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

Abstract

Background Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA). There are many contributing factors. The relationship between preoperative osteoarthritis (OA) severity and outcome post TKA remains unclear. This review explores the relationship between preoperative OA severity with patient reported pain, function and satisfaction post TKA. Methods A pre‐registered systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Major databases were searched until September 2017. We included studies assessing adults undergoing TKA for OA. Minimum follow‐up was 6 months. Methodological quality assessment was conducted using the Newcastle‐Ottawa Scale. Results Twenty cohort studies with 7478 patients were included. There were 16 good, one fair and three poor quality studies. Knee OA was most commonly reported according to the Kellgren and Lawrence tool. Ten studies showed statistically significant pain outcomes for those with worse preoperative OA. This was supported by meta‐analysis of the Knee Society Score pain change scores to final follow‐up for those with Kellgren and Lawrence grade 4 OA. Six studies showed statistically significant results for various aspect of functional recovery, although meta‐analysis of Knee Society Score function change scores identified no difference. Meta‐analysis of final follow‐up pain and function scores alone yielded no significant difference. Patients with more severe preoperative OA were more likely to be satisfied. There were no studies demonstrating that less severe OA resulted in better pain, function or satisfaction. Conclusion Review of available research indicates that TKA for OA improves pain, function and satisfaction. Those with more severe preoperative radiological knee OA benefit most.

Racial Differences in Pain and Function Following Knee Arthroplasty: A Secondary Analysis From a Multicenter Randomized Clinical Trial

“…African Americans were well represented in our sample, but other races and ethnicities were poorly represented, with only 9 additional subjects, and this lack of representation reduces generalizability for these populations. Finally, our study did not account for preoperative knee OA severity, a known predictor of poor outcome (50). It is possible that African Americans had milder knee OA than the non–African Americans, although we found no data to suggest that this is the case.…”

Safety of Total Knee Arthroplasty in the Treatment of Knee Osteoarthritis and Its Effect on Postoperative Pain and Quality of Life of Patients

“…Pain and dysfunction in knee joints are the main clinical manifestations of patients with KOA, and the purpose of treatment should be relieving pain and improving the knee joint function, so as to improve the quality of life of patients [20][21][22][23]. is study showed that the HSS scores of patients with KOA after surgery were significantly higher than the score before surgery (P < 0.05), and the postoperative pain scores increased with time, indicating that the patients' pain was alleviated gradually.…”

Three-dimensional gait characteristics of patients after unilateral total knee arthroplasty

“…Therefore, the knee joint is the joint most commonly involved in osteoarthritis [20] . TKA is a standard treatment for end-stage knee disease and works well [2–5,8,15] . The walking function is the most essential part of daily life activities.…”

“…The knee joint is a relatively complex joint of the human body. [2,3,5,[8][9][10]15,17,19] It needs to complete a wide range of joint movements under the condition of carrying human body gravity to meet the needs of human body movement. Therefore, the knee joint is the joint most commonly involved in osteoarthritis.…”