Innmann Moritz M, Lunz Andre, Fröhlich Larissa, Bruckner Thomas, Merle Christian, Reiner Tobias, Schiltenwolf Marcus
Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany.
J Clin Med. 2023 Aug 21;12(16):5420. doi: 10.3390/jcm12165420.
Knee range of motion and patient-reported outcome measures (PROMs) are often used as screening tools to assess the severity of knee osteoarthritis and guide the decision to refer patients to an arthroplasty clinic. However, there is little understanding regarding the correlation between these factors. Thus, the purpose of this study was to determine the correlation between patient-reported clinical function measured with the Oxford Knee Score (OKS), pain assessed using the visual analog scale (VAS), knee range of motion (ROM), and characteristic radiographic features in patients with advanced osteoarthritis of the knee. A prospective analysis of a consecutive series of 138 patients with advanced unilateral osteoarthritis (OA) of the knee was performed. The severity of radiographic OA was classified according to the most commonly used Kellgren and Lawrence classification (K&L). Spearman's rank correlation analysis and multiple linear regression analysis were performed. The OKS was used as a dependent variable and was adjusted for pain, ROM, and nine standardized radiographic parameters on multiple views of the tibiofemoral and patellofemoral joint. OKS and pain correlated weakly with the K&L grade (r = -0.289; = 0.001; r = 0.258; = 0.002). K&L grade and the degree of patellofemoral joint space narrowing were identified as independent factors being associated with a poorer OKS (coefficient -4.528, = 0.021; coefficient -2.211, = 0.038). Slightly worse results were identified for OKS and pain in patients with K&L grade 4 osteoarthritis compared to patients with K&L grade 3 osteoarthritis (∆OKS 5.5 points, < 0.001; ∆VAS 1.7 points, = 0.003). There was no significant difference for passive range of motion between patients with K&L grade 3 or 4. When counseling patients with advanced knee osteoarthritis who may be eligible for knee arthroplasty, it is essential to give primary consideration to pain levels and self-reported limitations experienced during daily activities. Relying solely on knee ROM and PROMs is not an effective screening method for guiding the decision to refer patients to an arthroplasty clinic.
膝关节活动范围和患者报告的结局指标（PROMs）常被用作筛查工具，以评估膝关节骨关节炎的严重程度，并指导将患者转诊至关节置换诊所的决策。然而，对于这些因素之间的相关性了解甚少。因此，本研究的目的是确定用牛津膝关节评分（OKS）测量的患者报告的临床功能、使用视觉模拟量表（VAS）评估的疼痛、膝关节活动范围（ROM）以及晚期膝关节骨关节炎患者的特征性影像学特征之间的相关性。对连续138例晚期单侧膝关节骨关节炎（OA）患者进行了前瞻性分析。根据最常用的凯尔格伦和劳伦斯分类法（K&L）对影像学OA的严重程度进行分类。进行了斯皮尔曼等级相关分析和多元线性回归分析。将OKS用作因变量，并针对疼痛、ROM以及胫股关节和髌股关节多个视图上的九个标准化影像学参数进行了调整。OKS和疼痛与K&L分级的相关性较弱（r = -0.289；P = 0.001；r = 0.258；P = 0.002）。K&L分级和髌股关节间隙狭窄程度被确定为与较差的OKS相关的独立因素（系数 -4.528，P = 0.021；系数 -2.211，P = 0.038）。与K&L 3级骨关节炎患者相比，K&L 4级骨关节炎患者的OKS和疼痛结果略差（∆OKS 5.5分，P < 0.001；∆VAS 1.7分，P = 0.003）。K&L 3级或4级患者之间的被动活动范围没有显著差异。在为可能符合膝关节置换条件的晚期膝关节骨关节炎患者提供咨询时，必须首要考虑疼痛程度以及日常活动中自我报告的受限情况。仅依靠膝关节ROM和PROMs并不是指导将患者转诊至关节置换诊所决策的有效筛查方法。
