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Predictors of Poor Long Term Outcome following Total Knee Replacement for Osteoarthritis

Swaminathan, Vikram

[Thesis]. Manchester, UK: The University of Manchester; 2019.

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Abstract

PURPOSE: Osteoarthritis (OA) is a chronic progressive degenerative disease, associated with significant morbidity and also healthcare utilisation. The disease is multifactorial, age-dependent, and characterised by articular cartilage loss, osteophyte formation and subchondral sclerosis of the bone. can lead to debilitating pain and dependence in affected people. . Management of Knee OA can be considered as non-surgical (or conservative) and surgical. Although Total Knee Replacement (TKR) remains the only curative procedure currently available for OA, a significant proportion of patients experience poor outcomes with chronic pain and functional limitations in both short (<12 months) and long term (>12 months) periods post-operatively. METHODS: This study focused on those who had a TKR during their participation in the Multicentre Osteoarthritis study (MOST), and had baseline data prior to TKR and follow-up data of at least 12 months following TKR. The primary outcome measure in the study was the Patient Acceptable Symptom State (PASS) criterion. PASS is a concept based on patient wellbeing or remission of symptoms, thus an important clinically relevant outcome measure. A PASS criterion was set using a threshold of â‰¥25 or greater on a 0-100 scaled Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain score and applied to subjects included from the MOST study, splitting the group into those who achieved PASS or not post TKR. Preoperative (baseline) variables were identified with subjects in both groups. Using univariate and multivariate analyses, factors which increased the likelihood of a poor long term outcome following TKR (â‰¥1 year) were investigated. RESULTS: The univariate analysis showed Widespread pain in all 5 body regions was associated with increased odds of unsatisfactory outcome â‰¥12 months following surgery compared to the presence of no other pain except the knee related symptoms (odds 5.06, 95% CI 1.85, 13.86, p = <0.001). In addition, all four psychological variables selected in this study were significantly associated with unsatisfactory outcome. However, once in a multivariable model, this is not seen. Only the catastrophizing score remains significantly associated with increased likelihood of poor outcome (odds 2.67, 95% CI 1.13, 6.30, p = 0.02). CONCLUSION: Using a long term outcome measure of PASS based on self-reported outcome measures, several pre-operative (baseline) variables were identified which could increase the likelihood of a poor long-term outcome following TKR for knee OA. The main clinician implication appears to be the need for appropriate assessment of psychological status in patients pre-operatively, in order to help predict the long term success of TKR for patients with knee OA.