Higher Function Scores and Satisfaction in Patients with Anteromedial Osteoarthritis Compared with Other Wear Patterns of the Knee: 2 Years after Both Total and Unicondylar Knee Arthroplasties

Abstract

Anteromedial osteoarthritis (AMOA) is a common wear pattern in primary osteoarthritic knees. In patients with bone-on-bone disease, the most appropriate surgical intervention is still a matter of debate. Knee arthroplasty is a well-accepted treatment to relieve symptoms and regain function. Unfortunately, satisfaction is limited, especially related to activities. A cross-sectional study was performed among patients treated with total knee arthroplasty (TKA) and unicondylar arthroplasty (UKA) to determine if the osteoarthritis wear pattern or type of prosthesis affects knee-specific function scores and satisfaction related to activities. All UKA patients (N = 100) were treated for AMOA. Based on radiological assessment of the wear pattern, TKA patients were divided into two groups: TKA for AMOA (N = 68) and true TKA (N = 99). The Knee injury and Osteoarthritis Outcomes Score (KOOS), new Knee Society score (KSS), anterior knee pain scale, visual analog scales (VASs) for satisfaction about activities, and net promoter score were collected. After 2 years' follow-up, the anterior knee pain scale and VAS satisfaction showed significantly better scores for patients treated with TKA for AMOA compared with the true TKA group. Also in the KOOS subscales, some differences were seen in favor of the TKA for AMOA group. The new KSS was not in favor of a specific wear pattern, but patients with AMOA treated with UKA performed better on the symptoms subscale compared with patients treated with TKA. In conclusion, patients treated with TKA for AMOA showed better knee-specific function scores and satisfaction scores compared with patients treated with TKA for other wear patterns, and only slight differences were found between both the AMOA groups (TKA for AMOA and UKA). Thus, the radiologic assessment of wear patterns might be useful to take into account the shared decision-making process, when discussing expectations, timing, and outcomes with knee osteoarthritis patients considering knee arthroplasty. When AMOA is present, it might be beneficial to choose UKA over TKA.

Keywords

knee arthroplasty - wear pattern - patient satisfaction - activities

Authors' Contribution

S.W.: Study design, data collection, interpretation of the data, drafting, and revision of article. A.H.: Data collection, data analysis, drafting the article. K.K.: Interpretation of the data, revision of article. G.K.: Study design and revision of article. R.G.: Study design, interpretation of the data, and revision of article.

• References

• 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
• 2 Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 2009; 16 (06) 473-478
• 3 Godest AC, de Cloke CS, Taylor M. , et al. A computational model for the prediction of total knee replacement kinematics in the sagittal plane. J Biomech 2000; 33 (04) 435-442
• 4 White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee. J Bone Joint Surg Br 1991; 73 (04) 582-586
• 5 van Raaij T, Reijman M, Brouwer RW, Jakma TS, Verhaar JN. Survival of closing-wedge high tibial osteotomy: good outcome in men with low-grade osteoarthritis after 10-16 years. Acta Orthop 2008; 79 (02) 230-234
• 6 Price A, Beard D, Thienpont E. Uncertainties surrounding the choice of surgical treatment for ‘bone on bone’ medial compartment osteoarthritis of the knee. Knee 2013; 20 (Suppl. 01) S16-S2
• 7 Zuiderbaan HA, van der List JP, Kleeblad LJ. , et al. Modern indications, results, and global trends in the use of unicompartmental knee arthroplasty and high tibial osteotomy in the treatment of isolated medial compartment osteoarthritis. Am J Orthop 2016; 45 (06) E355-E361
• 8 Skou ST, Roos EM, Laursen MB. , et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015; 373 (17) 1597-1606
• 9 Barlow T, Griffin D, Barlow D, Realpe A. Patients' decision making in total knee arthroplasty: a systematic review of qualitative research. Bone Joint Res 2015; 4 (10) 163-169
• 10 Bourne RB, Chesworth B, Davis A, Mahomed N, Charron K. Comparing patient outcomes after THA and TKA: is there a difference?. Clin Orthop Relat Res 2010; 468 (02) 542-546
• 11 Mont MA, Serna FK, Krackow KA, Hungerford DS. Exploration of radiographically normal total knee replacements for unexplained pain. Clin Orthop Relat Res 1996; (331) 216-220
• 12 Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: is it really an effective procedure for all?. Knee 2007; 14 (06) 417-423
• 13 Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y. Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 2013; 471 (01) 127-133
• 14 Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients' expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up. Acta Orthop 2009; 80 (01) 55-61
• 15 Witjes S, Gouttebarge V, Kuijer PP, van Geenen RC, Poolman RW, Kerkhoffs GM. Return to sports and physical activity after total and unicondylar knee arthroplasty : a systematic review and meta-analysis. Sports Med 2016; 46 (02) 269-292
• 16 Beard D, Price A, Cook J. , et al. Total or partial knee arthroplasty trial - TOPKAT: study protocol for a randomised controlled trial. Trials 2013; 14 (01) 292
• 17 Keyes GW, Carr AJ, Miller RK, Goodfellow JW. The radiographic classification of medial gonarthrosis. Correlation with operation methods in 200 knees. Acta Orthop Scand 1992; 63 (05) 497-501
• 18 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
• 19 Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society knee scoring system. Clin Orthop Relat Res 2012; 470 (01) 3-19
• 20 Kievit AJ, Breugem SJ, Sierevelt IN. , et al. Dutch translation of the Kujala anterior knee pain scale and validation in patients after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21 (11) 2647-2653
• 21 Hamilton DF, Lane JV, Gaston P. , et al. Assessing treatment outcomes using a single question: the net promoter score. Bone Joint J 2014; 96-B [phone]
• 22 Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?. Arch Phys Med Rehabil 2004; 85 (05) 815-822
• 23 Dowsey MM, Choong PF. The utility of outcome measures in total knee replacement surgery. Int J Rheumatol 2013; 2013: 506518
• 24 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
• 25 Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L. Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2012; 20 (03) 401-406
• 26 Dowsey MM, Nikpour M, Dieppe P, Choong PF. Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthritis Cartilage 2012; 20 (10) 1095-1102
• 27 Tilbury C, Holtslag MJ, Tordoir RL. , et al. Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis. A prospective cohort study of 573 patients. Acta Orthop 2016; 87 (01) 67-71
• 28 Hoorntje A, Witjes S, Koenraadt KLM, Aarts R, Weert T, van Geenen RCI. More severe preoperative Kellgren - Lawrence grades of knee osteoarthritis were partially associated with better preoperative patient-reported outcome in TKA patients. J Knee Surg 2018. doi: 10.1055/s-0038-1635114
• 29 Ruhdorfer A, Wirth W, Hitzl W, Nevitt M, Eckstein F. ; Osteoarthritis Initiative Investigators. Association of thigh muscle strength with knee symptoms and radiographic disease stage of osteoarthritis: data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2014; 66 (09) 1344-1353
• 30 Tuna S, Balcı N. The relationship between radiological severity and functional status in patients with knee osteoarthritis. Clin Rheumatol 2014; 33 (05) 667-670
• 31 Fortin PR, Penrod JR, Clarke AE. , et al. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum 2002; 46 (12) 3327-3330
• 32 Lingard EA, Katz JN, Wright EA, Sledge CB. ; Kinemax Outcomes Group. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am 2004; 86-A (10) 2179-2186
• 33 Liddle AD, Judge A, Pandit H, Murray DW. Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 2014; 384 (9952): 1437-1445
• 34 Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CAF, Murray DW. The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Joint J 2015; 97-B (11) 1493-1500
• 35 Ali AM, Pandit H, Liddle AD. , et al. Does activity affect the outcome of the Oxford unicompartmental knee replacement?. Knee 2016; 23 (02) 327-330
• 36 Maier MW, Kuhs F, Streit MR. , et al. Unicompartmental knee arthroplasty in patients with full versus partial thickness cartilage loss (PTCL): equal in clinical outcome but with higher reoperation rate for patients with PTCL. Arch Orthop Trauma Surg 2015; 135 (08) 1169-1175
• 37 Rolfson O, Bohm E, Franklin P. , et al; Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries. Patient-reported outcome measures in arthroplasty registries: report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries Part II. Recommendations for selection, administration, and analysis. Acta Orthop 2016; 87 (87) (Suppl. 01) 9-23
• 38 Konan S, Haddad FS. Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty?. Bone Joint J 2016; 98-B (10) , supple B ): 11-15
• 39 Si HB, Zeng Y, Shen B. , et al. The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (06) 1824-1832
• 40 Chen JY, Lo NN, Chong HC. , et al. The influence of body mass index on functional outcome and quality of life after total knee arthroplasty. Bone Joint J 2016; 98-B [phone]
• 41 Murray DW, Pandit H, Weston-Simons JS. , et al. Does body mass index affect the outcome of unicompartmental knee replacement?. Knee 2013; 20 (06) 461-465
• 42 Plate JF, Augart MA, Seyler TM. , et al. Obesity has no effect on outcomes following unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 645-651
• 43 Von Keudell A, Sodha S, Collins J, Minas T, Fitz W, Gomoll AH. Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis. Knee 2014; 21 (01) 180-184