Cross-sectional study of pain and disability at knee replacement surgery for osteoarthritis in 299 patients

doi:10.1016/j.jbspin.2007.01.038

Joint Bone Spine

Volume 74, Issue 6, December 2007, Pages 612-616

https://doi.org/10.1016/j.jbspin.2007.01.038 Get rights and content

Abstract

Objective

To evaluate pain and disability at the time of knee replacement surgery for osteoarthritis.

Methods

In this multicenter cross-sectional study, 299 patients at 12 orthopedic surgery centers in Lyon, France were evaluated on the day before knee replacement surgery. Pain severity was assessed on a visual analog scale (VAS) and function using the Lequesne index and the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC).

Results

There were 207 women and 92 men with a mean age of 73 years. Mean (±SD) VAS pain score upon walking was 55.8 ± 24 mm. Compared to patients with very severe disability (Lequesne index > 12), those with mild-to-severe disability (Lequesne index ≤ 12) were more likely to be older than 70 years (odds ratio [OR], 2.85; 95% confidence interval [95%CI], 1.25–5) and male (OR, 2.5; 95%CI, 1.3–5); they were less likely to have a body mass index > 27 kg/m² (OR, 2.2; 95%CI, 1.3–3.3) and to engage in sporting activities (OR, 3.3; 95%CI, 1.4–10).

Conclusion

Patients about to undergo knee replacement surgery had high levels of pain and disability, with little variation across centers. Nevertheless, the severity of pain and disability may depend in part on age, gender, body mass index, and sporting activities, which probably influence the decision to perform knee replacement surgery.

Introduction

Knee osteoarthritis is an extremely common condition. The standardized incidence rate is estimated at 24/10,000 person-years overall and increases gradually with age, reaching 10/1000 person-years in women aged 70–79 years [1]. Prevalence estimates after 70 years of age range from 20% to 50% according to the criteria used to define knee osteoarthritis [2], [3]. Total knee replacement (TKR) is a satisfactory treatment for advanced incapacitating knee osteoarthritis, with success rates of 50–100% in terms of pain and function [4], [5]. However, most studies of TKR outcomes exhibit methodological weaknesses such as failure to use validated scales to assess pain, function, and quality of life [7], [8], [9]; or failure to obtain preoperative data for comparison. The complication rate is unclear, about 18% on average [10].

There is no consensus about the indications for TKR or the optimal approach to outcome evaluation. Factors identified by research studies or experts as influencing the decision to perform TKA include the algofunctional index for pain and disability [7], [11], [12], [13], body mass index, age, and the psychological and social setting [14], [15]. In addition, the characteristics of the healthcare system [7] or physician [11], [16] may affect surgical decisions. To date, there are no international recommendations on the indications for TKA.

Despite the absence of universally accepted indications, TKA is being increasingly performed. In the USA, a 3-fold increase between 1990 and 2002 was reported [17]. Here, our primary objective was to evaluate pain severity and disability in patients about to undergo TKA in France. To this end, we used two validated measurement tools, the Lequesne index and the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Our secondary objective was to identify factors associated with TKA in patients with moderate pain and disability (Lequesne index ≤ 12).

Section snippets

Study design

We conducted a multicenter, prospective, cross-sectional, descriptive study in patients who met three inclusion criteria: knee osteoarthritis meeting American College of Rheumatology (ACR) criteria [18], scheduled TKA, and availability of at least one anteroposterior or schuss-view radiograph of the affected knee. Exclusion criteria were osteoarthritis of the target knee secondary to inflammatory joint disease, Paget's disease of bone, pyogenic or tuberculous arthritis, osteonecrosis of the

Results

We included 301 patients, of whom two were excluded, because of avascular osteonecrosis and poor-quality radiographs, respectively. Of the 12 centers that recruited patients to the study, six included more than 20 patients each and three more than 35 patients each; two of these three centers were public hospitals and one was a private center with two orthopedic surgeons. Median age of the 299 study patients was 74 years (range, 48–93 years). Of the 231 (77%) patients who were overweight (BMI > 25

Discussion

Our data on the epidemiology of TKA and on the severity of pain and functional impairment in patients selected for TKA are consistent with earlier reports. The original feature of our study is that patient characteristics were studied according to the Lequesne index just before surgery.

A minority (68/299, 23%) of our patients had a Lequesne index ≤ 12. Factors significantly associated with having a Lequesne index ≤ 12 at surgery were male gender and age older than 70 years. Neither variable was

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Original articleCross-sectional study of pain and disability at knee replacement surgery for osteoarthritis in 299 patients

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Study design

Results

Discussion

Arch Gerontol Geriatr

Joint Bone Spine

Osteoarthr Cartil

Joint Bone Spine

Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization

Arthritis Rheum

Epidemiology of hip and knee osteoarthritis

Epidemiol Rev

The prevalence of knee osteoarthritis in the elderly. The Framingham osteoarthritis study

Arthritis Rheum

Patient outcomes following tricompartimental total knee replacement. A meta-analysis

JAMA

New Zealand priority criteria project. Part 1: overview

BMJ

Patient outcomes after knee replacement

Clin Orthop

Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilization

Rheumatology

Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery

Arthritis Rheum

Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee

Arthritis Rheum

Epidemiology of total knee replacement in the United States medicare population

J Bone Joint Surg Am

Variation in orthopaedic surgeons' perceptions of the outcomes and the indications for knee replacement

CMAJ

Predicting the outcome of total knee arthroplasty

J Bone Joint Surg Am

Original article
Cross-sectional study of pain and disability at knee replacement surgery for osteoarthritis in 299 patients