Abstract
BackgroundTo evaluate whether clinical, radiographic or MRI findings are associated with long term risk for total knee arthroplasty (TKA) in persons with knee osteoarthritis.MethodsWe performed a follow-up analysis of 100 persons with knee osteoarthritis who participated in a clinical trial between 2000 and 2002. Clinical data as well as radiography and MRI of the inclusion knee were obtained in all participants. Data on TKA procedures were extracted from The Danish National Patient Register. Clinical, radiographic and MRI findings were analyzed for associations with subsequent TKA.ResultsDuring a mean follow-up period of 15 years, 66% received a TKA in the included knee (target knee); 37% also received a TKA in the other knee. The degree of joint space narrowing was highly associated with subsequent TKA (adjusted odds ratio (OR) 5.0 (95% confidence interval (95% CI) 2.6 – 9.9)) as was a radiological sum score comprising joint space narrowing, osteophytes, subchondral sclerosis and cysts (adjusted OR 1.7 (95% CI 1.3 – 2.1)). MRI detected bone marrow lesions, synovitis and effusion were similarly associated with subsequent TKA with an adjusted OR of 2.3 (95% CI 1.3 – 4.0), 2.8 (95% CI 1.5 – 5.2) and 1.9 (95% CI 1.2 – 3.1), respectively. Increased body mass index (BMI) was not associated with subsequent TKA in the target knee but was associated with TKA in the other knee (OR 2.3 (95% CI 1.2 – 4.3).ConclusionsRadiographic findings including joint space narrowing and MRI detected bone marrow lesions, synovitis and effusion were all significantly associated with the long term risk of TKA in persons with knee osteoarthritis.
Highlights
To evaluate whether clinical, radiographic or Magnetic resonance imaging (MRI) findings are associated with long term risk for total knee arthroplasty (TKA) in persons with knee osteoarthritis
Baseline demographics of the 17 participants excluded from the MRI analyses due to lack of MRI or patellofemoral OA did not differ from the participants included in the MRI analyses
There was no significant association between baseline demographics or Hyalgan treatment and the risk for TKA at follow-up (Table 1)
Summary
Radiographic or MRI findings are associated with long term risk for total knee arthroplasty (TKA) in persons with knee osteoarthritis. Osteoarthritis (OA) is the most prevalent joint disease and strongly associated with aging and obesity. The most important risk factors for knee OA include obesity, previous knee injury, and family history of OA [2]. A recent systematic review found that onset of OA knee pain in persons over 50 years of age was related to overweight or obesity in 25% of cases; only 5% were caused by previous knee injury [3]. This has led some to suggest that other factors may be involved in disease manifestation than in disease progression [2, 5]
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