title: Low grading of the severity of knee osteoarthritis pre-operatively is associated with a lower functional level after total knee replacement: a prospective cohort study with 12 months' follow-up.
abstract: The optimal timing of total knee replacement (TKR) in patients with osteoarthritis, in relation to the severity of disease, remains controversial. This prospective study was performed to investigate the effect of the severity of osteoarthritis and other commonly available pre- and post-operative clinical parameters on the clinical outcome in a consecutive series of cemented TKRs. A total of 176 patients who underwent unilateral TKR were included in the study. Their mean age was 68 years (39 to 91), 63 (36%) were male and 131 knees (74%) were classified as grade 4 on the Kellgren-Lawrence osteoarthritis scale. A total of 154 patients (87.5%) returned for clinical review 12 months post-operatively, at which time the outcome was assessed using the Knee Society score. A low radiological severity of osteoarthritis was not associated with pain 12 months post-operatively. However, it was significantly associated with an inferior level of function (p = 0.007), implying the need for increased focus on all possible reasons for pain in the knee and the forms of conservative treatment which are available for patients with lower radiological severity of osteoarthritis.
authors.affiliation: Research Unit for General Practice. The North Denmark Region, Fyrkildevej 7, 1. Sal 9220 Aalborg Ø, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Riis
authors.affiliation: Aalborg Hospital Science and Innovation Centre, Orthopaedic Surgery Research Unit, Soendre Skovvej 15, 9000 Aalborg, Denmark.
authors.forename: M S
authors.initials: MS
authors.lastname: Rathleff
authors.affiliation: Aalborg University, Department of Clinical Research, Fyrkildevej 7, 1. sal, 9220 Aalborg O, Denmark.
authors.forename: M B
authors.initials: MB
authors.lastname: Jensen
authors.affiliation: Aalborg University Hospital, Department of Orthopaedic Surgery, Hobrovej 18-22, 9000 Aalborg, Denmark.
authors.forename: O
authors.initials: O
authors.lastname: Simonsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D010147:Pain Measurement / Q000379:methods*; D057234:Preoperative Period; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Radiography; Total knee replacement; Treatment outcome.