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Defining and predicting radiographic knee osteoarthritis progression: a systematic review of findings from the osteoarthritis initiative

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purposes of this systematic review were to (1) identify the commonly used definitions of radiographic KOA progression, (2) summarize the important associative risk factors for disease progression based on findings from the OAI study and (3) summarize findings from radiographic KOA progression prediction modeling studies regarding the characterization of progression and outcomes.

Methods

A systematic review was performed by conducting a literature search of definitions, risk factors and predictive models for radiographic KOA progression that utilized data from the OAI database. Radiographic progression was further characterized into “accelerated KOA” and “typical progression,” as defined by included studies.

Results

Of 314 studies identified, 41 studies were included in the present review. Twenty-eight (28) studies analyzed risk factors associated with KOA progression, and 13 studies created or validated prediction models or risk calculators for progression. Kellgren–Lawrence (KL) grade based on radiographs was most commonly used to characterize KOA progression (50%), followed by joint space width (JSW) narrowing (32%) generally over 48 months. Risk factors with the highest odds ratios (OR) for progression included periarticular bone mineral density (OR 10.40), any knee injury within 1 year (OR 9.22) and baseline bone mineral lesions (OR 7.92). Nine prediction modeling studies utilized both clinical and structural risk factors to inform their models, and combined models outperformed purely clinical or structural models.

Conclusion

The cumulative evidence suggests that combinations of structural and clinical risk factors may be able to predict radiographic KOA progression, particularly in patients with accelerated progression. Clinically relevant and feasible prediction models and risk calculators may provide valuable decision-making support when caring for patients at risk of KOA progression, although standardization in modeling and variable identification does not yet exist.

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Funding

No funds, grants or other support were received for this investigation.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA

    Peter Y. Joo

  2. Harris Orthopaedics Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, GRJ-12-1223, Boston, MA, 02214, USA

    Alireza Borjali, Orhun K. Muratoglu & Kartik M. Varadarajan

  3. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA

    Alireza Borjali, Orhun K. Muratoglu & Kartik M. Varadarajan

  4. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Antonia F. Chen

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  1. Peter Y. Joo
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  2. Alireza Borjali
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  4. Orhun K. Muratoglu
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  5. Kartik M. Varadarajan
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Contributions

PJ participated in data collection and analysis, design of the study and drafted the manuscript. AB and OM participated in the design of the study and helped to draft the manuscript. AC and KV conceived of the study and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kartik M. Varadarajan.

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This systematic review was exempt from institutional ethical approval.

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Joo, P.Y., Borjali, A., Chen, A.F. et al. Defining and predicting radiographic knee osteoarthritis progression: a systematic review of findings from the osteoarthritis initiative. Knee Surg Sports Traumatol Arthrosc 30, 4015–4028 (2022). https://doi.org/10.1007/s00167-021-06768-5

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