Does knee malalignment increase the risk of development and progression of knee osteoarthritis? A systematic review

Objective. To examine the 6-year course of nontraumatic knee symptoms in adults in general practice, to identify prognostic factors for unfavorable outcome, and to develop a clinical prediction rule. Methods. Adults (ages >35 years) with incident nontraumatic knee symptoms (n ‫؍‬ 549) were followed for 6 years. Multivariable logistic regression analysis was used to identify prognostic factors associated with an unfavorable outcome, the area under the receiver operating curve (AUC) was calculated to determine discriminative ability, and a clinical prediction rule was developed. Unfavorable outcome is defined as persistent knee symptoms at 6-year followup or having undergone knee replacement surgery during followup.

Section: Discussioncontrasting

confidence: 98%

Six‐year course and prognosis of nontraumatic knee symptoms in adults in general practice: A prospective cohort study

Kastelein¹,

Luijsterburg²,

Belo³

et al. 2011

“…The study was only conducted in patients with medial compartment OA; therefore, it is not possible to generalize to patients with lateral compartment OA or patellofemoral disease. There was no assessment of varus-valgus alignment in this study, which has been recognized as a risk factor for radiographic progression (23,24). Recent studies using MRI have indicated that meniscal pathology is common in patients with knee OA, and degeneration and extrusion of the meniscus may also be reflected in loss of JSW using plain radiography (25).…”

Section: (3)mentioning

confidence: 84%

Identifying common trajectories of joint space narrowing over two years in knee osteoarthritis

Bartlett

Ling

Mayo

et al. 2011

Objective. Little is known about the natural history of knee osteoarthritis (OA). We sought to identify common patterns of joint space narrowing (JSN) in well-characterized knee OA patients in the placebo arm of a 2-year international study. Methods. We performed secondary data analyses of 622 adults ages 39 -80 years in North America (n ‫؍‬ 310) and Europe (n ‫؍‬ 312) with symptomatic knee OA. Fluoroscopically positioned semiflexed anteroposterior radiographs were obtained at 0, 12, and 24 months. Group-based trajectory modeling was used to identify distinctive groups of individuals with similar trajectories of JSN, taking into account sex, age, and body mass index. Results. Seven groups were identified. Four exhibited joint space width (JSW) stability over 2 years representing the most common trajectory (71%), which was unrelated to initial JSW. Atypical courses included slow, rapid, and moderate progressors; most had significant JSN at study entry. Slow progressors (20%) had a mean JSN of 0.2 mm over 2 years. Only 2% of the sample demonstrated rapid JSN (2.1 mm), while 7% had JSN of 0.7 mm. Rapid progressors tended to be men, while slow and moderate progressors were older and heavier. Conclusion. Most (70%) people with OA demonstrated no significant JSN over 2 years; 20% showed slow progression, 7% had moderate, and 2% had rapid JSN. Progressors tended to have less JSW at study entry and were older and heavier; rapid progressors were more likely to be men. Understanding common patterns of the course of knee OA may offer new opportunities to target those at greatest risk of disability.

“…Previous systematic reviews have sought to identify predictors of knee OA progression using radiographic change (5,6) or functional decline and change in pain (7) as outcome measures. Usual clinical practice is to gather information from both radiographs and patient-reported symptoms.…”

Section: Introductionmentioning

confidence: 99%

Patient characteristics that predict progression of knee osteoarthritis: A systematic review of prognostic studies

Chapple

Nicholson

Baxter

et al. 2011

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