Driban Jeffrey B, Stout Alina C, Duryea Jeffrey, Lo Grace H, Harvey William F, Price Lori Lyn, Ward Robert J, Eaton Charles B, Barbe Mary F, Lu Bing, McAlindon Timothy E
Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA.
Department of Radiology, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
BMC Musculoskelet Disord. 2016 Jul 19;17:299. doi: 10.1186/s12891-016-1158-9.
Accelerated knee osteoarthritis may be a unique subset of knee osteoarthritis, which is associated with greater knee pain and disability. Identifying risk factors for accelerated knee osteoarthritis is vital to recognizing people who will develop accelerated knee osteoarthritis and initiating early interventions. The geometry of an articular surface (e.g., coronal tibial slope), which is a determinant of altered joint biomechanics, may be an important risk factor for incident accelerated knee osteoarthritis. We aimed to determine if baseline coronal tibial slope is associated with incident accelerated knee osteoarthritis or common knee osteoarthritis.
We conducted a case-control study using data and images from baseline and the first 4 years of follow-up in the Osteoarthritis Initiative. We included three groups: 1) individuals with incident accelerated knee osteoarthritis, 2) individuals with common knee osteoarthritis progression, and 3) a control group with no knee osteoarthritis at any time. We did 1:1:1 matching for the 3 groups based on sex. Weight-bearing, fixed flexion posterior-anterior knee radiographs were obtained at each visit. One reader manually measured baseline coronal tibial slope on the radiographs. Baseline femorotibial angle was measured on the radiographs using a semi-automated program. To assess the relationship between slope (predictor) and incident accelerated knee osteoarthritis or common knee osteoarthritis (outcomes) compared with no knee osteoarthritis (reference outcome), we performed multinomial logistic regression analyses adjusted for sex.
The mean baseline slope for incident accelerated knee osteoarthritis, common knee osteoarthritis, and no knee osteoarthritis were 3.1(2.0), 2.7(2.1), and 2.6(1.9); respectively. A greater slope was associated with an increased risk of incident accelerated knee osteoarthritis (OR = 1.15 per degree, 95 % CI = 1.01 to 1.32) but not common knee osteoarthritis (OR = 1.04, 95 % CI = 0.91 to 1.19). These findings were similar when adjusted for recent injury. Among knees with varus malalignment a greater slope increases the odds of incident accelerated knee osteoarthritis; there is no significant relationship between slope and incident accelerated knee osteoarthritis among knees with normal alignment.
Coronal tibial slope, particularly among knees with malalignment, may be an important risk factor for incident accelerated knee osteoarthritis.
快速进展性膝骨关节炎可能是膝骨关节炎的一个独特亚型，与更严重的膝关节疼痛和功能障碍相关。识别快速进展性膝骨关节炎的危险因素对于识别可能发展为快速进展性膝骨关节炎的人群并尽早进行干预至关重要。关节表面的几何形状（如胫骨冠状面坡度）是关节生物力学改变的一个决定因素，可能是新发快速进展性膝骨关节炎的一个重要危险因素。我们旨在确定基线胫骨冠状面坡度是否与新发快速进展性膝骨关节炎或普通膝骨关节炎相关。
我们利用骨关节炎倡议研究中基线及随访前4年的数据和图像进行了一项病例对照研究。我们纳入了三组：1）新发快速进展性膝骨关节炎患者；2）普通膝骨关节炎进展患者；3）任何时候均无膝骨关节炎的对照组。我们根据性别对这三组进行1:1:1匹配。每次就诊时均获取负重、固定屈曲位的膝关节前后位X线片。一名阅片者手动测量X线片上的基线胫骨冠状面坡度。使用半自动程序在X线片上测量基线股骨胫骨角。为了评估坡度（预测因素）与新发快速进展性膝骨关节炎或普通膝骨关节炎（结局）与无膝骨关节炎（参照结局）之间的关系，我们进行了经性别调整的多项逻辑回归分析。
新发快速进展性膝骨关节炎、普通膝骨关节炎和无膝骨关节炎的平均基线坡度分别为3.1(2.0)、2.7(2.1)和2.6(1.9)。更大的坡度与新发快速进展性膝骨关节炎风险增加相关（每度OR = 1.15，95%CI = 1.01至1.32），但与普通膝骨关节炎无关（OR = 1.04，95%CI = 0.91至1.19）。调整近期损伤因素后，这些结果相似。在膝内翻畸形的膝关节中，更大的坡度增加了新发快速进展性膝骨关节炎的几率；在关节排列正常的膝关节中，坡度与新发快速进展性膝骨关节炎之间无显著关系。
胫骨冠状面坡度，尤其是在关节排列不齐的膝关节中，可能是新发快速进展性膝骨关节炎的一个重要危险因素。
