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Need for TKR predicted by baseline knee pain, function scores in patients taking chondroitin sulfate
In a post hoc analysis of a knee OA clinical trial, researchers found certain factors such as knee pain, function, cartilage volume loss and bone marrow lesions predicted the need for total knee replacement in patients taking chondroitin sulfate compared to placebo.
“Symptoms such as baseline knee pain and function, presence of [bone marrow lesions] BML, and knee cartilage volume loss over time may predict long-term occurrence of [total knee replacement] TKR,” Jean-Pierre Raynauld, MD, FRCPC, and colleagues wrote in the study. “These data demonstrate that it is possible to predict a ‘hard’ outcome such as TKR from knee OA clinical trial and MRI data.”
Of 57 patients in an intention-to-treat group in the original study, 13 patients had undergone TKR and one patient underwent TKR in their contralateral knee. Researchers used the knee MRIs from the original study to analyze cartilage volume and BMLs.
They found that WOMAC baseline pain, function and C-reactive protein levels predicted the need for TKR. Baseline BMLs in the medial compartment and the global knee score were also associated with TKR.
At 1 year, less improvement in patient WOMAC pain and function scores were associated with TKR, and a loss of at least 7% of cartilage volume in the medial compartment carried a 10.3 odds ratio of TKR. However, 1-year changes in C-reactive protein levels and BMLs were not linked to TKR.
Disclosure: Raynaud and Dorais are consultants for ArthroLab. Martell-Pelletier and Pelletier are owners of ArthroLab and consultants for Bioibérica. Haraoui, Choquette, Beaulieu, Bessette and Morin received honoraria from ArthroLab. Abram is an employee of ArthroLab.