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Osteoarthritis Cartilage. 2014 Oct;22(10):1542-9. doi: 10.1016/j.joca.2014.04.016. Epub 2014 Apr 30.

Trajectory of cartilage loss within 4 years of knee replacement--a nested case-control study from the osteoarthritis initiative.

Author information

1
Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany. Electronic address: felix.eckstein@pmu.ac.at.
2
Department of Epidemiology, Grad. Sch. of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
3
Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
4
Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
5
Department of Radiology, Boston University School of Medicine & Boston Imaging Core Lab (BICL), LLC, Boston, MA, USA.
6
Department of Radiology, Boston University School of Medicine & Boston Imaging Core Lab (BICL), LLC, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
7
OAI Coordinating Ctr., UCSF, San Francisco, CA, USA.
8
Novartis Pharma AG, Basel, Switzerland.
9
Merck KGaA, Darmstadt, Germany.
10
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
11
Royal North Shore Hospital & Northern Clinical School, University Sydney, Sydney, Australia.
12
Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Division of Rheumatology and University of Arizona Arthritis Center, University of Arizona College of Medicine, Tucson, AZ, USA.

Abstract

OBJECTIVE:

Knee replacement (KR) represents a clinically important endpoint of knee osteoarthritis (KOA). Here we examine the 4-year trajectory of femoro-tibial cartilage thickness loss prior to KR vs non-replaced controls.

METHODS:

A nested case-control study was performed in Osteoarthritis Initiative (OAI) participants: Cases with KR between 12 and 60 month (M) follow-up were each matched with one control (without KR through 60M) by age, sex, and baseline radiographic stage. Femoro-tibial cartilage thickness was measured quantitatively using magnetic resonance imaging (MRI) at the annual visit prior to KR occurrence (T0), and at 1-4 years prior to T0 (T-1 to T-4). Cartilage loss between cases and controls was compared using paired t-tests and conditional logistic regression.

RESULTS:

One hundred and eighty-nine knees of 164 OAI participants [55% women; age 64 ± 8.7; body mass index (BMI) 29 ± 4.5] had KR and longitudinal cartilage data. Comparison of annualized slopes of change across all time points revealed greater loss in the central medial tibia (primary outcome) in KRs than in controls [94 ± 137 vs 55 ± 104 μm; P = 0.0017 (paired t); odds ratio (OR) 1.36 (95% confidence interval (CI): 1.08-1.70)]. The discrimination was stronger for T-2 → T0 [OR 1.61 (1.33-1.95), n = 127] than for T-1 → T0, and was not statistically significant for intervals prior to T-2 [i.e., T-4 → T-2, OR 0.97 (0.67-1.41), n = 60]. Results were similar for total medial femoro-tibial cartilage loss (secondary outcome), and when adjusting for pain and BMI.

CONCLUSIONS:

In knees with subsequent replacement, cartilage loss accelerates in the 2 years, and particularly in the year prior to surgery, compared with controls. Whether slowing this cartilage loss can delay KR remains to be determined.

KEYWORDS:

Cartilage loss; Knee arthroplasty; Knee osteoarthritis; Knee replacement; Magnetic resonance imaging

PMID:
24792212
PMCID:
PMC4184997
DOI:
10.1016/j.joca.2014.04.016
[Indexed for MEDLINE]
Free PMC Article
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