Two-Year Outcomes are Equal in Kellgren-Lawrence Osteoarthritis Grades 1-4 after Total Knee Arthroplasty with Medial-Pivot Implants and Kinematic Alignment.

Abstract

Introduction While risks exist with total knee arthroplasty (TKA) and survivorship is not indefinite, delaying surgery may lead to further deterioration of the knee joint, functional outcomes, and health status. Most studies report that patients with high-grade osteoarthritis (OA) scores have higher satisfaction and functional scores, cautioning against TKA in those with lower OA grades. This study correlates Kellgren-Lawrence (KL) OA scores with outcomes following kinematically-aligned TKA. Methods Preoperative anteroposterior weight-bearing radiographs of 168 patients enrolled in a prospective trial were scored for KL grade. Patients were segregated into two groups: the low-grade OA group had KL scores of 1 or 2, the high-grade OA group had a KL score of 3 or 4. Outcomes as measured with Forgotten Joint Score (FJS), Knee Society Score (KSS), and Range of motion were compared up to 2-years. Results There were 29 subjects with low-grade KL scores and 127 with high-grade KL scores. There were no differences in BMI, age, or gender distribution. The only statistically significant difference was in the preoperative KSS Pain/Motion score, 60.6 in the low-grade OA group vs. 46.4 in the high-grade group (P<0.008). There were no significant differences between the groups in FJS at one or two-year follow-up. There were no differences in KSS Functional or Composite Scores, or in range of motion (ROM) at pre-op, 1-year or 2-years, and in KSS Pain/Motion at 1 or 2-years. Conclusion There were no significant differences in FJS, KSS, and ROM in patients with low- vs. high-grade OA up to 2-year follow-up. Patients with lower grade OA demonstrated substantial improvements in their FJS, KSS scores, and ROM indistinguishable from the higher-grade OA cohort up to 2-years, suggesting no shorter-term downside to earlier intervention with kinematically-aligned medial-pivot (MP) TKA.