Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Harris Orthopaedics Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, GRJ-12-1223, Boston, MA, 02214, USA.
Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4015-4028. doi: 10.1007/s00167-021-06768-5. Epub 2022 Feb 3.
The purposes of this systematic review were to (1) identify the commonly used definitions of radiographic KOA progression, (2) summarize the important associative risk factors for disease progression based on findings from the OAI study and (3) summarize findings from radiographic KOA progression prediction modeling studies regarding the characterization of progression and outcomes.
A systematic review was performed by conducting a literature search of definitions, risk factors and predictive models for radiographic KOA progression that utilized data from the OAI database. Radiographic progression was further characterized into "accelerated KOA" and "typical progression," as defined by included studies.
Of 314 studies identified, 41 studies were included in the present review. Twenty-eight (28) studies analyzed risk factors associated with KOA progression, and 13 studies created or validated prediction models or risk calculators for progression. Kellgren-Lawrence (KL) grade based on radiographs was most commonly used to characterize KOA progression (50%), followed by joint space width (JSW) narrowing (32%) generally over 48 months. Risk factors with the highest odds ratios (OR) for progression included periarticular bone mineral density (OR 10.40), any knee injury within 1 year (OR 9.22) and baseline bone mineral lesions (OR 7.92). Nine prediction modeling studies utilized both clinical and structural risk factors to inform their models, and combined models outperformed purely clinical or structural models.
The cumulative evidence suggests that combinations of structural and clinical risk factors may be able to predict radiographic KOA progression, particularly in patients with accelerated progression. Clinically relevant and feasible prediction models and risk calculators may provide valuable decision-making support when caring for patients at risk of KOA progression, although standardization in modeling and variable identification does not yet exist.
本系统评价的目的是：(1) 确定放射学 KOA 进展常用的定义；(2) 根据 OAI 研究结果总结疾病进展的重要关联风险因素；(3) 总结放射学 KOA 进展预测模型研究中关于进展和结局的描述。
通过对 OAI 数据库中数据进行文献检索，对放射学 KOA 进展的定义、风险因素和预测模型进行系统评价。根据纳入研究的定义，将放射学进展进一步描述为“加速性 KOA”和“典型进展”。
在 314 项研究中，有 41 项研究纳入本综述。28 项研究分析了与 KOA 进展相关的风险因素，13 项研究建立或验证了进展的预测模型或风险计算器。基于影像学的 Kellgren-Lawrence (KL) 分级是最常用于描述 KOA 进展的方法（50%），其次是关节间隙狭窄（32%），通常在 48 个月以上。进展风险最高的比值比（OR）因素包括关节周围骨矿物质密度（OR 10.40）、1 年内任何膝关节损伤（OR 9.22）和基线骨矿物质病变（OR 7.92）。有 9 项预测建模研究利用临床和结构风险因素来构建其模型，综合模型优于单纯的临床或结构模型。
累积证据表明，结构和临床风险因素的组合可能能够预测放射学 KOA 进展，特别是在进展加速的患者中。具有临床意义且可行的预测模型和风险计算器可能在照顾 KOA 进展风险患者时提供有价值的决策支持，尽管建模和变量识别尚未标准化。
