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FRI0320 Radiographic features, better than clinical features, represent actual joint degeneration and inflammation: Considerations for total knee replacement surgery
  1. T.N. De Boer1,
  2. S.C. Mastbergen1,
  3. A.M. Huisman2,
  4. A.A. Polak3,
  5. W.H. Noort-vanderLaan1,
  6. J.W. Bijlsma1,
  7. F.P. Lafeber1
  1. 1Rheumatology & Clinical Immunology, University Medical Center, Utrecht
  2. 2Rheumatology
  3. 3Orthopedics, Sint Franciscus Gasthuis, Rotterdam, Netherlands

Abstract

Background Clinically, osteoarthritis (OA) is characterized by joint pain, tenderness, limitation of movement, crepitus, occasional effusion, and local inflammation. Pain, joint deformation, and stiffness of the joint capsule may lead to severe restriction of function, and in the long term to disability. In end-stage disease total knee replacement (TKR) surgery might become a treatment option. Indication for TKR is primarily based on persistent pain and functional disability despite conservative therapy. Unfortunately, specific indications for timing of TKR are not clearly defined. Radiographic joint damage adds to decision-making, but is not leading.

Objectives The aim of this study is to evaluate whether radiographic characteristics and/or clinical characteristics prior to TKR predict actual cartilage damage and/or synovial inflammation.

Methods Demographics, radiographic features of OA (K&L and Altman grade) and clinical symptoms (WOMAC-pain, -stiffness, and -physical function) of 172 knee OA patients were assessed shortly before TKR. NSAIDs and acetaminophen use was registered. During surgery, cartilage and synovial tissue were obtained and evaluated by macroscopy, histology, and biochemistry. To examine the relationship of radiographic features as well as clinical features with the actual cartilage damage and synovial inflammation, binary logistic regression modeling was used. All analyses were performed with and without adjustment for demographics age, gender, and BMI.

Results The average K&L score of this population was 3.1 (range 1-4). The average Altman scores for this population were 2.5 (range 0-3) for joint space narrowing and 3.2 (range 0.8-6) for the osteophytes. Both the K&L score and the Altman osteophyte score were associated with the actual macroscopic cartilage damage [2.375, p=0.006/2.229, p=0.005, respectively]. Joint space narrowing also showed an association with macroscopic cartilage damage [1.619, p=0.067]. Additionally, osteophyte score was associated with macroscopical synovial inflammation [1.593, p=0.029] and histological synovial inflammation [1.454, p=0.039], suggesting synovial inflammation to be involved in osteophyte formation. No clinical parameter related to any of the actual structural cartilage damage of synovial inflammation parameters.

Conclusions Radiographic OA characteristics correlate better with actual cartilage damage and synovial inflammation parameters in patients undergoing TKR than clinical parameters do. As such, it is important to include radiographic OA characteristics when selecting patients for TKR.

Disclosure of Interest None Declared

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