Abstract
Introduction
The Kellgren–Lawrence score helps the orthopedic surgeon to classify the severity of knee osteoarthritis (OA) before total knee arthroplasty (TKA). There might be a discrepancy between subjective complaints of the patients and radiologically visible changes of the knee joint in many cases. In this context, we performed a prospective clinical study to compare the preoperative degree of knee OA using the Kellgren–Lawrence score with the intraoperative extent of cartilage damage during primary TKA.
Materials and methods
A total of 251 primary TKA surgeries due to a primary knee OA were prospectively included. Preoperative Kellgren–Lawrence score was determined using standardized preoperative plain radiographs of three views; anteroposterior, lateral and skyline of the patella by a senior radiologist. Intraoperatively, in all cases, photographs of the medial, lateral, and patellofemoral joint compartments were taken. Using the International Cartilage Repair Society (ICRS) score, the degree of chondromalacia was assessed. Subsequently, correlation analysis was performed using the Pearson–Clopper 95% confidence interval (CI).
Results
There were higher intraoperative scores compared to the preoperative scores in 160 of all cases (63.7% of 251, 95% CI 57.5–69.7%). A mismatch of two score grade points was found in 8.4% (95% CI 5.3–12.5%). The most common mismatch was noted in patients with preoperative Kellgren–Lawrence score of 3 and an intraoperative score of 4 in 48.2% (95% CI 41.9–54.6%).
Conclusions
The preoperative radiographs using Kellgren–Lawrence underestimate the severity of knee osteoarthritis. The true extent of articular cartilage damage can be better appreciated intraoperatively. In patients undergoing primary TKA, the correlation of clinical symptoms with radiological findings is crucial in deciding when to perform the surgery. Besides, other imaging modalities may be used as an adjunct when the clinical findings and plain radiographs do not correlate.
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Acknowledgements
We acknowledge the professional support from Mr. Sven Brügmann regarding the intraoperative high-quality photographs.
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The authors declare that they have no conflict of interest regarding this manuscript. Outside the manuscript, one or more of the authors of this paper have disclosed the following disclosures: Waldemar Link, Hamburg, Germany, Zimmer Biomet, USA, Ceramtec, Heraeus.
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This study was performed after obtaining approval from the institutional review board. The PV number is “5367”.
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Abdelaziz, H., Balde, O.M., Citak, M. et al. Kellgren–Lawrence scoring system underestimates cartilage damage when indicating TKA: preoperative radiograph versus intraoperative photograph. Arch Orthop Trauma Surg 139, 1287–1292 (2019). https://doi.org/10.1007/s00402-019-03223-6
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DOI: https://doi.org/10.1007/s00402-019-03223-6