More Severe Radiographic Osteoarthritis Is Associated With Increased Improvement in Patients’ Health State Following a Total Knee Arthroplasty

Abstract

Background: To assess whether preoperative radiological severity of osteoarthritis (OA) is related to the level of improvement in patients' health state measured 1 year after total knee arthroplasty (TKA). Methods: Radiographic severity of OA was graded using the Kellgren-Lawrence (KL) classification. Two independent observers were blinded to patients' outcome scores. Health-related quality of life was measured using EQ-5D-3L preoperatively and at 12-month follow-up. The 5 dimensions of the EQ-5D were converted into a health state index score. The association between KL grade and improvement in health state score was analyzed using multiple linear regression. Results: Among 156 consecutive patients (68% females, mean age 69 years) who underwent primary TKA, 3 knees (2%) were classified as KL grade 2, 115 as KL grade 3 (74%), and 38 as KL grade 4 (24%). Follow-up rate was 77%. There was substantial intra-rater and inter-rater agreement (Cohen's kappa ¼ 0.80 and 0.79). Most patients (64%) had clinically significant improvement in their health state score 1 year after TKA. However, after adjusting for relevant covariates, patients with severe OA (KL grade 4) were found to have significantly more improvement in their health state score than patients with mild or moderate OA (KL grade 2 or 3, respectively). Separate analysis of the 5 EQ-5D dimensions showed that the KL group differences were most evident in the "usual activities" and "pain/discomfort" dimensions. Conclusion: Patients with severe OA have significantly more improvement in their usual activities and pain/discomfort 1 year after TKA than patients with less severe OA.

Development of Postoperative Pain in Patients with End-Stage Knee Osteoarthritis Is Associated with Upregulation of Genes Related to Extracellular Matrix Degradation, Inflammation, and Apoptosis Measured in the Peripheral Blood before Knee Surgery

“…The positive correlation of pain indices and DN4 scores with PainDETECT, HADS depression/anxiety, and BPI pain severity variables, as observed in our study, indicates the association of neuropathic pain symptoms with pain intensity in the preoperative time, and it has also been suggested previously [ 13 ]. Our observation of slightly higher BPI pain severity prior to surgery in patients who were satisfied with the surgery is supported by previous observations indicating that patients with severe OA have significantly more improvement in their usual activities and pain after knee surgery than patients with less severe OA [ 42 ].…”

Preoperative predictors of health-related quality of life changes (EQ-5D and EQ VAS) after total hip and knee replacement: a systematic review

“…Scott et al (2021) [ 50 ] also found no significant effects of the KL grade on HRQoL changes after TKR. In contrast, a study by Rehman et al (2020) [ 48 ] evaluated whether severe radiographic OA was related to improvements in HRQoL after TKR. The results indicated that patients with severe OA, especially KL grade 4, had more clinically meaningful improvement in their EQ-5D Index than patients with less severe OA [ 48 ].…”

Metabolic equivalent of task scores avoid the ceiling effect observed with conventional patient-reported outcome scores following knee arthroplasty

“…A Norwegian study concluded that TKA offers a greater improvement in health state to patients as the radiological severity of osteoarthritis increases, using the EQ-5D as the endpoint at 12 months post-surgery. 23 The severe ceiling effect demonstrated with the EQ-5D calls this conclusion into question, as when the most common score postoperatively is 1, patients with more severe arthritis have more to gain than patients whose preoperative scores are closer to the ceiling.…”