Abstract
BackgroundControversy exists regarding the relationship between radiographic findings and clinical status in knee osteoarthritis. Although the surgical indication for total knee arthroplasty (TKA) should be based on pain, clinical status, and the deterioration of quality of life, the radiographic study is the most commonly used criterion for preoperative evaluation. The objective of this study is to find out the relationship between the Ahlbäck classification and clinical status in patients undergoing TKA.Methods1329 protocols were collected from preoperative studies in four multicentric working groups (the Interax, Duracon, Scorpio, and Triathlon Spanish groups) in 30 Spanish hospitals. Mean age was 70.4 years (SD: 6.8; range: 35 to 98); 76.3% of patients were women. Patients entered the study whenever the surgeon found that medical treatment was insufficient to control pain and functional limitation. Data were collected using electronic Case Report Forms, and included Ahlbäck grading scores, Hospital for Special Surgery Knee Score (HSS), SF-12, and other clinical and epidemiologic variables.ResultsAccording to the Ahlbäck grading system, patients were divided as follows: 243 grade I (18.3%), 358 grade II (26.9%), 416 grade III (31.3%), 241 grade IV (18.1%), and 71 grade V (5.3%). As for HSS, the following scores were obtained: <60 points in 925 patients (69.6%), 60 to 69 points in 286 patients (21.5%), 70 to 84 points in 112 patients (8.4%) and 85 to 100 points in 6 patients (0.5%). Scores showed a statistically significant difference depending on Ahlbäck grade, with a clear tendency towards decrease in HSS scores as the Ahlbäck grade increases (p<0.001). However, the HSS score difference between Ahlbäck grades I and V was of 9.56 points only. Comparing the status of the patients at the start (1994) and at the end (2010) of the data collection process, we observed that patients who underwent surgery in the last years were older and showed a lower Ahlbäck grade.ConclusionsWe found a relationship between Ahlbäck grading and the preoperative clinical score. The range of variability of the HSS score between the different Ahlbäck grades is small.
Highlights
Controversy exists regarding the relationship between radiographic findings and clinical status in knee osteoarthritis
Regarding Hospital for Special Surgery Knee-Rating Score (HSS), we found an average score of 53.12 points (SD: 12.56): 925 patients showed an HSS score
There was a statistically significant difference in the HSS scores depending on the Ahlbäck grade, with a clear tendency towards decrease in HSS scores as the Ahlbäck grade increases (p
Summary
Controversy exists regarding the relationship between radiographic findings and clinical status in knee osteoarthritis. The surgical indication for total knee arthroplasty (TKA) should be based on pain, clinical status, and the deterioration of quality of life, the radiographic study is the most commonly used criterion for preoperative evaluation. Among United States adults, the prevalence of knee OA and symptomatic knee OA is 37.4% and 12.1%, respectively (4.3 million older US adults) It may affect all kinds of people, it is more frequent in individuals with great body mass index (BMI ≥ 30), greater age, races/ethnicities such as nonHispanic Blacks, and among men with manual labor tibial osteotomy, etc. The Hospital for Special Surgery Knee-Rating Score (HSS) [6] is one the most regularly used questionnaires to assess knee status, both preoperatively and after TKA This classification system assigns a maximum of 100 points, which are subdivided into six categories: pain, function, range of motion, muscular strength, flexion contracture, and stability. It is easy to self-complete and it has been employed to follow the changes in healthrelated quality of life after a surgical procedure, such as a TKA [7]
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