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Zvi YS, Tamura S, Rubin J, Seref-Ferlengez Z, Kamara E. Severity Of Radiographic Osteoarthritis: Association with Improved Patient Reported Outcomes Following Knee Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00013. [PMID: 38748497 PMCID: PMC11098231 DOI: 10.5435/jaaosglobal-d-24-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The Kellgren and Lawrence (KL) classification for knee osteoarthritis estimates disease severity. Its utility in predicting patient-reported outcomes (PROs) after primary total knee arthroplasty (pTKA) has been suggested. We hypothesized that patients who had higher preoperative KL grades would demonstrate greater improvements in PROs after pTKA. METHODS This was a retrospective review of patients who underwent pTKA between 2016 and 2021. Two observers graded preoperative radiographs (KL1/2, KL3, and KL4). Knee Injury and Osteoarthritis Outcome Score (KOOS) for activities of daily living (KOOS-ADL) and pain (KOOS-Pain) were collected at preoperative and 12-month postoperative visits. Changes in KOOS-ADL (ΔADL) and changes in KOOS-Pain (ΔPain) scores were compared from the preoperative to 12-month postoperative mark across different groups, with the minimal clinically important difference (MCID) for both ΔADL (MCID-ADL) and ΔPain (MCID-Pain) also being calculated. A P-value of < 0.05 was considered statistically significant. RESULTS A total of 1651 patients were included in the study. The KL3 and KL4 groups exhibited significantly higher ΔADL scores and ΔPain scores compared with the KL1/2 group (P < 0.01). Patients who had KL3 and KL4 were 1.42 (P = 0.03) and 1.88 (P < 0.01) times, respectively, more likely to achieve MCID-ADL compared with those who had KL1/2. Furthermore, patients who had a KL4 were 1.92 times (P < 0.01) more likely to reach MCID-Pain compared with those who had KL1/2. CONCLUSIONS This study determined that patients who had higher preoperative KL grades experienced markedly greater improvements in KOOS-ADL and KOOS-Pain scores than those who had lower KL grades. These findings offer surgeons an objective tool when counseling patients on expected outcomes after pTKA.
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Affiliation(s)
- Yoav S. Zvi
- From the Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY (Dr. Zvi, Dr. Seref-Ferlengez, and Dr. Kamara), and the Albert Einstein College of Medicine, New York, NY (Mr. Tamura, Mr. Rubin)
| | - Shoran Tamura
- From the Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY (Dr. Zvi, Dr. Seref-Ferlengez, and Dr. Kamara), and the Albert Einstein College of Medicine, New York, NY (Mr. Tamura, Mr. Rubin)
| | - Jonathan Rubin
- From the Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY (Dr. Zvi, Dr. Seref-Ferlengez, and Dr. Kamara), and the Albert Einstein College of Medicine, New York, NY (Mr. Tamura, Mr. Rubin)
| | - Zeynep Seref-Ferlengez
- From the Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY (Dr. Zvi, Dr. Seref-Ferlengez, and Dr. Kamara), and the Albert Einstein College of Medicine, New York, NY (Mr. Tamura, Mr. Rubin)
| | - Eli Kamara
- From the Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY (Dr. Zvi, Dr. Seref-Ferlengez, and Dr. Kamara), and the Albert Einstein College of Medicine, New York, NY (Mr. Tamura, Mr. Rubin)
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Blackburn AZ, Ottesen TD, Katakam A, Bedair HS, Melnic CM. Mental Robustness May Be Associated With Improved Physical Function in Bilateral Total Knee Arthroplasty Patients. J Arthroplasty 2024; 39:1207-1213. [PMID: 37981110 DOI: 10.1016/j.arth.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND In accordance with the high incidence of bilateral knee osteoarthritis, many patients have undergone bilateral total knee arthroplasty (BTKA). Whether patients undergo bilateral procedures in a staged or simultaneous fashion, the physical and mental burden of undergoing 2 major orthopedic procedures is considerable. The aims of this study were to (1) investigate differences between minimal clinically important difference (MCID) achievement between staged versus simultaneous BTKA, and (2) identify the patient variables, specifically mental scores, that were associated with MCID achievement in patients undergoing BTKA. METHODS Simultaneous and staged BTKA patients within a single health care network from 2016 to 2021 were retrospectively reviewed. Patient demographics, surgery details, and Patient-Reported Outcome Measurement Information System Physical Function Short Forms 10a (PROMIS PF10a), PROMIS Mental scores, and Knee Disability Osteoarthritis Outcome Scores (KOOS) were reviewed. Preoperative and postoperative patient-reported outcome measures were collected before the first total knee arthroplasty (TKA) and after the second TKA, respectively, in staged BTKA patients. The final cohort consisted of 249 patients, with an average age of 66 years (range, 21 to 87), 63% women, and an average body mass index of 32 (range, 20 to 52), at a mean follow-up of 1.1 years (range, 0.5 to 2.4). Multivariate regressions were performed on MCID PF10a and KOOS achievement, as well as whether the BTKA was performed simultaneously versus staged. RESULTS A preoperative PROMIS Mental score in the upper 2 quartiles was associated with MCID PF10a achievement in BTKA. Men and surgeries performed at an Academic Medical Center were negatively associated with the achievement of MCID KOOS. Interestingly, those who underwent simultaneous BTKA were less likely to achieve MCID KOOS than those who underwent a staged BTKA. CONCLUSIONS Preoperative mental robustness may be positively associated with improved physical function outcome in BTKA patients.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Taylor D Ottesen
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Goh GS, Schwartz AM, Friend JK, Grace TR, Wickes CB, Bolognesi MP, Austin MS. Patients Who Have Kellgren-Lawrence Grade 3 and 4 Osteoarthritis Benefit Equally From Total Knee Arthroplasty. J Arthroplasty 2023; 38:1714-1717. [PMID: 37019313 DOI: 10.1016/j.arth.2023.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Recently, some payers have limited access to total knee arthroplasty (TKA) to patients who have Kellgren-Lawrence (KL) grade 4 osteoarthritis only. This study compared the outcomes of patients who have KL grade 3 and 4 osteoarthritis after TKA to determine if this new policy is justified. METHODS This was a secondary analysis of a series originally established to collect outcomes for a single, cemented implant design. A total of 152 patients underwent primary, unilateral TKA at two centers from 2014 to 2016. Only patients who had KL grade 3 (n = 69) or 4 (n = 83) osteoarthritis were included. There was no difference in age, sex, American Society of Anesthesiologists score, or preoperative Knee Society Score (KSS) between the groups. Patients who had KL grade 4 disease had a higher body mass index. KSS and Forgotten Joint Score (FJS) were collected preoperatively and at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Generalized linear models were used to compare outcomes. RESULTS Controlling for demographics, improvements in KSS were comparable between the groups at all time points. There was no difference in KSS, FJS, and the proportion that achieved the patient acceptable symptom state for FJS at 2 years. CONCLUSION Patients who had KL grade 3 and 4 osteoarthritis experienced similar improvement at all time points up to 2 years after primary TKA. There is no justification for payers to deny access to surgical treatment for patients who have KL grade 3 osteoarthritis and have otherwise failed nonoperative treatment.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Andrew M Schwartz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer K Friend
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Trevor R Grace
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - C Baylor Wickes
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Okayoshi T, Okamoto Y, Wakama H, Otsuki S, Neo M. The flexion-extension gap is predictive of patient-reported outcome measures after cruciate-retaining total knee arthroplasty. Knee 2023; 41:150-160. [PMID: 36702049 DOI: 10.1016/j.knee.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/13/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We aimed to evaluate the association between the flexion-extension gap difference and patient-reported outcome measures after total knee arthroplasty (TKA). METHODS This was a retrospective case-control study of 60 cruciate-retaining single-radius TKAs. Soft tissue balancing was measured using an offset seesaw tensioner and centre-type digital knee balancer under joint distraction forces of 20-50 lbf and 1.5 times body mass index (1.5 BMI). At the last follow up of 2.0-6.5 (mean, 4.5) years postoperatively, patients were asked if they perceived their knee joint as 'natural' (26 knees) or 'artificial' (34 knees). Age, sex, and the flexion-extension gap were compared between the two groups. A receiver operating characteristic curve was used to determine cut-off values of variables predictive of a natural joint perception. RESULTS Natural joint perception was associated with a greater flexion-extension gap difference under a distraction force of 1.5 BMI (P = 0.016), higher knee function (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, P = 0.019), and quality of life (EuroQol 5-Dimension, P = 0.029). A gap difference of 0.95 mm under 1.5 BMI distraction predicted a natural joint perception post-TKA (sensitivity, 97.1%; specificity, 88.5%). Using a gap threshold of 1.0 mm under a 1.5 BMI distraction force yielded significant between-group differences in postoperative flexion (P = 0.040), satisfaction (P = 0.043), knee joint function (P < 0.001), quality of life (P = 0.032), and posterior femoral condylar offset (P = 0.037) CONCLUSION: A flexion-extension gap difference ≥1.0 mm under a distraction force of 1.5 BMI predicted superior outcomes, including patient satisfaction, after cruciate-retaining TKA. It was suggested that posterior femoral condylar offset could influence this finding.
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Affiliation(s)
- Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan
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Robinson PG, Kay RS, MacDonald D, Murray AD, Clement ND. Golfers have greater preoperative and equal postoperative function when undergoing total knee arthroplasty compared to non-golfers. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1083-1089. [PMID: 35362779 PMCID: PMC8973671 DOI: 10.1007/s00590-022-03253-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
Background Approximately 10% to 20% of patients with joint arthroplasties are golfers. The aim of this study was to assess if being a golfer is associated with functional outcomes, satisfaction or improvement in quality of life (QoL) compared to non-golfers following total knee arthroplasty. Methods All patients undergoing primary total knee arthroplasty (TKA) over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on postoperative function and health-related outcomes. Results The study cohort consisted of a total of 514 patients undergoing TKA. This included 223 (43.3%) male patients and 291 (56.7%) female patients, with an overall mean age of 70 (SD 9.5) years. The preoperative Oxford Knee Score (OKS) was significantly higher in golfers when adjusting for confounders (Diff 3.4 [95% CI 1 to 5.8], p = 0.006). There was no difference in postoperative outcomes between golfers and non-golfers. There was however a trend towards a higher Forgotten Joint Score (FJS) in the golfers (difference 9.3, 95% CI − 0.2 to 18.8, p = 0.056). Of the 48 patients who reported being golfers at the time of their surgery, 43 (89.6%) returned to golf and 88.4% of those were satisfied with their involvement in golf following surgery. Conclusions Golfers had better preoperative and equal postoperative knee specific function compared to non-golfers. The majority of golfers returned to golf by one year and were satisfied with their involvement in the game. Level of evidence III.
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Affiliation(s)
- P G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,PGA European Tour Performance Institute, Virginia Water, UK
| | - R S Kay
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
| | - D MacDonald
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A D Murray
- PGA European Tour Performance Institute, Virginia Water, UK.,Sports and Exercise Medicine, University of Edinburgh, Edinburgh, UK.,Medical and Scientific Department, The R&A, St. Andrews, UK
| | - N D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Schatz C, Klein N, Marx A, Buschner P. Preoperative predictors of health-related quality of life changes (EQ-5D and EQ VAS) after total hip and knee replacement: a systematic review. BMC Musculoskelet Disord 2022; 23:58. [PMID: 35039045 PMCID: PMC8764845 DOI: 10.1186/s12891-021-04981-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcomes are of ever-increasing importance in medical decision-making. The EQ-5D is one of the generic instruments measuring health-related quality of life (HRQoL) in arthroplasty. This review aimed to identify possible predictors of HRQoL changes for patients undergoing total knee replacements (TKR) or total hip replacements (THR). METHODS A systematic literature review according to the PRISMA guidelines was conducted, searching several databases. Preoperative to postoperative HRQoL changes were evaluated in patients undergoing THR or TKR, using the EQ-5D visual analog scale (VAS) or the preference-based EQ-5D Index were evaluated. Articles were considered with prospectively or retrospectively collected data, as well as registry data, each with statistical analyses of patient-related factors. RESULTS Eight hundred eighty-two articles were found, of which 21 studies met the inclusion criteria. Predictors were distinguished in alterable and non-alterable ones. The EQ-5D Index indicated a tendency towards beneficial improvements for patients with a high body mass index (BMI) (> 40) and no significant results for the VAS. Additionally, one study found that patient education and preoperative physiotherapy appeared to enhance HRQoL. Some evidence indicated that male gender was negatively associated with changes in the VAS and the EQ-5D Index, but one study reported the opposite. Changes in VAS and EQ-5D Index were lower for older patients, whereas a higher educational level seemed to be advantageous. A high Charnley class led to deteriorating changes in VAS, although a high Kellgren Lawrence classification was positively associated with the EQ-5D Index, in a limited number of studies. For all results, clinical relevance was calculated differently and mainly reported as uncertain or small. CONCLUSIONS The literature on this topic was weak and offers only limited guidance. Results for alterable predictors, such as the BMI, indicated valuable improvements for highly obese patients. Further, high-quality research is required to support medical decision-making. LEVEL OF EVIDENCE Level IV, according to the OCEBM Levels of Evidence Working Group.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany.
| | - Nina Klein
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Antonia Marx
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Okamoto Y, Wakama H, Okayoshi T, Matsuyama J, Otsuki S, Neo M. Spinopelvic mismatch is associated with patient-reported outcome measures after total knee arthroplasty at a mean follow-up of 15 years. Knee 2022; 34:156-166. [PMID: 34923348 DOI: 10.1016/j.knee.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/02/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely performed; yet, up to 25% of patients are dissatisfied with outcomes. Our aim was to evaluate the association between a spinopelvic mismatch and patient-reported outcomes after TKA. METHODS This was a retrospective study of 101 TKAs performed for osteoarthritis, at a mean 14.6 (range, 10.0-18.0) years post-surgery. Postoperative knee joint perception was evaluated as 'artificial', with or without restrictions, or 'natural'. Age, sex and the spinopelvic mismatch were compared between the 'artificial' (n = 54) and 'natural' (n = 47) perception groups. Multiple logistic regression analysis was used to identify predictive factors of an artificial perception, with a receiver operating characteristic curve to identify cut-off values for significant factors. RESULTS A spinopelvic mismatch, defined as a pelvic incidence minus lumbar lordosis (PI-LL) ≥ 10°, was associated with an artificial perception (odds ratio, 1.57; 95% confidence interval, 1.29-3.22; P = 0.023). An artificial joint perception was related to lower Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR, P = 0.021) and EuroQol 5-Dimension (EQ-5D, P = 0.025) scores. The cut-off PI-LL of 11° differentiated the groups with a sensitivity of 87.0% and specificity of 91.9%. Postoperative KOOS-JR (P < 0.001), EQ-5D (P = 0.014), satisfaction (P = 0.015), knee extension angle (P = 0.024), and perception (P = 0.032) differed between the groups when the PI-LL threshold was set at 10°. CONCLUSION A spinopelvic mismatch (PI-LL ≥ 10°) is associated with a risk of artificial perception of function after TKA. Measurement of the PI-LL could assist patients and surgeons to predict TKA outcomes.
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Affiliation(s)
- Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
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