Knee alignment does not predict incident osteoarthritis - The Framingham Osteoarthritis Study
Knee alignment does not predict incident osteoarthritis - The Framingham Osteoarthritis Study
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DOI：
10.1002/art.22508
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发表时间：
2007-04-01
影响因子：
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通讯作者：
Zhang, Yuqing
中科院分区：
文献类型：
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作者：
Hunter, David J.;Niu, Jingbo;Zhang, Yuqing
Objective.在基线时无膝骨关节炎（OA）的受试者中，研究膝关节对线不良与OA发生的关系，以确定对线不良是否是疾病发生的风险因素，或仅仅是疾病严重程度增加的标志。我们从骨折性骨关节炎研究的参与者中选择了110例胫股（TF）OA病例膝关节（76例受试者）和356例随机对照膝关节（178例受试者）。例膝关节在基线时（1992-1994年检查）没有OA，但在随访时（2002-2005年检查）发生了OA（Kellgren/Lawrence分级>= 2）（两次检查之间平均间隔8.75年）。对照膝关节在基线时没有OA。使用标准方案和eFilm查看软件读取完全伸展膝关节负重的标准化数字X线片。我们测量了解剖轴、髁突角、胫骨平台角和髁胫骨平台角。观察者间组内相关系数（ICC）范围为0.93至0.96，观察者内ICC范围为0.94至0.97。在一项膝关节特异性分析中，我们使用广义估计方程，校正年龄、性别和体重指数（BMI），检查了每种对线测量与TF OA风险的关系。我们使用相同的方法来评估每种对线测量与内侧TF OA风险之间的关联。病例人群中的受试者年龄较大，BMI高于对照组。对齐值呈正态分布，病例组和对照组之间无差异。在调整年龄、性别和BMI后，与任何对线测量的最低四分位数类别相比，最高四分位数类别的OA事件没有显著增加（解剖轴和髁胫骨平台角趋势的P值分别为0.83和0.80）。内侧间室OA也观察到类似的结果。我们发现，基线膝关节对线与偶发性X线TF OA或内侧TF OA无关。这些结果表明，对线不良不是OA的危险因素，而是疾病严重程度和/或进展的标志。
Objective. To examine the relationship of knee malalignment to the occurrence of knee osteoarthritis (OA) among subjects without radiographic OA at baseline to determine whether malalignment is a risk factor for incident disease or simply a marker of increasing disease severity.Methods. We selected 110 incident tibiofemoral (TF) OA case knees (76 subjects) and 356 random control knees (178 subjects) from among participants in the Framingham Osteoarthritis Study. Case knees did not have OA at baseline (1992-1994 examination) but had developed OA (Kellgren/Lawrence grade >= 2) at followup (2002-2005 examination) (mean of 8.75 years between examinations). Control knees did not have OA at baseline. Standardized digital radiographs of the fully extended knee with weight-bearing were read using a standard protocol and eFilm viewing software. We measured the anatomic axis, the condylar angle, the tibial plateau angle, and the condylar tibial plateau angle. The interobserver intraclass correlation coefficient (ICC) ranged from 0.93 to 0.96 and the intraobserver ICC from 0.94 to 0.97. In a knee-specific analysis, we examined the relationship of each alignment measurement to the risk of TF OA using generalized estimating equations, adjusting for age, sex, and body mass index (BMI). We used the same approach to assess the association between each alignment measurement and the risk of medial TF OA.Results. Subjects in the case population were older and had a higher BMI than the controls. The alignment values were normally distributed and were not different between the cases and the controls. After adjustment for age, sex and BMI, there was no significant increase in incident OA in the highest quartile compared with the lowest quartile category for any of the alignment measures (P for trend for anatomic axis and condylar tibial plateau angle was 0.83 and 0.80, respectively). Similar results were also observed for medial compartment OA.Conclusion. We found that baseline knee alignment is not associated with either incident radiographic TF OA or medial TF OA. These results suggest that malalignment is not a risk factor for OA, but rather is a marker of disease severity and/or its progression.