The course of pain and function in osteoarthritis and timing of arthroplasty: the CHECK cohort.
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ABSTRACT: 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.
SUBMITTER: Gademan MGJ
PROVIDER: S-EPMC6202767 | biostudies-literature | 2018 Oct
REPOSITORIES: biostudies-literature
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