Abstract
Purpose
The association between severity of radiographic osteoarthritis with patient pain, function, and satisfaction following total knee arthroplasty has been disputed. The discrepancies in current literature prompt us to further examine this association in a systematic review and meta-analysis.
Methods
The OVID-Medline, Embase, and Web of Science databases were searched from their inception up to Mar 2020. The main independent variable was osteoarthritis severity as defined by preoperative radiographs. The outcomes measured were pain, function and satisfaction following total knee arthroplasty. A minimum of three studies assessing the same patient-reported outcome measures were included in the meta-analysis, as well as those separating patients by chronic pain or dissatisfaction.
Results
29 studies were included in this study. Significant heterogeneity was seen between radiographic evaluation and reported outcomes. Patients with only mild radiographic osteoarthritis were more likely to suffer from chronic pain (odds ratio = 2.45, 95% CI = 1.80–3.34, p < 0.001) and dissatisfaction (odds ratio = 2.43, 95% CI = 1.79–3.31, p < 0.001) compared to patients with severe osteoarthritis. A significant association was found between mild radiographic severity and lower total Western Ontario and McMaster Universities Osteoarthritis scores (95% CI = − 0.37–0.06, p = 0.006) as well as Knee Society Scores (CI: − 0.54–0.16, p < 0.001).
Conclusion
Patients with mild radiographic osteoarthritis are anticipated to gain less from total knee arthroplasty compared to those with severe osteoarthritis. They are also at risk for chronic pain and dissatisfaction and should be consulted about this risk prior to surgery.
Level of evidence
III.
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Abbreviations
- BMI:
-
Body mass index
- KL:
-
Kellgren and Lawrence
- KOOS:
-
Knee injury and osteoarthritis outcome score
- KSS:
-
Knee society score
- OA:
-
Osteoarthritis
- OKS:
-
Oxford knee score
- FS:
-
Short form
- TKA:
-
Total knee arthroplasty
- UKA:
-
Unicondylar knee arthroplasty
- VAS:
-
Visual analog scale
- WOMAC:
-
The Western Ontario and McMaster Universities osteoarthritis index
References
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop 468:57–63
Buckwalter JA, Stanish WD, Rosier RN, Schenck RC Jr, Dennis DA, Coutts RD (2001) The increasing need for nonoperative treatment of patients with osteoarthritis. Clin Orthop 385:36–45
Cankaya D, Çakır Y, Yoldaş B, Toprak A, Tabak Y (2016) The influence of social and demographic features on functional level and quality of life after total knee arthroplasty. Turk J Phys Med Rehabil 62:3
Chang CB, Yoo JH, Koh IJ, Kang YG, Seong SC, Kim TK (2010) Key factors in determining surgical timing of total knee arthroplasty in osteoarthritic patients: age, radiographic severity, and symptomatic severity. J Orthop Trauma 11:21–27
Dowsey MM, Nikpour M, Dieppe P, Choong PFM (2012) Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthr Cartil 20:1095–1102
Feeley B, Gallo R (2010) Management of osteoarthritis of the knee in the active patient. J Am Acad Orthop Surg 18:406–416
Finger B, Brase J, He J, Gibson WJ, Wirtz K, Flynn BC (2017) Elevated hemoglobin A1c is associated with lower socioeconomic position and increased postoperative infections and longer hospital stay after cardiac surgical procedures. Ann Thorac Surg 103:145–151
Galea VP, Rojanasopondist P, Connelly JW, Bragdon CR, Huddleston JI, Ingelsrud LH, Malchau H, Troelsen A (2020) Changes in patient satisfaction following total joint arthroplasty. J Arthroplasty 35:32–38
Gidwani S, Tauro B, Whitehouse S, Newman JH (2003) Do patients need to earn total knee arthroplasty? J Arthroplasty 18:199–203
Giesinger JM, Loth FL, MacDonald DJ, Giesinger K, Patton JT, Simpson AHRW, Howie CR, Hamilton DF (2018) Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patient’s body mass index. Knee Surg Sports Traumatol Arthrosc 26:3257–3264
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32:3854–3860
Harkess JW, Murphy RF, Mihalko WM (2014) The progression of total knee arthroplasty from 1993–2013. Curr Orthop Prac 25(2):136–142
Haynes J, Sassoon A, Nam D, Schultz L, Keeney J (2017) Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty. Knee 24:663–669
Hoorntje A, Witjes S, Koenraadt KLM, Aarts R, de 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
Kahn TL, Soheili A, Schwarzkopf R (2013) Outcomes of total knee arthroplasty in relation to preoperative patient-reported and radiographic measures: data from the osteoarthritis initiative. Geriatr Orthop Surg Rehabil 4(4):117–126
Katz JN (2014) Appropriateness of total knee replacement. Arthritis Rheum 66:1979–1981
Kim TK, Chang CB, Kang YG, Kim SJ, Seong SC (2009) Causes and predictors of patient’s dissatisfaction after uncomplicated total knee arthroplasty. J Arthroplasty 24:263–271
Keurentjes JC, Fiocco M, So-Osman C, Onstenk R, Koopman-Van Gemert AW, Pöll RG, Kroon HM, Vlieland TP, Nelissen RG (2013) Patients with severe radiographic osteoarthritis have a better prognosis in physical functioning after hip and knee replacement: a cohort-study. PLoS One 8(4):e59500
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
Losina E, Katz JN (2012) Total knee arthroplasty on the rise in younger patients: are we sure that past performance will guarantee future success? Arthritis Rheum 64:339–341
Lundblad H, Kreicbergs A, Söderlund V, Ulfgren A-K, Stiller C-O, Jansson K-Å (2012) The value of preoperative grade of radiographic and histological changes in predicting pain relief after total knee arthroplasty for osteoarthritis. Knee Surg Sports Traumatol Arthrosc 20:1815–1821
Meding JB, Ritter MA, Faris PM, Keating EM, Harris W (2001) Does the preoperative radiographic degree of osteoarthritis correlate to results in primary total knee arthroplasty? J Arthroplasty 16(1):13–16
Merle-Vincent F, Couris CM, Schott A-M, Conrozier T, Piperno M, Mathieu P, Vignon E (2011) Factors predicting patient satisfaction 2 years after total knee arthroplasty for osteoarthritis. J Bone Spine 78:383–386
Nam D, Nunley RM, Barrack RL (2014) Patient dissatisfaction following total knee replacement. J Bone Joint Surg Br 96-B:96–100
Niemeläinen M, Moilanen T, Huhtala H, Eskelinen A (2019) Outcome of knee arthroplasty in patients aged 65 years or less: a prospective study of 232 patients with 2-year follow-up. Scand J Surg 108:313–320
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2011) The newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Health Research Institute
Peck CN, Childs J, McLauchlan GJ (2014) Inferior outcomes of total knee replacement in early radiological stages of osteoarthritis. Knee 21:1229–1232
Perry KI, Strasser NL, Harmsen WS, Pagnano MW, Trousdale RT (2015) Minimal preoperative degenerative arthritis may not predict poor TKA outcome. Orthopedics 38:e681-684
Petersen KK, Simonsen O, Laursen MB, Arendt-Nielsen L (2018) The role of preoperative radiologic severity, sensory testing, and temporal summation on chronic postoperative pain following total knee arthroplasty. Clin J Pain 34:193–197
Polkowski GG, Ruh EL, Barrack TN, Nunley RM, Barrack RL (2013) Is pain and dissatisfaction after TKA related to early-grade preoperative osteoarthritis? Clin Orthop Relat Res 471:162–168
Reginster JY, Deroisy R, Rovati LC, Lee RL, Lejeune E, Bruyere O, Giacovelli G, Henrotin Y, Dacre JE, Gossett C (2001) Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 357:251–256
Riddle DL, Golladay GJ, Jiranek WA, Perera RA (2017) External validation of a prognostic model for predicting nonresponse following knee arthroplasty. J Arthroplasty 32(4):1153–1158
Riis A, Rathleff MS, Jensen MB, Simonsen O (2014) Low grading of the severity of knee osteoarthritis pre-operatively is associated with a lower functional level after total knee replacement: a prospective cohort study with 12 month’s follow-up. Bone Joint J 96-B:1498–1502
Schnurr C, Jarrous M, Güdden I, Eysel P, König DP (2013) Pre-operative arthritis severity as a predictor for total knee arthroplasty patient’s satisfaction. Int Orthop 37(7):1257–1261
Scott CE, Oliver WM, MacDonald D, Wade FA, Moran M, Breusch SJ (2016) Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age. Bone Joint J 98(12):1625–1634
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(8):2573–2579
Tilbury C, Holtslag MJ, Tordoir RL, Leichtenberg CS, Verdegaal SH, Kroon HM, Fiocco M, Nelissen RG, Vliet Vlieland TP (2016) Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis: a prospective cohort study of 573 patients. Acta Orthop 87(1):67–71
Valdes AM, Doherty SA, Zhang W, Muir KR, Maciewicz RA, Doherty M (2012) Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. Semin Arthritis Rheum 41(4):568–575
van de Water RB, Leichtenberg CS, NelissenKroon RGHM, Kaptijn HH, OnstenkVerdegaal RSH, Vlieland TP, Gademan MG (2019) Preoperative radiographic osteoarthritis severity modifies the effect of preoperative pain on pain/function after total knee arthroplasty: results at 1 and 2 years postoperatively. J Bone Joint Surg Am 15(101):879–87
Vekama L, Puolakka T, Honkasalo M, Huhtala H, Moilanen T, Jämsen E (2015) Functional gain following knee replacement in patients aged 75 and older: a prospective follow-up study. Aging Clin Exp Res 27(6):865–876
Vina ER, Hannon MJ, Kwoh CK (2016) Improvement following total knee replacement surgery: exploring preoperative symptoms and change in preoperative symptoms. Semin Arthritis Rheum 45(5):547–555
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
Zabawa L, Li K, Chmell S (2019) Patient dissatisfaction following total knee arthroplasty: external validation of a new prediction model. Eur J Orthop Surg Traumatol 29:861–867
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NS, DS, and KK reviewed the articles and extracted data independently using a standardized data abstraction form. MY, SH, NS and MK conceived and were responsible for the design of the study. NS wrote the manuscript and all co-authors helped in its editing. IS was responsible for final editing. All authors read and approved the final manuscript.
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Shohat, N., Heller, S., Sudya, D. et al. Mild radiographic osteoarthritis is associated with increased pain and dissatisfaction following total knee arthroplasty when compared with severe osteoarthritis: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30, 965–981 (2022). https://doi.org/10.1007/s00167-021-06487-x
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DOI: https://doi.org/10.1007/s00167-021-06487-x