Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis

• Published in: BMC musculoskeletal disorders 2010-05, Vol.11 (1), p.86-86, Article 86
• Main Authors: Zeni, Jr, Joseph A, Axe, Michael J, Snyder-Mackler, Lynn
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Analysis; Arthritis; Arthroplasty, Replacement, Knee - standards; Arthroplasty, Replacement, Knee - statistics & numerical data; Care and treatment; Causality; Clinical medicine; Decision-making; Development and progression; Disability Evaluation; Exercise Test; Female; Health care access; Humans; Joint surgery; Knee; Knee Joint - diagnostic imaging; Knee Joint - pathology; Knee Joint - physiopathology; Male; Middle Aged; Muscle Strength Dynamometer; Muscle Weakness - diagnosis; Muscle Weakness - etiology; Muscle Weakness - physiopathology; Musculoskeletal diseases; Older people; Osteoarthritis; Osteoarthritis, Knee - diagnosis; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - surgery; Pain; Patient education; Patient satisfaction; Patient Selection; Physical Examination; Physical therapy; Postoperative period; Predictive Value of Tests; Prognosis; Quadriceps Muscle - physiopathology; Radiography; Range of Motion, Articular - physiology; Research article; Severity of Illness Index; Studies; Surgery; Surveys and Questionnaires
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/1471-2474-11-86

Arthritis is a leading cause of disability in the United States. Total knee arthroplasty (TKA) has become the gold standard to manage the pain and disability associated with knee osteoarthritis (OA). Although more than 400,000 primary TKA surgeries are performed each year in the United States, not all individuals with knee OA elect to undergo the procedure. No clear consensus exists on criteria to determine who should undergo TKA. The purpose of this study was to determine which clinical factors will predict the decision to undergo TKA in individuals with end-stage knee OA. Knowledge of these factors will aid in clinical decision making for the timing of TKA. Functional data from one hundred twenty persons with end-stage knee OA were obtained through a database. All of the individuals complained of knee pain during daily activities and had radiographic evidence of OA. Functional and clinical tests, collectively referred to as the Delaware Osteoarthritis Profile, were completed by a physical therapist. This profile consisted of measuring height, weight, quadriceps strength and active knee range of motion, while functional mobility was assessed using the Timed Up and Go (TUG) test and the Stair Climbing Task (SCT). Self-perceived functional ability was measured using the activities of daily living subscale of the Knee Outcome Survey (KOS-ADLS). A logistic regression model was used to identify variables predictive of TKA use. Forty subjects (33%) underwent TKA within two years of evaluation. These subjects were significantly older and had significantly slower TUG and SCT times (p < 0.05). Persons that underwent TKA were also significantly weaker, had lower self-reported function and had less knee extension than persons who did not undergo TKA. No differences between groups were seen for BMI, gender, knee flexion ROM and unilateral versus bilateral joint disease. Using backward regression, age, knee extension ROM and KOS-ADLS together significantly predicted whether or not a person would undergo TKA (p