcaya-Moreno MF, Martinez-Mendez D, Marco-Gomez L, Lopez-Prats FA (2018) Comparison of functional outcomes between the first and second knee in staged bilateral total knee arthroplasty with diverse intervals between stages. J Arthroplasty 33:2863–2867

    Article  Google Scholar 

  16. Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M et al (2004) OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage 12:389–399

    CAS  Article  Google Scholar 

  17. Qutob M, Winemaker M, Petruccelli D, de Beer J (2013) Staged bilateral total knee arthroplasty: does history dictate the future? J Arthroplasty 28:1148–1151

    Article  Google Scholar 

  18. Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92:1253–1258

    CAS  Article  Google Scholar 

  19. Stone OD, Duckworth AD, Curran DP, Ballantyne JA, Brenkel IJ (2017) Severe arthritis predicts greater improvements in function following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:2573–2579

    CAS  Article  Google Scholar 

  20. Walker LC, Clement ND, Bardgett M, Weir D, Holland J, Gerrand C et al (2019) Correction to: The WOMAC score can be reliably used to classify patient satisfaction after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:340

    Article  Google Scholar 

  21. Warner SC, Richardson H, Jenkins W, Kurien T, Doherty M, Valdes AM (2017) Neuropathic pain-like symptoms and pre-surgery radiographic severity contribute to patient satisfaction 4.8 years post-total joint replacement. World J Orthop 8:761–769

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sina Babazadeh.

Ethics declarations

Funding

Some authors did receive royalties, paid consultancy and research support from companies or suppliers but none were directly related to this study.

Conflict of interest

The authors did not recieve and will not receive any benefits or funding from any commercial party related directly or indirectly to the subject of this article.

Ethics approval

This study was approved by the institutional review board of our institution (QA19122).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Babazadeh, S., Spelman, T.D., Dowsey, M.M. et al. Low grade of radiographic osteoarthritis predicts unsatisfactory response of the contralateral knee replacement in two-stage bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 875–881 (2022). https://doi.org/10.1007/s00167-021-06465-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-021-06465-3

Keywords

  • Knee
  • Total knee replacement
  • Osteoarthritis
  • Radiographs
  • Arthroplasty
  • Personal satisfaction
  • Arthritis
  • X-rays