The Course of Pain and Function in Osteoarthritis and Timing of Arthroplasty: the CHECK Cohort

Overview

Journal Acta Orthop

Specialty Orthopedics

Date 2018 Oct 24

PMID 30350757

Citations 5

Authors

Maaike G J Gademan

Hein Putter

Wilbert B van den Hout

Margreet Kloppenburg

Stefanie N Hofstede

Suzanne C Cannegieter

Rob G H H Nelissen

Perla J Marang-van de Mheen

Affiliations

Soon will be listed here.

Abstract

Background and purpose - It is unknown whether different trajectories of pain or function are associated with timing of total hip or knee arthroplasty (THA/TKA) in osteoarthritis (OA) patients. We investigated this association in early symptomatic OA patients. Patients and methods - Data from the prospective Dutch CHECK cohort (patients with early hip/knee OA complaints) covering 9 years of follow-up were used. Pain and function were measured annually using the WOMAC questionnaires. Changes in pain/function over time were estimated using a linear mixed model adjusted for baseline age, sex, BMI, maximal Kellgren and Lawrence score, number of painful joints, and comorbidities. The same covariates were included in a Cox regression model, with time to first arthroplasty as event. Both were combined in a joint model to assess the association between changes in pain/function and time to arthroplasty. Results - Of the 868 eligible patients, 84 received a TKA/THA during follow-up. Patients receiving arthroplasty were somewhat older, had a higher Kellgren and Lawrence score and worse WOMAC scores at baseline. Irrespective of receiving arthroplasty, about two-thirds of the patients showed at least 1 period of deterioration of pain/function (≥ 10 points WOMAC subscale). In approximately two fifths this deterioration was followed by another deterioration in the following year. Worse pain and function levels increased the hazard of receiving THA/TKA (1.08 [95% CI 1.06-1.10] for pain and 1.07 [CI 1.05-1.08] for function). Changes in pain or function over time were not associated with timing of THA/TKA Interpretation - Worse pain and function levels rather than long-term changes are associated with timing of THA/TKA.

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