title: Comparing the functional impact of knee replacements in two cohorts.
abstract: BACKGROUND
  To examine if different rates of total knee replacement (TKR) in two similar cohorts with symptomatic knee osteoarthritis (OA) were associated with different functional impact of disease.
  
  
  METHODS
  Subjects from the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI), persons with or at high risk of OA, had knee radiographs, completed Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) surveys and had TKRs confirmed at each visit. At each visit, subjects were defined as having symptomatic OA (SxOA) if ≥ one knee had pain and radiographic OA or if they had a TKR. WOMAC function scores at each visit were compared by analysis of covariance adjusting for age, sex, body mass index, race, site, depression, comorbidity, painful leg joints and knees affected. Post-TKR function scores were imputed to estimate scores that would have been present without TKR.
  
  
  RESULTS
  Subjects with SxOA (n>750 in MOST and in OAI) had a mean age 66 to 67 years; most were women and were White. Subjects were followed 4-5 years. Among those with SxOA, more TKRs were done in MOST (35%) than OAI (19%). Adjusted mean WOMAC function (0-68, 68 = worst) improved from 26.9 to 21.9 in MOST and from 24.5 to 22.0 in OAI (difference between MOST and OAI in change in WOMAC function, p = .01). Estimates of function without TKRs showed function would not have changed in MOST (23.2 at baseline to 22.4).
  
  
  CONCLUSIONS
  Functional status of subjects with knee OA in MOST improved more than in OAI, probably because of higher rates of TKRs. The decline suggests that TKR diminishes the functional impact of OA in the community.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Niu
authors.forename: Michael
authors.initials: M
authors.lastname: Nevitt
authors.forename: Charles
authors.initials: C
authors.lastname: McCulloch
authors.forename: James
authors.initials: J
authors.lastname: Torner
authors.forename: C Elizabeth
authors.initials: CE
authors.lastname: Lewis
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.affiliation: From the Clinical Epidemiology Unit, Boston University School of Medicine, 650 Albany Street, Suite X200, Boston, MA 02118, USA. dfelson@bu.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Felson
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology*