Improvement following total knee replacement surgery: Exploring preoperative symptoms and change in preoperative symptoms

Abstract

Objective To determine whether changes in preoperative osteoarthritis (OA) symptoms are associated with improvement after total knee replacement (TKR) and to identify predictors of clinically significant improvement. Methods Data on Osteoarthritis Initiative participants who were annually assessed and underwent TKR were included. T0 was the assessment prior to TKR while T-1 was the assessment prior to that. T+2 was the second assessment after TKR. We compiled data on the Western Ontario and McMaster Universities OA Index (WOMAC), OA-related symptoms and radiographic severity. We defined clinically significant improvement as improvement in WOMAC total score ≥ to the minimal important difference (MID) (0.5 SD of mean change) between T0 and T+2 and also considered other definitions of improvement. Logistic regression models were performed to evaluate the relationship between improvement and preoperative measures. Results Improved (n=211) compared to unimproved (n=58) patients had greater worsening of their WOMAC pain (p=0.002) and disability (p<0.001) from T-1 to T0. Preoperative measures as predictors of improvement included: higher WOMAC disability (OR 1.08, p<0.001), presence of chronic OA symptoms in the surgical knee (OR 5.77, p=0.033), absence of OA-related symptoms in the contralateral knee (OR 9.25, p<0.001), exposure to frequent knee-bending (OR 3.46, p=0.040), and having a Kellgren-Lawrence x-ray grade of ≥2 in the contralateral knee (OR 4.71, p=0.010). Conclusions More than 75% of participants had improvement after TKR. Improved patients were more likely to have escalation of OA pain and disability prior to surgery than unimproved patients. Other pre-operative measures predicted improvement after TKR.

Radiographic severity of knee osteoarthritis and its relationship to outcome post total knee arthroplasty: a systematic review

“…The same relationship was also demonstrated in two further studies . Conversely, Vina et al . in a recent publication found a weak association between OA severity and WOMAC pain scores postoperatively.…”

“…The effect of preoperative X‐ray grade of OA and postoperative pain scores was assessed in 16 studies . Six reported pain outcomes according to the KSS.…”

“…Functional outcomes were assessed in 15 studies . Six articles showed statistically significant results for various aspects of functional recovery after TKA.…”

“…Seven studies utilized the KSS 13,15,18,[30][31][32][33] and the Western Ontario and McMaster Universities Osteoarthritis Index (WOM-AC), 8,16,18,22,[34][35][36] respectively. The short-form health survey and its variations were used in five studies.…”

“…The effect of preoperative X-ray grade of OA and postoperative pain scores was assessed in 16 studies. 13,[15][16][17][18]21,22,[28][29][30][31][32][33][34][35][36] Six reported pain outcomes according to the KSS. Four studies 13,15,30,33 (n = 1214) demonstrated statistically significant pain outcomes for those with worse preoperative grade of OA up to 3 years postoperatively.…”