Meniscus surgery, radiographic progression of knee osteoarthritis and risk of subsequent knee replacement: Data from the Osteoarthritis Initiative

Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534

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Table. The frequency of bone marrow edema and subchondral cyst on each bone Group

Patient group Patient group Control under 50 over 50 group

P-value

Number average age ± SD (years) Lunate Bone marrow edema Cyst Triquetral Bone marrow edema Cyst Ulna Bone marrow edema Cyst

47 33.3 ± 98

38 61.5 ± 9.2

11 31.6 ± 9.1

2 (4.3%) 0(0%)

13(34.2%) 9 (23.7%)

1 (9.1%) 0 (0%)

<0.001 * <0.001 *

1 (2.1%) 0(0%)

7(18.4%) 2(5.3%)

0 (0%) 0(0%)

0.03 * 0.37

6(12.8%) 1(2.1%)

10(26.3%) 2(5.3%)

0(0%) 0(0%)

0.09 0.71

431 CORRELATION OF RADIOGRAPHIC HAND OSTEOARTHRITIS, PAIN, AND CLINICAL DIAGNOSIS e ANALYSIS OF 601 INDIVIDUALS FROM THE OSTEOARTHRITIS INITIATIVE

Outcome Variable Self-reported physician diagnosis No Radiographic Hand OA Radiographic Hand OA Self-reported hand pain No Radiographic Hand OA Radiographic Hand OA Physical exam: Heberden's nodes No Radiographic Hand OA Radiographic Hand OA

No Outcome n (%)

Outcome n (%)

Ageadjusted OR

276 (95%)

14 (5%)

REFERENCE

215 (75%)

73 (25%)

5.36

255 (84%)

48 (16%)

REFERENCE

219 (73.5%)

79 (26.5%)

1.93

267 (88%)

36 (12%)

REFERENCE

154 (52%)

141 (48%)

5.68

95% CI

[2.84-10.12]

[1.24-3.02]

[3.63-8.91]

Kappa statistic

0.21

0.11

0.36

L.F. Schaefer y, J.B. Driban z, T.E. McAlindon z, C.B. Eaton x, M.B. Roberts x, S.E. Smith y, J. Duryea y. y Brigham and Women's Hosp., Harvard Med. Sch., Boston, MA, USA; z Tufts Med. Ctr., Boston, MA, USA; x Brown Univ. Ctr. for Primary Care & Prevention, Providence, RI, USA Purpose: Hand osteoarthritis (HOA) can be a cause of pain and impairment of hand functionality. The diagnosis is generally made clinically and with the help of hand radiographs. Few studies have evaluated the association between radiographic HOA and self-reported hand pain or physician diagnosis. Our aim was to evaluate the association of radiographic HOA with hand pain and self-reported diagnosis of HOA. Methods: We randomly selected 601 participants from the Osteoarthritis Initiative (OAI) who had hand radiographs at baseline and at the 48-month time point. One investigator read the baseline posteroanterior radiographs of the dominant hand, and scored each joint according to the Kellgren-Lawrence (KL) scale. Osteoarthritis (OA) at the joint level was defined as KL-grade 2 or higher. Radiographic HOA was defined as two or more finger joints that met the joint-specific definition for OA on at least two separate digits. We calculated kappa statistics to examine the association between radiographic HOA and self-reported hand pain as well as the self-reported physician’s diagnosis of HOA and observed Heberden’s nodes as reported in the OAI dataset. We also calculated odds ratio and 95% confidence intervals to assess the likelihood that someone with radiographic HOA would have self-reported hand pain, self-reported physician diagnosis of HOA, or Heberden’s nodes compared with someone without radiographic HOA. Results: The 601 individuals were mostly female (57%), 61 (9) years of age, white (83%), and overweight (mean body mass index ¼ 28.6 [4.6] kg/m^2). The table below shows the association between radiographic HOA and three clinical outcomes (pain, physician diagnosis, observed Heberden’s nodes). Overall, 29.6% had radiographic HOA, 15.1% reported a physician diagnosis of HOA, and 29.5% had observable Heberden’s nodes. Despite low levels of agreement between radiographic HOA and clinical outcomes, we found that the presence of radiographic HOA was strongly associated with the presence of hand pain, physician diagnosis, and Heberden’s nodes. 75% and 74%of people with radiographic HOA at baseline did not report a physician’s diagnosis or hand pain, respectively. Conclusions: Radiographic HOA increases the likelihood that a person will also report hand pain or a physician-diagnosis of HOA, which may indicate they sought care for hand pain. Consistent with previous research we also found that a high percentage of individuals with radiographic HOA neither reported a physician’s diagnosis nor pain. Modifying the definition of radiographic HOA to be more conservative may improve the association between radiographic HOA and clinical findings. We also found associations between radiographic HOA and observed Heberden’s nodes. This could be due to the fact that Heberden’s nodes may be the physical manifestation of osteophytes, which are a component of the KL grading system.

Imaging: Knee, Hip 432 MENISCUS SURGERY, RADIOGRAPHIC PROGRESSION OF KNEE OSTEOARTHRITIS AND RISK OF SUBSEQUENT KNEE REPLACEMENT: DATA FROM THE OSTEOARTHRITIS INITIATIVE B. Zikria y, N. Hafezi Nejad y, F. Roemer z, A. Guermazi z, S. Demehri y. y Johns Hopkins Univ., Baltimore, MD, USA; z Boston Univ., Boston, MA, USA Purpose: To investigate the risk of radiographic progression of knee osteoarthritis (OA) and knee replacement (KR) associated with meniscus surgery in subjects with or without preceding knee injury; while adjusting for the effect of the other determinants of KR including age, gender, body mass index (BMI), physical activity (PASE: Physical Activity Scale in the Elderly), patients’ symptoms (WOMAC total score: Western Ontario and McMaster Questionnaire) and radiographic features of OA (Kellgren and Lawrence (KL) grade). Methods: The analysis was performed on the osteoarthritis initiative (OAI) cohort (n¼4796), using eight and nine years of follow-up for radiographic progression of knee OA and KR, respectively. We identified subjects who had meniscus surgery with (n¼564) or without (n¼147) preceding knee injury at the baseline evaluation. Cox hazard analysis was used to extract the adjusted hazard ratios (aHR) and to determine the risk of radiographic progression of knee OA (defined as an increase in joint space narrowing (JSN)) and KR. Results: Meniscus surgery without preceding knee injury is associated with increased risk of radiographic progression of knee OA (aHR: 1.45 (1.12e1.89); P<0.001) and KR (2.09 (1.52e2.89; P<0.001), respectively. However, meniscus surgery with preceding knee injury was not associated with a significant risk of radiographic progression of knee OA (HR: 0.92 (0.77e1.09), P: 0.321) or KR (aHR: 1.02 (0.79e1.34), P: 0.854), respectively. Additionally, meniscus surgery without preceding knee injury was associated with higher risk of KR in subjects with radiographic KL grade less than or equal to 2 (aHR: 6.97 (3.56e13.64)) in comparison with subjects with KL grade of greater than 2 (aHR: 1.76 (1.22e2.54); P for interaction < 0.05). Conclusions: In the absence of preceding knee injury, meniscus surgery is associated with increased risk of radiographic progression of OA and KR, especially patients with fewer radiographic features of OA (KL grade <¼ 2).

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Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534

Table 1. Baseline characteristics of the study population Group 1

Group 2

Group 3

Meniscus surgery without preceding knee injury

Meniscus surgery with preceding knee injury

Rest of the cohort

Numbers

147

564

4085

Age (Years) Gender (Female %) BMI PASE WOMAC KL grade

62.00 ± 8.47 * 50.2 % 29.31 ± 4.47 160.55 ± 84.92 22.05 ± 19.09 2.47 ± 1.15

58.19 ± 8.56 47.2 % 28.83 ± 4.66 178.02 ± 90.23 18.53 ± 16.58 2.43 ± 1.20

61.54 ±9.22 48.5 % 28.57 ±4.87 158.48 ± 81.00 15.49 ± 16.63 1.47 ± 1.21

P value

<0.001 <0.001 0.101 <0.001 <0.001 <0.001

Data are presented as mean ± standard deviation.

Table 2. Risk of radiographic progression of knee osteoarthritis and knee replacement among subjects who had meniscus surgery without preceding knee injury (Group 1 vs. Group 3: rest of the cohort) Model

Radiographic progression of knee osteoarthritis

P value

Knee replacement

2.34 (1.16e1.59) 2.26(1.74e2.93) 2.15(1.66e2.79)

<0.001 <0.001 <0.001

4.83(3.52e6.63) 4.75(3.45e6.53) 3.94(2.86e5.43)

<0.001 <0.001 <0.001

1.45(1.12e1.89)

<0.001

2.09(1.52e2.89)

<0.001

Hazard Ratio (95% Confidence Interval) 1. Unadjusted 2. Adjusted for: Age, gender and BMI 3. Adjusted for: Age, gender, BMI, PASE, WOMAC 4. Adjusted for: Age, gender, BMI PASE, WOMAC KL grade

P value

Hazard Ratio (95% Confidence Interval)

Table 3. Risk of radiographic progression of knee osteoarthritis and knee replacement among subjects who had meniscus surgery with preceding knee injury (Group 2 vs. Group 3: rest of the cohort). Model

Radiographic progression of knee osteoarthritis

P value

Hazard Ratio (95% Confidence Interval) 1. Unadjusted 2. Adjusted for: Age, gender and BMI 3. Adjusted for: Age, gender, BMI PASE, WOMAC 4. Adjusted for: Age, gender, BMI PASE, WOMAC KL grade

Knee replacement

P value

Hazard Ratio (95% Confidence Interval)

1.36(1.16e1.59) 1.53 (1.30e1.80) 1.46(1.24e1.72)

<0.001 <0.001 <0.001

2.17(1.70e2.77) 2.61 (2.02e3.36) 2.32 (1.79e3.00)

<0.001 <0.001 <0.001

0.92 (0.77e1.09)

0.321

1.02(0.79e1.34)

0.854

Table 4. Risk of radiographic progression of knee osteoarthritis and knee replacement with regard to meniscus surgery without vs. with preceding knee injury (Group 1 vs. Group 2) Model

Radiographic progression of knee osteoarthritis

P value

Hazard Ratio (95% Confidence Interval) 1. Unadjusted 2. Adjusted for: Age, gender and BMI 3. Adjusted for: Age, gender, BMI PASE, WOMAC 4. Adjusted for: Age, gender, BMI PASE, WOMAC KL grade

Knee replacement

P value

Hazard ratio (95% Confidence Interval)

1.72 (1.28e2.30) 1.54 (1.14e2.08) 1.54 (1.14e2.08)

<0.001 0.005 0.005

2.20(1.53e3.17) 1.80(1.24e2.63) 1.70(1.16e2.50)

<0.001 0.002 0.006

1.57(1.16e2.13)

0.003

1.89(1.28e2.79)

0.001

433 OA MAY NOT BE AS STRUCTURALLY HETEROGENEOUS AS EXPECTED: SHAPE ANALYSIS OF ALL KNEES FROM THE OSTEOARTHRITIS INITIATIVE REVEALS A CONSISTENT PATTERN OF BONE SHAPE CHANGE OVER 8 YEARS M.A. Bowes y, K. De Souza y, G.R. Vincent y, P.G. Conaghan z. y Imorphics Ltd, Manchester, United Kingdom; z Univ. of Leeds, Leeds, United Kingdom Purpose: Osteoarthritis is often referred to as a heterogeneous disease, even within a single anatomical location, such as the knee. Bone pathology is integral to the OA process, but change in 3D bone shape is difficult to interpret when examining individual radiographs, or slices within an MR image. Statistical shape modelling (SSM)

provides a convenient method for study of systematic change, as each bone shape is reduced to a series of principal components. The aim of this study was to determine whether 3D changes in bone shape were similar for all participants in the OAI, or whether clusters were distinguishable. Methods: All baseline knees from the Osteoarthritis Initiative, which had Dual Echo Steady State water-excitation MR images (DESS-we) were included in the analysis of shape vs KL grade. Images were searched with active appearance models (AAMs) of the femur; AAMs are a form of SSM. Each femur shape is recorded as a series of 70 principal components (PCs); being the number of PCs needed to represent 98% of the variance in the AAM, which was trained using 96 femurs representing a range of KL grades.