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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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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

  1. 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

    Article  PubMed  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. 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

    Google Scholar 

  4. 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

    Article  Google Scholar 

  5. 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

    Article  CAS  Google Scholar 

  6. Feeley B, Gallo R (2010) Management of osteoarthritis of the knee in the active patient. J Am Acad Orthop Surg 18:406–416

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Gidwani S, Tauro B, Whitehouse S, Newman JH (2003) Do patients need to earn total knee arthroplasty? J Arthroplasty 18:199–203

    Article  CAS  PubMed  Google Scholar 

  10. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. Harkess JW, Murphy RF, Mihalko WM (2014) The progression of total knee arthroplasty from 1993–2013. Curr Orthop Prac 25(2):136–142

    Article  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  PubMed Central  Google Scholar 

  16. Katz JN (2014) Appropriateness of total knee replacement. Arthritis Rheum 66:1979–1981

    Article  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. 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  PubMed  Google Scholar 

  20. 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

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

    Article  CAS  PubMed  Google Scholar 

  23. 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

    Article  Google Scholar 

  24. Nam D, Nunley RM, Barrack RL (2014) Patient dissatisfaction following total knee replacement. J Bone Joint Surg Br 96-B:96–100

    Article  CAS  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

  27. Peck CN, Childs J, McLauchlan GJ (2014) Inferior outcomes of total knee replacement in early radiological stages of osteoarthritis. Knee 21:1229–1232

    Article  CAS  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    Article  PubMed  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. 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

    Article  CAS  PubMed  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

  33. 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

    Article  CAS  PubMed  Google Scholar 

  34. 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

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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

    Article  PubMed  Google Scholar 

  36. 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

    Article  CAS  PubMed  Google Scholar 

  37. 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

    Article  PubMed  Google Scholar 

  38. 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

    Article  PubMed  Google Scholar 

  39. 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

    Article  Google Scholar 

  40. 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

    Article  PubMed  Google Scholar 

  41. 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

    Article  PubMed  Google Scholar 

  42. 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  PubMed  PubMed Central  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

    Noam Shohat, Snir Heller, Dan Sudya, Ilan Small, Kefah Khawalde, Muhammad Khatib & Mustafa Yassin

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  1. Noam Shohat
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Contributions

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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Correspondence to Noam Shohat.

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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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