Download PDF
J Knee Surg 2019; 32(03): 211-217
DOI: 10.1055/s-0038-1635114
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

More Severe Preoperative Kellgren–Lawrence Grades of Knee Osteoarthritis were Partially Associated with Better Postoperative Patient-Reported Outcomes in TKA Patients

Alexander Hoorntje
1   Department of Orthopaedic Surgery, AMC, Amsterdam, The Netherlands
2   Department of Orthopaedic Surgery, Amphia Ziekenhuis Locatie Molengracht, Breda, Noord-Brabant, The Netherlands
,
Suzanne Witjes
2   Department of Orthopaedic Surgery, Amphia Ziekenhuis Locatie Molengracht, Breda, Noord-Brabant, The Netherlands
,
Koen L. M. Koenraadt
2   Department of Orthopaedic Surgery, Amphia Ziekenhuis Locatie Molengracht, Breda, Noord-Brabant, The Netherlands
,
Ruud Aarts
3   Department of Radiology, Amphia Ziekenhuis Locatie Molengracht, Breda, Noord-Brabant, The Netherlands
,
Thomas de Weert
3   Department of Radiology, Amphia Ziekenhuis Locatie Molengracht, Breda, Noord-Brabant, The Netherlands
,
Rutger C. I. van Geenen
2   Department of Orthopaedic Surgery, Amphia Ziekenhuis Locatie Molengracht, Breda, Noord-Brabant, The Netherlands
› Author Affiliations
Further Information

Publication History

18 September 2017

28 January 2018

Publication Date:
28 February 2018 (online)

    Permissions and Reprints

Abstract

Total knee arthroplasty (TKA) is a successful procedure, although up to 20% of patients remain dissatisfied. Preoperative identification of appropriate TKA candidates is essential for improving satisfaction. This study investigated if preoperative radiographic severity was associated with postoperative pain, function, and quality of life after TKA. We performed a cross-sectional cohort study including 327 TKA patients. Radiographic severity was determined by two independent radiologists using the Kellgren and Lawrence (KL) score. The Knee Injury and Osteoarthritis Outcome Score (KOOS), the New Knee Society Score (New KSS), and Anterior Knee Pain Score (AKPS) were collected. We evaluated the association between KL grade and patient-reported outcome measures (PROMs) with the use of regression analysis techniques. Out of 228 responders, 195 patients completed the questionnaire sufficiently. Forty-seven patients were classified as KL grades 1 to 2, and 144 patients were classified as KL grades 3 to 4. The inter-observer reliability between both radiologists was substantial (ϰ = 0.67). After adjusting for age, sex, and body mass index (BMI), the New KSS subscales symptoms and expectations, and the KOOS subscale quality of life were significantly higher in the KL grades 3 to 4 group. However, neither the remaining KOOS subscales and AKPS nor KOOS change scores differed between both groups. Thus, more severe osteoarthritis (OA) resulted in better outcomes after TKA, although this association was not observed for all PROMs. The use of new PROMs, such as the New KSS, could be more reliable because of lower ceiling effects than the KOOS. Investigating the value of additional methods to assess radiographic severity (such as semi-flexed knee radiographs and MRI) is imperative to reliably identify knee OA.

Keywords

knee arthroplasty - osteoarthritis - radiograph - Kellgren–Lawrence - PROMs
 

  • References

  • 1 Carr AJ, Robertsson O, Graves S. , et al. Knee replacement. Lancet 2012; 379 (9823): 1331-1340
    CrossrefPubMedSearch in Google Scholar
  • 2 Ma HM, Lu YC, Ho FY, Huang CH. Long-term results of total condylar knee arthroplasty. J Arthroplasty 2005; 20 (05) 580-584
    CrossrefPubMedSearch in Google Scholar
  • 3 Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452: 35-43
    CrossrefPubMedSearch in Google Scholar
  • 4 Hasegawa M, Naito Y, Yamaguchi T, Wakabayashi H, Sudo A. Factors contributing to patient satisfaction and expectations following computer-assisted total knee arthroplasty. J Knee Surg 2017
    PubMed
  • 5 Dowsey MM, Gunn J, Choong PFM. Selecting those to refer for joint replacement: who will likely benefit and who will not?. Best Pract Res Clin Rheumatol 2014; 28 (01) 157-171
    CrossrefPubMedSearch in Google Scholar
  • 6 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
    CrossrefPubMedSearch in Google Scholar
  • 7 Anderson JG, Wixson RL, Tsai D, Stulberg SD, Chang RW. Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplasty 1996; 11 (07) 831-840
    CrossrefPubMedSearch in Google Scholar
  • 8 Merle-Vincent F, Couris CM, Schott A-M. , et al; Osteoarthritis Section of the French Society for Rheumatology. Factors predicting patient satisfaction 2 years after total knee arthroplasty for osteoarthritis. Joint Bone Spine 2011; 78 (04) 383-386
    CrossrefPubMedSearch in Google Scholar
  • 9 Gylvin SH, Jørgensen CC, Fink-Jensen A, Kehlet H. Psychiatric disease as a risk factor in fast-track hip and knee replacement. Acta Orthop 2016; 87 (05) 439-443
    CrossrefPubMedSearch in Google Scholar
  • 10 Furu M, Ito H, Nishikawa T. , et al. Quadriceps strength affects patient satisfaction after total knee arthroplasty. J Orthop Sci 2016; 21 (01) 38-43
    CrossrefPubMedSearch in Google Scholar
  • 11 Valdes AM, Doherty SA, Zhang W, Muir KR, Maciewicz RA, Doherty M. Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty. Semin Arthritis Rheum 2012; 41 (04) 568-575
    CrossrefPubMedSearch in Google Scholar
  • 12 Kohn MD, Sassoon AA, Fernando ND. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res 2016; 474 (08) 1886-1893
    CrossrefPubMedSearch in Google Scholar
  • 13 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
    CrossrefPubMedSearch in Google Scholar
  • 14 Kellgren JH, Jeffrey M, Ball J. The Epidemiology of Chronic Rheumatism. Atlas of Standard Radiographs of Arthritis. Oxford, UK: Blackwell Scientific Publications; 1963
    Search in Google Scholar
  • 15 Dowsey MM, Nikpour M, Dieppe P, Choong PFM. Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthritis Cartilage 2012; 20 (10) 1095-1102
    CrossrefPubMedSearch in Google Scholar
  • 16 Dowsey MM, Dieppe P, Lohmander S, Castle D, Liew D, Choong PFM. The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis. Knee 2012; 19 (06) 860-865
    CrossrefPubMedSearch in Google Scholar
  • 17 Keurentjes JC, Fiocco M, So-Osman C. , et al. Patients with severe radiographic osteoarthritis have a better prognosis in physical functioning after hip and knee replacement: a cohort-study. PLoS One 2013; 8 (04) e59500
    CrossrefPubMedSearch in Google Scholar
  • 18 Tilbury C, Holtslag MJ, Tordoir RL. , et al. 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 2016; 87 (01) 67-71
    CrossrefPubMedSearch in Google Scholar
  • 19 Noble PC, Scuderi GR, Brekke AC. , et al. Development of a new Knee Society scoring system. Clin Orthop Relat Res 2012; 470 (01) 20-32
    CrossrefPubMedSearch in Google Scholar
  • 20 Kievit AJ, Breugem SJM, Sierevelt IN. , et al. Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21 (11) 2647-2653
    CrossrefPubMedSearch in Google Scholar
  • 21 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1 (01) 64
    CrossrefPubMedSearch in Google Scholar
  • 22 Schiphof D, de Klerk BM, Kerkhof HJM. , et al. Impact of different descriptions of the Kellgren and Lawrence classification criteria on the diagnosis of knee osteoarthritis. Ann Rheum Dis 2011; 70 (08) 1422-1427
    CrossrefPubMedSearch in Google Scholar
  • 23 Felson DT, Niu J, Guermazi A, Sack B, Aliabadi P. Defining radiographic incidence and progression of knee osteoarthritis: suggested modifications of the Kellgren and Lawrence scale. Ann Rheum Dis 2011; 70 (11) 1884-1886
    CrossrefPubMedSearch in Google Scholar
  • 24 Cushnaghan J, Bennett J, Reading I. , et al. Long-term outcome following total knee arthroplasty: a controlled longitudinal study. Ann Rheum Dis 2009; 68 (05) 642-647
    CrossrefPubMedSearch in Google Scholar
  • 25 Thompson SM, Salmon LJ, Webb JM, Pinczewski LA, Roe JP. Construct validity and test re-test reliability of the forgotten joint score. J Arthroplasty 2015; 30 (11) 1902-1905
    CrossrefPubMedSearch in Google Scholar
  • 26 Ramkumar PN, Harris JD, Noble PC. Patient-reported outcome measures after total knee arthroplasty: a systematic review. Bone Joint Res 2015; 4 (07) 120-127
    CrossrefPubMedSearch in Google Scholar
  • 27 Stone OD, Duckworth AD, Curran DP, Ballantyne JA, Brenkel IJ. Severe arthritis predicts greater improvements in function following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (08) 2573-2579
    CrossrefPubMedSearch in Google Scholar
  • 28 Riis A, Rathleff MS, Jensen MB, Simonsen O. 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 months' follow-up. Bone Joint J 2014; 96-B (11) 1498-1502
    CrossrefPubMedSearch in Google Scholar
  • 29 Schiphof D, Boers M, Bierma-Zeinstra SMA. Differences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis. Ann Rheum Dis 2008; 67 (07) 1034-1036
    CrossrefPubMedSearch in Google Scholar
  • 30 Gossec L, Jordan JM, Mazzuca SA. , et al; OARSI-OMERACT task force “total articular replacement as outcome measure in OA”. Comparative evaluation of three semi-quantitative radiographic grading techniques for knee osteoarthritis in terms of validity and reproducibility in 1759 X-rays: report of the OARSI-OMERACT task force. Osteoarthritis Cartilage 2008; 16 (07) 742-748
    CrossrefPubMedSearch in Google Scholar
  • 31 Schwaiger BJ, Gersing AS, Mbapte Wamba J, Nevitt MC, McCulloch CE, Link TM. Can signal abnormalities detected with MR imaging in knee articular cartilage be used to predict development of morphologic cartilage defects? 48-Month data from the osteoarthritis initiative. Radiology 2016; 281 (01) 158-167
    CrossrefPubMedSearch in Google Scholar
  • 32 Rolfson O, Bohm E, Franklin P. , et al; Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries. Report of the patient-reported outcome measures working group of the International Society of Arthroplasty Registries Part II. Recommendations for selection, administration, and analysis. Acta Orthop 2016; 87 (01) (Suppl. 01) 9-23
    CrossrefPubMedSearch in Google Scholar