Background Osteoarthritis (OA) is a slowly progressive degenerative joint disorder most frequently seen in the middle aged and older people. OA has a high prevalence causing pain and loss of function. There is still no cure for the disease. The current treatment of OA is initially conservative, predominantly focused on the relief of pain, minimizing functional disability, and limiting progression of joint damage. When conservative treatment fails and joint preserving surgery is not or no longer indicated, knee replacement of the affected joint becomes necessary. A proper selection of patients for total knee replacement surgery is crucial in the light of the exponentially growing numbers with its socioeconomic impact.
Objectives The present study evaluated potential radiographic and clinical predictors for clinical outcome of knee replacement surgery in a cohort of patients with end-stage knee OA treated in regular practice in an orthopedic department of a general hospital in the Netherlands.
Methods Patients (172) with severe OA who were eligible for total knee replacement surgery in a general hospital were included. Demographics, clinical, and radiographic data were collected. WOMAC data were collected prospective pre-treatment, and after surgery (post-treatment). OARSI-OMERACT response criteria based on WOMAC questionnaires were used to evaluate clinical success. Severity of radiographic joint damage was evaluated according to Kellgren & Lawrence and Altman atlas. Pre-treatment characteristics associated with responder status were investigated using multivariate logistic regression analyses.
Results Patients showed on average a clear improvement in WOMAC scores at a mean of 18 months post-treatment (33.0±20.0 improvement in WOMAC pain). Based on WOMAC response criteria 55% of the patients were classified as responders. In multivariate logistic regression, younger age (OR=0.930; 95%CI: 0.864-1.002), more severe pain (OR=0.966; 95%CI: 0.937-0.997) and more radiographic damage (OR=3.456; 95%CI: 1.568-7.618) was associated with good response. Results were similar when patients with missing outcomes were classified as non-responders or responders in a sensitivity analysis.
Conclusions This study shows that still a significant number of patients do not have a good response to joint replacement surgery. A good response was clearly associated with more severe radiographic joint damage and possibly with age and WOMAC pain at time of operation. These results need further validation in larger cohorts and might become of use to a more accurate patient selection for knee replacement surgery.
Disclosure of Interest None Declared
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