Elsevier

The Journal of Arthroplasty

Volume 36, Issue 2, February 2021, Pages 507-513
The Journal of Arthroplasty

Primary Knee
Do Knee Osteoarthritis Patterns Affect Patient-Reported Outcomes in Total Knee Arthroplasty? Results From an International Multicenter Prospective Study With 3-Year Follow-Up

https://doi.org/10.1016/j.arth.2020.08.033Get rights and content

Abstract

Background

The aim of this multicenter study is to answer (1) Does patellofemoral osteoarthritis (OA) affect preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) scores in total knee arthroplasty (TKA)? and (2) Do different OA patterns affect preoperative and postoperative KOOS scores in TKA?

Methods

This international, multicenter prospective study examined 384 TKA patients. Compartmental OA was divided into (1) medial, (2) medial + patellofemoral, (3) lateral, (4) lateral + patellofemoral, (5) medial + lateral (bicompartmental), and (6) medial + lateral + patellofemoral (tricompartmental), based on preoperative anterior-posterior and lateral ± skyline radiographs with Kellgren-Lawrence grade III-IV and joint space width <2.5 mm. KOOS was collected preoperatively, 1 year postoperatively, and 3 years postoperatively. Higher KOOS score represented better clinical state, for example, higher KOOS Pain score indicated less pain.

Results

Patellofemoral OA had no effect on preoperative KOOS scores (P > .15). Compared to medial ± patellofemoral OA patients, bicompartmental/tricompartmental OA patients had less preoperative pain (KOOS Pain 7.4, P = .03) and higher daily function (KOOS-ADL [Activities of Daily Living] 7.1, P = .05), and higher 1-year postoperative daily function (KOOS-ADL 9.2, P = .03) and sports activity (KOOS Sports & Recreation Function 15.0, P = .04), while lateral ± patellofemoral OA patients had more symptoms (KOOS-Symptoms 7.0, P < .01), more pain (KOOS-Pain 7.5, P = .01), lower daily function (KOOS-ADL 9.3, P < .01), and lower quality of life (KOOS-QOL 9.0, P = .04), at 3 years postoperatively.

Conclusion

Patellofemoral OA does not affect medial ± lateral OA patients’ preoperative KOOS scores, challenging the importance of patellofemoral OA in TKA. Lateral ± patellofemoral OA patients have lower postoperative KOOS scores than medial/more progressed compartmental OA patients, indicating that patients with less common OA patterns present with unique surgical challenges. Further development of indications for and correct timing of TKA surgery in different patient subgroups is needed.

Section snippets

Patient Population

In total, 384 patients (mean age 64; 65% female) undergoing TKA between the years 2011 and 2014 were eligible in this international multicenter prospective study conducted at 11 sites across the United States (4 centers), Europe (2 centers in Denmark, 1 center in Sweden, and 1 center in Spain), Asia (2 centers in South Korea), and Australia (1 center). The study is an industry-funded multicenter study with the main aim of studying the performance of vitamin E diffused highly-crosslinked

Does Patellofemoral Osteoarthritis Affect Preoperative Knee Injury and Osteoarthritis Outcome Scores in Total Knee Arthroplasty?

In total, 276 (71.9%) patients had medial OA, 45 (11.7%) medial + patellofemoral OA, 34 (8.9%) lateral OA, 7 (1.8%) lateral + patellofemoral OA, 12 (3.1%) bicompartmental OA, and 10 (2.6%) tricompartmental OA (Table 1). Patient demographics were similar in all groups, except for fewer female bicompartmental and tricompartmental OA patients, and less component malalignment in bicompartmental OA patients (Table 1). Lateral OA patients had some of the lowest preoperative and postoperative KOOS

Discussion

Patellofemoral OA does not affect medial ± lateral OA patients’ preoperative KOOS scores, challenging the importance of patellofemoral OA in TKA. Lateral ± patellofemoral OA patients have lower postoperative KOOS scores than medial/more progressed compartmental OA patients, indicating that patients with less common OA patterns present with unique surgical challenges. Further development of indications for and correct timing of TKA surgery in different patient subgroups is needed.

Data were

Conclusions

Patellofemoral OA does not seem to affect preoperative KOOS scores in patients with medial and/or lateral OA, challenging the importance of patellofemoral OA in TKA. Bicompartmental/tricompartmental OA patients have less preoperative pain and higher daily function as well as higher 1-year postoperative daily function and sports activity, compared to medial ± patellofemoral OA patients. Lateral ± patellofemoral OA patients have more symptoms, more pain, lower daily function, and lower QOL, at

Acknowledgments

The authors would like to thank Thomas Kallemose, MSc, for essential help with statistical work. This work was supported by Partners Healthcare Massachusetts General Hospital, Boston, MA [grant number 05012019]. Partners Healthcare Massachusetts General Hospital did not have any involvement in study design, collection, analysis, interpretation of data, writing of the article, and in the decision to submit the article for publication.

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.08.033.

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