Page 52 - The value of total hip and knee arthroplasties for patients

Chapter 3
A main strength of our study was the inclusion of a wide range of validated PROMs, covering all items of diseasespecific outcome measures in functioning, pain, and healthrelated quality of life. Using all these outcome measures, both measures of pain and daily activities, we observed differences between groups according to radiographic severity. Another strength was that all radiographs were read by a single observer with extensive experience, who was blinded regarding patient data. In addition,this was a prospective study with a relatively large cohort with only 20% loss to follow-up in theTHA group and only 23% loss to follow-up in theTKA group. Our study also had a number of limitations. It only included KL grading applied to the anteroposterior and posteranterior radiographs from the preoperative hip and knee.
In the study by Dowsey et al.4, not only KL grading but also the severity of joint space narrowing (JSN; 0–3) and osteophyte formation (0–3) using the Osteoarthritis Research Society International (OARSI) atlas, and the degree of bone attrition, were taken into account. In that study, radiographs showing advanced OA (KL 3–4) were further subdivided by including data from the individual score of JSN and bone attrition.
In addition, the patients included in the present study were a selection of all patients who underwent THA or TKA and it was carried out in 1 center in 1 country. However, the preoperative characteristics of the patients and their change scores over time are well in line with those observed in other large cohorts.13, 16, 17
In conclusion, this study shows that in patients who underwent THA, but not TKA, more severe radiographic OA preoperatively was associated with a better outcome regarding pain and function.
This study was supported by the Dutch Arthritis Association (grant number LLP13).
50