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Adults with incident accelerated knee osteoarthritis are more likely to receive a knee replacement: data from the Osteoarthritis Initiative

  • Davis, Julie E.1
  • Liu, Shao-Hsien2
  • Lapane, Kate2
  • Harkey, Matthew S.1
  • Price, Lori Lyn3, 4
  • Lu, Bing5
  • Lo, Grace H.6, 7
  • Eaton, Charles B.8
  • Barbe, Mary F.9
  • McAlindon, Timothy E.1
  • Driban, Jeffrey B.1
  • 1 Tufts Medical Center, Division of Rheumatology, 800 Washington Street, Box #406, Boston, MA, 02111, USA , Boston (United States)
  • 2 University of Massachusetts Medical School, Department of Quantitative Health Sciences, 55 Lake Avenue North, AC7-073, Worcester, MA, 01655, USA , Worcester (United States)
  • 3 Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, 800 Washington Street, Box #63, Boston, MA, 02111, USA , Boston (United States)
  • 4 Tufts University, Tufts Clinical and Translational Science Institute, 800 Washington Street, Box #63, Boston, MA, 02111, USA , Boston (United States)
  • 5 Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street PBB-B3, Boston, MA, 02115, USA , Boston (United States)
  • 6 Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, Medical Care Line and Research Care Line, Houston, TX, USA , Houston (United States)
  • 7 Baylor College of Medicine, Section of Immunology, Allergy, and Rheumatology, 1 Baylor Plaza, BCM-285, Houston, TX, 77030, USA , Houston (United States)
  • 8 Alpert Medical School of Brown University, Center for Primary Care and Prevention, 111 Brewster Street, Pawtucket, RI, 02860, USA , Pawtucket (United States)
  • 9 Temple University School of Medicine, Department of Anatomy and Cell Biology, 3500 North Broad Street, Philadelphia, PA, 19140, USA , Philadelphia (United States)
Published Article
Clinical Rheumatology
Publication Date
Feb 08, 2018
DOI: 10.1007/s10067-018-4025-2
Springer Nature


We aimed to determine if knees with incident accelerated knee osteoarthritis (AKOA) were more likely to receive a knee replacement (KR) than those with common knee osteoarthritis (KOA) or no KOA. We conducted a nested cohort study using data from baseline and the first 9 years of the Osteoarthritis Initiative (OAI). Eligible knees had no radiographic KOA at baseline (Kellgren-Lawrence [KL] < 2). We classified 3 groups using KL grades from the first 8 years of the OAI: 1) AKOA: knee progressed to advance-stage KOA (KL 3/4) in ≤ 4 years, 2) common KOA: knee increased in KL grade (excluding AKOA), and 3) No KOA: no change in KL grade by 8 years. The outcome was a KR (partial or total) at or before the 9-year OAI visit. We conducted a logistic regression with generalized linear mixed model and adjusted for age, body mass index, and sex. Overall, 14% of knees with AKOA received a KR by the 9th year compared with 1% and < 1% of those with common or no KOA, respectively. Knees that developed AKOA were > 80x and ~ 25x more likely to receive a KR than knees with no KOA or incident common KOA (adjusted odds ratio = 25.08; 95% confidence interval = 9.63-65.34). In conclusion, approximately 1 in 7 knees that develop AKOA received a KR; however, KRs were rare in the OAI among other knees with no radiographic KOA at baseline. Urgent steps are needed to identify adults at high-risk for AKOA and develop prevention strategies regarding the modifiable risk factors.

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