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Radiographic grade at index surgery may influence TKR risk for contralateral knee
Sayeed SA. J Arthroplasty. Published online: Sept. 30, 2010. doi: 10.1016/j.arth.2010.08.016.
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Results from a 10-year study revealed a significant link between the radiographic grade at the time of index surgery and risk of future total knee replacement for the contralateral knee.
Siraj A. Sayeed, MD, MEng, and colleagues at the Mayo Clinic, Rochester, Minn., identified 646 patients who underwent primary cruciate-retaining total knee replacement between 1984 and 1994. Patient age ranged from 40 to 75 years.
The results showed that the 10-year probability of having a contralateral knee after index knee surgery was 36%. The probability rose to 70% when grade 4 radiographic changes were present. Demographic factors did not influence the risk of future contralateral knee, the authors wrote.
“The radiographic grade of the contralateral knee at the time of index surgery was found to correlate strongly with the future risk of contralateral total knee,” Sayeed and colleagues wrote.
The authors are to be congratulated on a valuable study that provides physicians in practice with practical information for counseling their patients on the need for subsequent knee arthroplasty following a unilateral procedure.
We are all familiar with data suggesting that the natural history of knee osteoarthritis is associated with a poor natural history; however, specific data examining the risk of a contralateral procedure was lacking.
I am commonly asked by patients undergoing total knee arthroplasty, "How does my other knee look?" or "Will I need the other side done?" even when they have no symptoms on that side. I will now be able to advise such patients that approximately one third of patients undergoing total knee arthroplasty will undergo a contralateral procedure within 10 years, and that their risk is increased if their X-rays show grade 4 changes.
— Craig J. Della Valle, MD
Associate Professor of Orthopedic Surgery
Rush University Medical Center
Chicago