The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacement
Abstract Background Knee osteoarthritis (KOA) has a complex, multifactorial nature with well-established risk factors which may influence treatment decisions. Here we want to identify distinctive characteristics between patients receiving conservative treatment versus total knee replacement (TKR), a...
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BMC
2025-02-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05552-2 |
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| author | Fabiola Ojeda Laura Tío Francisco Castro-Domínguez Simone Tassani Jerome Noailly Jordi Monfort |
| author_facet | Fabiola Ojeda Laura Tío Francisco Castro-Domínguez Simone Tassani Jerome Noailly Jordi Monfort |
| author_sort | Fabiola Ojeda |
| collection | DOAJ |
| description | Abstract Background Knee osteoarthritis (KOA) has a complex, multifactorial nature with well-established risk factors which may influence treatment decisions. Here we want to identify distinctive characteristics between patients receiving conservative treatment versus total knee replacement (TKR), analyzing both patient-specific and knee-specific features. Methods This case–control study compared patients assigned to TKR versus conservative management, examining subjects aged 60–75 years with radiographically confirmed KOA (Kellgren–Lawrence grades 2–3), with all participants evaluated by blinded clinicians using validated assessment tools including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital Anxiety and Depression Scale (HADs), Pain Catastrophizing Scale (PCS) and Daily physical activity (DPA) questionnaires. The study employed multivariate analysis of variance for continuous variables at both patient and knee levels, followed by univariate analysis of variance for significant factors, while logistic and linear regression analyses were used to calculate odds ratios, with Bonferroni corrections applied to adjust p-values for multiple comparisons. Results Between 2016 and 2020, the study included 87 patients (51 women and 36 men) with a mean age of 67.7 years in both treatment groups, with a slightly higher body mass index (BMI) of 31.9 kg/m2 in the TKR group vs 30.5 kg/m2 in the conservative management group. TKR patients demonstrated significantly worse scores in WOMAC, HADS, and PCS compared to the conservative management group, though DPA levels remained similar between both groups. At the knee level, women demonstrated significantly higher pain sensitivity and central sensitization compared to men, with no differences between conservative and TKR groups. Conclusions Patients undergoing TKR exhibited significantly worse baseline clinical outcomes, particularly in WOMAC scores, despite having similar radiographic severity to those receiving conservative treatment, suggesting that functional and symptomatic measures may be more valuable than radiographic findings in determining surgical intervention. |
| format | Article |
| id | doaj-art-3f766a88ae6a4e99bc1c34926c26acbe |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-3f766a88ae6a4e99bc1c34926c26acbe2025-02-09T12:47:01ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-02-0120111210.1186/s13018-025-05552-2The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacementFabiola Ojeda0Laura Tío1Francisco Castro-Domínguez2Simone Tassani3Jerome Noailly4Jordi Monfort5Rheumatology Service, Hospital del MarHospital del Mar Research InstituteCentro Médico TeknonBCN MedTech, DTIC, Universitat Pompeu FabraBCN MedTech, DTIC, Universitat Pompeu FabraRheumatology Service, Hospital del MarAbstract Background Knee osteoarthritis (KOA) has a complex, multifactorial nature with well-established risk factors which may influence treatment decisions. Here we want to identify distinctive characteristics between patients receiving conservative treatment versus total knee replacement (TKR), analyzing both patient-specific and knee-specific features. Methods This case–control study compared patients assigned to TKR versus conservative management, examining subjects aged 60–75 years with radiographically confirmed KOA (Kellgren–Lawrence grades 2–3), with all participants evaluated by blinded clinicians using validated assessment tools including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital Anxiety and Depression Scale (HADs), Pain Catastrophizing Scale (PCS) and Daily physical activity (DPA) questionnaires. The study employed multivariate analysis of variance for continuous variables at both patient and knee levels, followed by univariate analysis of variance for significant factors, while logistic and linear regression analyses were used to calculate odds ratios, with Bonferroni corrections applied to adjust p-values for multiple comparisons. Results Between 2016 and 2020, the study included 87 patients (51 women and 36 men) with a mean age of 67.7 years in both treatment groups, with a slightly higher body mass index (BMI) of 31.9 kg/m2 in the TKR group vs 30.5 kg/m2 in the conservative management group. TKR patients demonstrated significantly worse scores in WOMAC, HADS, and PCS compared to the conservative management group, though DPA levels remained similar between both groups. At the knee level, women demonstrated significantly higher pain sensitivity and central sensitization compared to men, with no differences between conservative and TKR groups. Conclusions Patients undergoing TKR exhibited significantly worse baseline clinical outcomes, particularly in WOMAC scores, despite having similar radiographic severity to those receiving conservative treatment, suggesting that functional and symptomatic measures may be more valuable than radiographic findings in determining surgical intervention.https://doi.org/10.1186/s13018-025-05552-2OsteoarthritisTotal knee replacementRisk factors |
| spellingShingle | Fabiola Ojeda Laura Tío Francisco Castro-Domínguez Simone Tassani Jerome Noailly Jordi Monfort The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacement Journal of Orthopaedic Surgery and Research Osteoarthritis Total knee replacement Risk factors |
| title | The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacement |
| title_full | The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacement |
| title_fullStr | The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacement |
| title_full_unstemmed | The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacement |
| title_short | The role of sex, age, and BMI in treatment decisions for knee osteoarthritis: conservative management versus total knee replacement |
| title_sort | role of sex age and bmi in treatment decisions for knee osteoarthritis conservative management versus total knee replacement |
| topic | Osteoarthritis Total knee replacement Risk factors |
| url | https://doi.org/10.1186/s13018-025-05552-2 |
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