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From Early Radiographic Knee Osteoarthritis to Joint Arthroplasty: Determinants of Structural Progression and Symptoms
Author(s) -
Roemer Frank W.,
Kwoh C. Kent,
Fujii Tomoko,
Han Michael J.,
Boudreau Robert M.,
Hunter David J.,
Eckstein Felix,
John Markus R.,
Guermazi Ali
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23545
Subject(s) - medicine , osteoarthritis , radiography , womac , synovitis , joint replacement , knee pain , magnetic resonance imaging , quality of life (healthcare) , arthroplasty , physical therapy , surgery , arthritis , radiology , pathology , alternative medicine , nursing
Objective To assess structural progression in knees with no/mild radiographic osteoarthritis ( OA ) (i.e., Kellgren/Lawrence [K/L] grades 0–2) that will undergo knee replacement during a 5‐year period; to assess differences in structural damage on magnetic resonance imaging ( MRI ) in knees with no/mild radiographic OA versus those with severe radiographic OA (i.e., K/L grades 3 and 4) at baseline; and to assess differences in pain levels between those groups. Methods All participants who underwent knee replacement from baseline to 60 months were drawn from the Osteoarthritis Initiative. MRI s were assessed for bone marrow lesions ( BML s), Hoffa synovitis, and effusion synovitis (i.e., hyperintensity signal changes in the fat pad and abnormal amount of capsular distension due to intraarticular joint fluid and/or synovial thickening) at baseline and at the time point before knee replacement (T0). The Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and Knee Injury and Osteoarthritis Outcome Score ( KOOS ) pain were used for pain characterization. WOMAC activities of daily living and KOOS quality of life were applied to characterize functional status of the included participants. Logistic regression was used to assess the association of no/mild radiographic OA with these MRI features and pain. Results Based on inclusion criteria, 181 knees were selected. Participants were predominantly female (57.8%) with a mean age of 64.4 years. A total of 51 knees (28.2%) had no/mild radiographic OA at baseline. Of these, 51.0% progressed to severe radiographic OA . No/mild radiographic OA knees showed higher odds of BML s in the patellofemoral joint at baseline (odds ratio [ OR ] 7.92 [95% confidence interval (95% CI ) 3.45–18.16]) and T0 ( OR 9.44 [95% CI 4.00–22.28]) compared to severe radiographic OA knees. In addition, no/mild radiographic OA knees were associated with change from no pain to pain from baseline to T0 (adjusted OR 5.48 [95% CI 1.25–24.00]). Conclusion More than half of the knees with no/mild radiographic OA before knee replacement progressed to severe radiographic OA during 4 years of follow‐up. BML s in the patellofemoral joint were more often seen among knees that had no/mild radiographic OA . Worsening pain status may contribute to knee replacement in knees with no/mild radiographic OA .