Identification of early prognostic factors for knee and hip arthroplasty; a long-term follow-up of the CHECK cohort.

BACKGROUND: Patients with the clinical symptoms of knee or hip osteoarthritis without solid X-ray features present a therapeutic dilemma. The question arises whether the decision for a surgical treatment should be based on the clinical presentation or the X-ray. OBJECTIVE: To determine prognostic patient factors for knee and hip arthroplasty when the X-ray does only show Kellgren and Lawrence grade 0-2 osteoarthritis. STUDY DESIGN: Nationwide prospective cohort study. METHODS: Participants of the Cohort Hip and Cohort Knee (CHECK) with KL 0-2 osteoarthritis on the X-ray were contacted to determine whether any knee or hip arthroplasty had taken place. A Cox proportional hazards regression analysis was performed to find baseline patient factors predicting the decision for arthroplasty. RESULTS: Regarding the knee, sex HR 0.207 P = 0.030, BMI HR 1.081 P = 0.018 and WOMAC total sum score HR 1.022 P = 0.017 were statistically significant predictors of the outcome arthroplasty. Age was not a significant predictor (P = 0.079). Concerning the hip, sex HR 2.103 P = 0.012, age HR 1.062 P = 0.022 and WOMAC total sum score HR 1.019 P = 0.029 were found to be statistically significant predictors for arthroplasty. BMI (P = 0.576), contralateral pain (P = 0.877) and health perception (P = 0.405) did not predict the end point hip arthroplasty. CONCLUSION: Predictors for knee arthroplasty were being female, having a higher BMI and a higher WOMAC total sum score. Predictors for hip arthroplasty were being male, having a higher age and a higher WOMAC total sum score. The incidence of arthroplasty was 5.1% (10.2 years) for the knee and 10.2% (9.7 years) for the hip.

Long-term Effect of Injection Treatment for Osteoarthritis in the Knee by Orthokin Autologous Conditioned Serum.

Background Orthokin is an intra-articular autologous conditioned serum (ACS). Its use might have a beneficial biological effect on pain and function of osteoarthritis in the knee. However, earlier studies lack any consensus on its clinical application and disease modifying effect. Objective The aim of this study was to investigate the long-term effect of Orthokin injection treatment on prevention of surgical treatment for end-stage knee osteoarthritis. Study Design Prospective cohort study. Methods Patients of the previously published Orthokin cohort were contacted to determine whether any intra-articular surgical intervention or osteotomy of the study knee had taken place during the past decade. A log-rank test was performed to evaluate the differences in the survival distribution for the 2 types of intervention: Orthokin versus placebo. Results The survival distributions for the 2 interventions were not statistically significantly different, χ2(1) = 2.069, P = 0.150. After 7.5 ± 3.9 years, 46.3% of the placebo and 40.3% of the Orthokin group had been treated surgically. Conclusion The use of Orthokin in knee osteoarthritis patients did not result in a delay regarding surgical treatment. Clinical Relevance The intra-articular use of Orthokin does not seem to prevent or delay surgical intervention at 10 years after treatment for end-stage knee osteoarthritis.