The role of knee alignment in disease progression and functional decline in knee osteoarthritis
The role of knee alignment in disease progression and functional decline in knee osteoarthritis
复制标题
DOI：
10.1001/jama.286.2.188
复制
发表时间：
2001-07-11
影响因子：
120.7
通讯作者：
Dunlop, DD
中科院分区：
文献类型：
--
作者：
Sharma, L;Song, J;Dunlop, DD
膝关节骨关节炎（OA）是老年人残疾的主要原因。很少有疾病进展或功能下降的风险因素已被确定。髋-膝-踝的排列影响膝关节的负荷分布;内翻和外翻对线分别增加了内侧和外侧载荷。目的检验以下假设：（1）内翻对线增加了随后18个月内内侧膝关节OA进展的风险，（2）外翻对线增加了随后外侧膝关节OA进展的风险，（3）更严重的对线不良与更大的关节间隙损失相关，以及（4）1997年3月进行的一项前瞻性纵向队列研究，到2000年3月在芝加哥的一个学术医学中心，伊利诺伊州。参与者：从社区招募了总共237名患有原发性膝关节OA的人，其定义为存在明确的胫股骨赘和至少一些需要膝关节活动的困难; 230例（97%）完成了研究。主要结果测量OA进展，定义为半屈曲关节间隙狭窄严重程度的al级增加，结果基线时内翻对线与内侧进展几率增加4倍相关，校正年龄、性别和体重指数后，（校正比值比[OR]，4.09; 95%置信区间[CI]，2.20-7.62）。基线时外翻对线与侧向进展的几率增加近5倍相关（校正OR，4.89; 95% CI，2.13-11.20）。内翻的严重程度与随后18个月内更大的内侧关节间隙丢失相关（R=0.52;优势膝关节的95% CI，0.40-0.62），外翻的严重程度与随后更大的外侧关节间隙丢失相关（R=0.35;优势膝关节的95% CI，0.21-0.47）。具有超过5度的对齐在调整年龄、性别、体重指数和疼痛后，基线时双膝关节内翻（任一方向）与18个月内双膝关节5度或更小的对线相比，与更大的功能恶化相关。外翻对线增加了外侧骨性关节炎进展风险，对线不良的负担预示着身体功能的下降，且这些影响可以在短短18个月的观察后检测到。
Context Knee osteoarthritis (OA) is a leading cause of disability in older persons. Few risk factors for disease progression or functional decline have been identified. Hip-knee-ankle align ment influences load distribution at the knee; varus and valgus alignment increase medial and lateral load, respectively.Objective To test the hypotheses that (1) varus alignment increases risk of medial knee OA progression during the subsequent 18 months, (2) valgus alignment increases risk of subsequent lateral knee OA progression, (3) greater severity of malalignment is associated with greater subsequent loss of joint space, and (4) greater burden of malalignment is associated with greater subsequent decline in physical function.Design and Setting Prospective longitudinal cohort study conducted March 1997 to March 2000 at an academic medical center in Chicago, ill.Participants A total of 237 persons recruited from the community with primary knee OA, defined by presence of definite tibiofemoral osteophytes and at least some difficulty with knee-requiring activity; 230 (97%) completed the study.Main Outcome Measures Progression of OA, defined as al-grade increase in severity of joint space narrowing on semiflexed, fluoroscopically confirmed knee radiographs; change in narrowest joint space width; and change in physical function between baseline and 18 months, compared by knee alignment at baseline.Results Varus alignment at baseline was associated with a 4-fold increase in the odds of medial progression, adjusting for age, sex, and body mass index (adjusted odds ratio [OR], 4.09; 95% confidence interval [CI], 2.20-7.62). Valgus alignment at baseline was associated with a nearly 5-fold increase in the odds of lateral progression (adjusted OR, 4.89; 95% CI, 2.13-11.20). Severity of varus correlated with greater medial joint space loss during the subsequent 18 months (R=0.52; 95% CI, 0.40-0.62 in dominant knees), and severity of valgus correlated with greater subsequent lateral joint space loss (R=0.35; 95% CI, 0.21-0.47 in dominant knees). Having alignment of more than 5 degrees (in either direction) in both knees at baseline was associated with significantly greater functional deterioration during the 18 months than having alignment of 5 degrees or less in both knees, after adjusting for age, sex, body mass index, and pain.Conclusion This is, to our knowledge, the first demonstration that in primary knee OA varus alignment increases risk of medial OA progression, that valgus alignment increases risk of lateral OA progression, that burden of malalignment predicts decline in physical function, and that these effects can be detected after as little as 18 months of observation.