The course of pain and function in osteoarthritis and timing of arthroplasty: the CHECK cohort

Oct 24, 2018Acta orthopaedica

Changes in pain and movement in osteoarthritis and when joint replacement happens: the CHECK study

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Abstract

Of the 868 eligible patients, 84 received a total hip or knee arthroplasty during follow-up.

Patients who underwent arthroplasty were generally older and had higher baseline severity of osteoarthritis, as indicated by the Kellgren and Lawrence score.
About two-thirds of all patients experienced at least one significant deterioration in pain or function during the study period.
In approximately two-fifths of these cases, deterioration in pain or function was followed by another decline the subsequent year.
Higher levels of pain and worse function were associated with an increased likelihood of undergoing total hip or knee arthroplasty.
Changes in pain or function over time did not correlate with the timing of the arthroplasty.

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Background and purpose - It is unknown whether different trajectories of pain or function are associated with timing of total hip or knee arthroplasty (THA/TKA) in osteoarthritis (OA) patients. We investigated this association in early symptomatic OA patients. Patients and methods - Data from the prospective Dutch CHECK cohort (patients with early hip/knee OA complaints) covering 9 years of follow-up were used. Pain and function were measured annually using the WOMAC questionnaires. Changes in pain/function over time were estimated using a linear mixed model adjusted for baseline age, sex, BMI, maximal Kellgren and Lawrence score, number of painful joints, and comorbidities. The same covariates were included in a Cox regression model, with time to first arthroplasty as event. Both were combined in a joint model to assess the association between changes in pain/function and time to arthroplasty. Results - Of the 868 eligible patients, 84 received a TKA/THA during follow-up. Patients receiving arthroplasty were somewhat older, had a higher Kellgren and Lawrence score and worse WOMAC scores at baseline. Irrespective of receiving arthroplasty, about two-thirds of the patients showed at least 1 period of deterioration of pain/function (≥ 10 points WOMAC subscale). In approximately two fifths this deterioration was followed by another deterioration in the following year. Worse pain and function levels increased the hazard of receiving THA/TKA (1.08 [95% CI 1.06-1.10] for pain and 1.07 [CI 1.05-1.08] for function). Changes in pain or function over time were not associated with timing of THA/TKA Interpretation - Worse pain and function levels rather than long-term changes are associated with timing of THA/TKA.

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The course of pain and function in osteoarthritis and timing of arthroplasty: the CHECK cohort

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