Predicting Total Knee Replacement from Symptomology and Radiographic Structural Change Using Artificial Neural Networks-Data from the Osteoarthritis Initiative (OAI).

Stephan Heisinger,Wolfgang Hitzl,Sebastian Cotofana,Gerhard M Hobusch,Reinhard Windhager

doi:10.3390/jcm9051298

Abstract

The aim of the study was to longitudinally investigate symptomatic and structural factors prior to total knee replacement (TKR) surgery in order to identify influential factors that can predict a patient’s need for TKR surgery. In total, 165 participants (60% females; 64.5 ± 8.4 years; 29.7 ± 4.7 kg/m2) receiving a TKR in any of both knees within a four-year period were analyzed. Radiographic change, knee pain, knee function and quality of life were annually assessed prior to the TKR procedure. Self-learning artificial neural networks were applied to identify driving factors for the surgical procedure. Significant worsening of radiographic structural change was observed prior to TKR (p ≤ 0.0046), whereas knee symptoms (pain, function, quality of life) worsened significantly only in the year prior to the TKR procedure. By using our prediction model, we were able to predict correctly 80% of the classified individuals to undergo TKR surgery with a positive predictive value of 84% and a negative predictive value of 73%. Our prediction model offers the opportunity to assess a patient’s need for TKR surgery two years in advance based on easily available patient data and could therefore be used in a primary care setting.

Highlights

Osteoarthritis (OA) contributes strongly to one individual’s global disability and has been shown to be the leading cause of immobility and impaired health related quality of life in the elderly as compared to any other chronic disease [1,2,3,4]
Subjects were excluded from the Osteoarthritis Initiative (OAI) if the following conditions were present: rheumatoid arthritis, bilateral knee arthroplasty or pre-existing plans to undergo bilateral knee arthroplasty in the 3 years, bilateral Osteoarthritis Research Society International (OARSI) stage 3 knee OA [12], positive pregnancy test, inability to provide a blood sample, use of ambulatory aids other than a single straight cane for >50% of the time, comorbid conditions that might interfere with 4-year participation, unlikely to reside in the clinic area for at least 3 years, current participation in a double-blind randomized controlled trial and being unwilling to sign an informed consent
Demographic data of the 165 participants (60% females) included in this analysis revealed a mean age of 64.5 ± 8.4 years with a mean BMI of 29.7 ± 4.7 kg/m2. 85% of the study sample were of Caucasian ethnicity, 59% had an annual income of more than 50,000 United States Dollar (USD) and 50% had received during their education a college degree or above

Summary

Introduction

Osteoarthritis (OA) contributes strongly to one individual’s global disability and has been shown to be the leading cause of immobility and impaired health related quality of life in the elderly as compared to any other chronic disease [1,2,3,4]. Radiographic evidence of end-stage knee OA and consistent pain refractory to treatment have been postulated to be the leading key indicators for the taking the decision for total knee replacement (TKR) surgery [6,7]. Of those two criteria, the x-ray imaging-based assessment of the knee joint is the more objective and reliable method and has been shown to serve as a good parameter when trying to evaluate the patient’s need for TKR [8,9,10,11,12]. As it has been shown that the x-ray status of the knee does not fully reflect one patient’s pain and symptom status, there is a need to include symptom parameters such as pain, loss of function and quality of life and to balance each factor on an individual basis when taking the decision for performing TKR surgery [13]

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