Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Rheumatic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-city, Tokyo, 183-8524, Japan.
Clin Rheumatol. 2023 Sep;42(9):2341-2352. doi: 10.1007/s10067-023-06620-w. Epub 2023 May 24.
This study aimed to investigate the trend of joint destruction patterns on knee radiographs of patients with rheumatoid arthritis (RA) undergoing total knee arthroplasty (TKA) over the past 16 years.
Medial joint space, lateral joint space, medial spur area, lateral spur area (L-spur), and femoro-tibial angle were obtained from 831 preoperative knee radiographs of patients with RA who underwent TKA between 2006 and 2021 using software capable of automatic measurements. Non-hierarchical clustering was performed based on these five parameters. Trends in the five individual radiographic parameters and the ratio of each cluster were investigated during the target period. Moreover, clinical data from 244 cases were compared among clusters to identify factors associated with this trend.
All parameters, except for L-spur, showed significant increasing trends from 2006 to 2021. The radiographs were clustered into groups according to the characteristic pattern of radiographic findings: cluster 1 (conventional RA type), with bicompartmental joint space narrowing (JSN), less spur formation, and valgus alignment; cluster 2 (osteoarthritis type), with medial JSN, medial osteophytes, and varus alignment; and cluster 3 (less destructive type), with mild bicompartmental JSN, less spur formation, and valgus alignment. The ratio of cluster 1 showed a significantly decreasing trend contrary to the significantly increasing trend in clusters 2 and 3. The DAS28-CRP of cluster 3 was higher than those of clusters 1 and 2.
Radiographs of TKA recipients with RA are increasingly presenting osteoarthritic features in recent decades. Key Points • Using automated measurement software, morphological parameters were measured from radiographs of 831 patients with rheumatoid arthritis who had undergone TKA in the past 16 years. • Cluster analysis based on the radiographic parameters revealed that the radiographs of patients with end-stage knee arthritis requiring total knee arthroplasty were classified into three groups. • In patients with rheumatoid arthritis who have undergone total knee arthroplasty in the past 16 years, the proportion of clusters with features of osteoarthritis and difficult-to-treat rheumatoid arthritis has increased, while the proportion of conventional rheumatoid arthritis has decreased.
本研究旨在探讨过去 16 年中接受全膝关节置换术（TKA）的类风湿关节炎（RA）患者膝关节 X 线片关节破坏模式的趋势。
使用能够自动测量的软件，从 2006 年至 2021 年期间接受 TKA 的 831 例 RA 患者的 831 例术前膝关节 X 线片中获得内侧关节间隙、外侧关节间隙、内侧骨赘区、外侧骨赘区（L 骨赘）和股胫角。基于这五个参数进行非层次聚类。在目标期间调查五个单独的放射学参数和每个聚类的比例的趋势。此外，比较 244 例病例的聚类之间的临床数据，以确定与该趋势相关的因素。
除 L 骨赘外，所有参数均显示从 2006 年到 2021 年呈显著增加趋势。根据放射学发现的特征模式将 X 线片聚类为组：组 1（常规 RA 型），具有双间室关节间隙变窄（JSN）、较少的骨赘形成和外翻排列；组 2（骨关节炎型），具有内侧 JSN、内侧骨赘和内翻排列；和组 3（破坏性较小的类型），具有轻度双间室 JSN、较少的骨赘形成和外翻排列。与组 2 和组 3 的显著增加趋势相反，组 1 的比例呈显著下降趋势。组 3 的 DAS28-CRP 高于组 1 和组 2。
在过去的几十年中，接受 RA 全膝关节置换术的患者的 X 线片越来越多地呈现出骨关节炎特征。关键点 • 使用自动测量软件，从过去 16 年中接受 TKA 的 831 例类风湿关节炎患者的 X 线片中测量形态参数。 • 基于放射学参数的聚类分析表明，需要全膝关节置换术的终末期膝关节关节炎患者的 X 线片可分为三组。 • 在过去 16 年接受全膝关节置换术的类风湿关节炎患者中，具有骨关节炎和难以治疗的类风湿关节炎特征的聚类比例增加，而常规类风湿关节炎的比例下降。
