The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease
The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease
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DOI：
10.1002/art.10530
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发表时间：
2002-10-01
影响因子：
--
通讯作者：
Sharma, L
中科院分区：
文献类型：
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作者：
Cerejo, R;Dunlop, DD;Sharma, L
Objective.内翻和外翻对线不良分别增加内侧和外侧骨关节炎（OA）进展的风险。诸如对准的机械因素的影响不仅取决于该因素本身，还取决于接头的状态。轻度OA损伤较小的关节可能比中度OA损伤较大的关节更不易受到对线不良的影响。我们的目标是根据疾病的基线阶段来探讨对线对膝关节OA后续进展的影响。从社区招募的230例膝关节OA患者（定义为骨赘和症状的存在）在基线和18个月随访时对双下肢进行了评估。在全肢X线片上测量股骨和胫骨机械轴相交的角度。间隔特异性进展定义为在X线透视确认位置后拍摄的半屈曲膝关节X线片上关节间隙狭窄严重程度等级在基线和18个月之间增加。根据OA的基线分期将膝关节分组为Kellgren/Lawrence（K/L）0-1、2或3级。采用广义估计方程进行Logistic回归估计进展优势比。在这项纵向研究中，230名受试者（173名女性和57名男性，平均年龄64.0岁，平均体重指数30.4 kg/m2）共377个K/L 0-3级膝关节。在轻度OA（K/L 2级）膝关节中，基线时内翻对线的内侧间室18个月进展几率显著增加4倍。在K/L 2级膝关节中，vaigus对线使外侧进展的几率增加2倍（接近显著性）。在中度OA膝关节（K/L 3级）中，内翻或外翻对线增加了进展风险（10倍）。虽然在膝关节骨性关节炎的几乎所有检查阶段都提示了对线不良的一些影响，但在基线时中度（K/L 3级）骨性关节炎的膝关节中，内翻或内翻对线不良对随后18个月内骨性关节炎进展几率的影响更大，这可能是由于关节脆弱性更大，对线不良程度略重。
Objective. Varus and valgus malalignment increase the risk of medial and lateral osteoarthritis (OA) progression, respectively. The impact of a mechanical factor such as alignment depends not only on the factor itself, but also on the state of the joint. The less-damaged joint of mild OA may be less vulnerable to malalignment effects than the more-damaged joint of moderate OA. Our goal was to explore the impact of alignment on subsequent progression of knee OA according to the baseline stage of disease.Methods. Two hundred thirty patients with knee OA (defined by the presence of osteophytes and symptoms) recruited from the community underwent assessment of both lower limbs at baseline and at an 18-month followup. Alignment was measured on a full-limb radiograph as the angle made by the intersection of the femoral and tibial mechanical axes. Compartment-specific progression was defined as an increase between baseline and 18 months in the grade of severity of joint space narrowing on radiographs of semiflexed knees taken after fluoroscopic confirmation of position. Knees were grouped according to their baseline stage of OA as Kellgren/Lawrence (K/L) grades 0-1, 2, or 3. Progression odds ratios were estimated from logistic regression using generalized estimating equations.Results. There were 377 K/L grade 0-3 knees in 230 subjects (173 women and 57 men, mean age 64.0 years, mean body mass index 30.4 kg/m(2)) in this longitudinal study. In knees with mild OA (K/L grade 2), the odds of 18-month progression in the medial compartment were significantly increased 4-fold by varus alignment at baseline. In K/L grade 2 knees, the odds of lateral progression were increased 2-fold by vaigus alignment (approaching significance). In knees with moderate OA (K/L grade 3), the risk of progression was comparably increased by varus or valgus alignment (10-fold).Conclusion. While some effect of malalignment was suggested at almost all stages of knee OA examined, the impact of varus or vaigus malalignment on the odds of OA progression over the ensuing 18 months was greater in knees with moderate (K/L grade 3) OA at baseline, possibly due to greater joint vulnerability with some contribution from slightly more severe malalignment.