Is Pain and Dissatisfaction After TKA Related to Early-grade Preoperative Osteoarthritis?

Polkowski, Gregory G.; Ruh, Erin L.; Barrack, Toby; Nunley, Ryan M.; Barrack, Robert L.

doi:10.1007/s11999-012-2465-6

Cited by 52 publications

(45 citation statements)

References 3 publications

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“…While the literature supports substantial improvement in clinical outcome measures following TKA among younger patients, higher failure rates have been noted when compared to older patients [8,11]. Younger patients are more likely to experience residual symptoms after total knee replacement and patients with lesser degrees of radiographic arthritis may be more likely to be dissatisfied with their total knee replacement [18,19]. Studies that previously addressed the relationships of osteoarthritis severity and alignment on TKA outcomes have not provided a direct comparison of outcomes related to categorical patient age.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients with less severe radiographic disease may be more likely to experience persistent pain that causes them to seek additional medical treatment. Polkowski et al have noted that as many as 50% of patients who present for assessment of a painful TKA with acceptable postoperative radiographs had only mild or moderate preoperative radiographic disease at the time of their primary TKA procedure [19]. While several published studies have suggested a relationship between preoperative malalignment and obesity on the progression of knee osteoarthritis and postoperative TKA clinical outcome scores, these studies have not specifically reported on the radiographic disease severity of patients related to patient age at the time of TKA surgery [4][5][6]8,11,22].…”

Section: Introductionmentioning

confidence: 99%

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Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty

et al. 2017

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“…Third, patients undergoing UKAs are younger compared with patients undergoing TKAs, therefore, their expectations are high, and the results of UKAs in these patients may be disappointing [21]. Finally, there is increasing evidence that patients with mild or moderate OA who undergo knee arthroplasty, even those with severe symptoms, have a higher revision rate than patients with severe arthritis [16,17,19]. These patients may be overrepresented in the UKA group because the less invasive operation may be performed for patients with less severe arthritis.…”

Section: Discussionmentioning

confidence: 99%

Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study

Niinimäki

Eskelinen

Mäkelä

et al. 2014

Clinical Orthopaedics &Amp; Related Research

154

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Background Balancing the relative advantages and disadvantages of unicompartmental knee arthroplasties (UKAs) against those for TKAs can be challenging. Survivorship is one important end point; arthroplasty registers repeatedly report inferior midterm survival rates, but longer-term data are sparse. Comparing survival directly by using arthroplasty register survival reports also may be inadequate because of differences in indications, implant designs, and patient demographics in patients having UKAs and TKAs. Questions/purposes The aims of this study were to assess the survivorship of UKA in the context of one large, northern European registry, and to compare the rates of survivorship with those of cemented TKAs performed for primary knee osteoarthritis during the same 27-year period. Methods From the Finnish Arthroplasty Register, we obtained the data for 4713 patients undergoing UKAs for primary osteoarthritis (mean age, 63.5 years; minimum followup, 0 years; mean, 6.0 years; range, 0-24 years) who had surgical revision between 1985 and 2011. From this cohort, we calculated the Kaplan-Meier survivorship for revision performed for any reason and compared it with the survivorship of 83,511 patients (mean age, 69.5 years; minimum followup 0 years; mean, 6.4 years; range, 0-27 years) with TKAs treated for primary osteoarthritis during the same period. Data were adjusted for age and sex in a comparative analysis.

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“…Besides radiologic criteria, depression, higher BMI, younger age and female gender were associated with higher postoperative dissatisfaction rates. A recently published study compared the pre-operative osteoarthritis severity in four cohorts with and without persisting pain after TKA [24]. In the cohort with persisting pain, the rate of patients with pre-operative early grade osteoarthritis averaged 49 %, while only 5-10 % of the patients without persistent pain suffered from low-grade osteoarthritis before operation.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative arthritis severity as a predictor for total knee arthroplasty patients’ satisfaction

Schnurr

Jarrous

Güdden

et al. 2013

International Orthopaedics (SICOT)

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Purpose Studies have shown that up to 25 % of TKA patients are dissatisfied with the implanted knee, even if registry data shows ten-year revision rates below 5 %. It has been the question of our study, if it would be possible to identify those patients at risk for dissatisfaction pre-operatively. Methods The data of 1,121 consecutive TKA patients with a follow-up between one and six years have been analysed retrospectively. Demographic, radiologic and perioperative variables have been recorded and all patients were asked by questionnaire for satisfaction with the implanted knee. Logistic regression models have been used to identify significant risk factors. Results The data of 996 patients (89 %) were complete, 849 (85.2 %) reported satisfaction and 147 (14.8 %) dissatisfaction. Patients' satisfaction was independent of the time after operation (p=0.285). The only factor which influenced patients' satisfaction was the osteoarthritic severity. In comparison to severe arthritis Kellgren Lawrence IV°, the risk for dissatisfaction was 2.556-fold elevated for arthritis grade III°(p<0.001) and 2.956-fold higher for grade II°(p=0.001). Conclusions Patients suffering from mild or moderate osteoarthritis are at risk for dissatisfaction after TKA. The TKA indication in those patients should therefore be critically proven. Furthermore, to adjust patients' expectations, the elevated dissatisfaction risk in case of mild or moderate osteoarthritis should be included into patients' pre-operative information.

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Is Pain and Dissatisfaction After TKA Related to Early-grade Preoperative Osteoarthritis?

Abstract: A high percentage of patients referred for unexplained pain after TKA had early-grade osteoarthritis preoperatively. Patients undergoing TKA for less than Grade 3 or 4 OA should be informed that they may be at higher risk for persistent pain and dissatisfaction.

Cited by 52 publications

References 3 publications

Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty

Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty

Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study

Pre-operative arthritis severity as a predictor for total knee arthroplasty patients’ satisfaction

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