Journal article
Functional Impairment Is a Risk Factor for Knee Replacement in the Multicenter Osteoarthritis Study
Clinical orthopaedics and related research, Vol.473(8), pp.2505-2513
08/2015
DOI: 10.1007/s11999-015-4211-3
PMCID: PMC4488226
PMID: 25754756
Abstract
Debilitating pain associated with knee osteoarthritis (OA) often leads patients to seek and complete total knee arthroplasty (TKA). To date, few studies have evaluated the relation of functional impairment to the risk of TKA, despite the fact that OA is associated with functional impairment.
The purpose of our study was to (1) evaluate whether function as measured by WOMAC physical function subscale was associated with undergoing TKA; and (2) whether any such association varied by sex.
The National Institutes of Health-funded Multicenter Osteoarthritis Study (MOST) is an observational cohort study of persons aged 50 to 79 years with or at high risk of symptomatic knee OA who were recruited from the community. All eligible subjects with complete data were included in this analysis. Our study population sample consisted of 2946 patients with 5796 knees; 1776 (60%) of patients were women. We performed a repeated-measures analysis using baseline WOMAC physical function score to predict the risk of TKA from baseline to 30 months and WOMAC score at 30 months to predict risk of incident TKA from 30 months to 60 months. We used generalized estimating equations to account for the correlation between two knees within an individual and across the two periods. We calculated relative risk (RR) of TKA over 30 months by WOMAC function using a score of 0 to 5 as the referent in multiple binomial regressions with log link.
Those with the greatest functional impairment (WOMAC scores 40-68; 62 TKAs in 462 knee periods) had 15.5 times (95% confidence interval [CI], 7.6-31.8; p<0.001) the risk of undergoing TKA over 30 months compared with the referent group (12 TKAs in 3604 knee periods), adjusting for basic covariates, and 5.9 times (95% CI, 2.8-12.5; p<0.001) the risk after further adjusting for knee pain severity. At every level of functional limitation, the RR for TKA for women was higher than for men, but interaction with sex did not reach significance after adjustment for covariates including ipsilateral pain (p=0.138).
Baseline physical function appears to be an important element in patients considering TKA. Future studies should examine whether interventions to improve function can reduce the need for TKA.
Level III, observational cohort study.
Details
- Title: Subtitle
- Functional Impairment Is a Risk Factor for Knee Replacement in the Multicenter Osteoarthritis Study
- Creators
- Barton L Wise - Center for Musculoskeletal Health, University of California, Davis School of Medicine, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA, barton.wise@ucdmc.ucdavis.eduJingbo NiuDavid T FelsonJean HietpasAlesia SadoskyJames TornerCora E LewisMichael Nevitt
- Resource Type
- Journal article
- Publication Details
- Clinical orthopaedics and related research, Vol.473(8), pp.2505-2513
- DOI
- 10.1007/s11999-015-4211-3
- PMID
- 25754756
- PMCID
- PMC4488226
- NLM abbreviation
- Clin Orthop Relat Res
- ISSN
- 0009-921X
- eISSN
- 1528-1132
- Publisher
- United States
- Grant note
- U01 AG018947 / NIA NIH HHS U01 AG018832 / NIA NIH HHS K12HD051958 / NICHD NIH HHS UO1 AG18832 / NIA NIH HHS U01 AG019069 / NIA NIH HHS K12 HD051958 / NICHD NIH HHS UO1 AG18947 / NIA NIH HHS R01 HD043500 / NICHD NIH HHS P50 AR063043 / NIAMS NIH HHS K24 AR048841 / NIAMS NIH HHS UO1 AG18820 / NIA NIH HHS P50 AR060752 / NIAMS NIH HHS R01 HD43500 / NICHD NIH HHS UO1 AG19069 / NIA NIH HHS U01 AG018820 / NIA NIH HHS
- Language
- English
- Date published
- 08/2015
- Academic Unit
- Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9983995149602771
Metrics
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