The online version of this article (doi:10.1186/s12891-017-1486-4) contains supplementary material, which is available to authorized users.
This 1-year prospective cohort study aimed to compare the changes in clinical symptoms and functional disability between patients with coexisting patellofemoral (PF) and tibiofemoral (TF) osteoarthritis (OA) and those with isolated TFOA.
Seventy-two patients with medial knee OA were enrolled. Knee pain and functional disability were assessed at baseline and at 1-year follow-up using the Japanese Knee Osteoarthritis Measure (JKOM) and a visual analog scale (VAS). We performed two-way analysis of covariance for the clinical outcome variables to examine, time (baseline and follow-up), group (coexisting PFOA and isolated TFOA), and time-group interaction effects. Furthermore, we conducted post-hoc exploratory analysis to address the possibility that dividing patients according to location of PFOA (i.e., isolated lateral, isolated medial, and mixed [bilateral]) may identify a distinct subgroup with different changes in clinical outcomes at 1-year follow-up.
We detected group effects only in scores of the JKOM pain subscale (P = 0.012) and VAS (P = 0.033), adjusted for age, sex, and body mass index. Patients with coexisting PFOA have stable moderate level knee pain and functional disability throughout the year which is significantly worse than that in those with isolated TFOA. Post-hoc subgroup analysis demonstrated that change of knee pain likely varied with location of PFOA. Patients with isolated lateral PFOA had mild/moderate level knee pain, and their VAS scores were likely to improve, whereas those with mixed PFOA exhibited stable to worsening moderate/severe knee pain.
Although we did not detect differences in changes in clinical symptoms and functional disability between patients with coexisting PFOA and those with isolated TFOA, our findings indicate that patients with coexisting PFOA had worse clinical symptoms and functional disability than those with isolated TFOA. The results of the exploratory analysis suggested that patients with coexisting PFOA might have heterogeneous clinical outcomes, and presence of mixed PFOA might be an indicator of severe clinical knee OA.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96. CrossRefPubMed
Pisters MF, Veenhof C, van Dijk GM, Heymans MW, Twisk JW, Dekker J. The course of limitations in activities over 5 years in patients with knee and hip osteoarthritis with moderate functional limitations: risk factors for future functional decline. Osteoarthritis Cartilage. 2012;20(6):503–10. CrossRefPubMed
Hinman RS, Crossley KM. Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis. Rheumatology (Oxford). 2007;46(7):1057–62. CrossRef
Duncan RC, Hay EM, Saklatvala J, Croft PR. Prevalence of radiographic osteoarthritis--it all depends on your point of view. Rheumatology (Oxford). 2006;45(6):757–60. CrossRef
Iijima H, Fukutani N, Aoyama T, Fukumoto T, Uritani D, Kaneda E, Ota K, Kuroki H, Matsuda S. Clinical Impact of Coexisting Patellofemoral Osteoarthritis in Japanese Patients With Medial Knee Osteoarthritis. Arthritis Care Res (Hoboken). 2016;68(4):493–501. CrossRef
Farrokhi S, Piva SR, Gil AB, Oddis CV, Brooks MM, Fitzgerald GK. Association of severity of coexisting patellofemoral disease with increased impairments and functional limitations in patients with knee osteoarthritis. Arthritis Care Res (Hoboken). 2013;65(4):544–51. CrossRef
van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, Dekker J. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil. 2014;95(10):1962–8. CrossRefPubMed
Waarsing JH, Bierma-Zeinstra SM, Weinans H. Distinct subtypes of knee osteoarthritis: data from the Osteoarthritis Initiative. Rheumatology (Oxford). 2015;54(9):1650–8. CrossRef
Akai M, Doi T, Fujino K, Iwaya T, Kurosawa H, Nasu T. An outcome measure for Japanese people with knee osteoarthritis. J Rheumatol. 2005;32(8):1524–32. PubMed
Zhang Y, Glynn RJ, Felson DT. Musculoskeletal disease research: should we analyze the joint or the person? J Rheumatol. 1996;23(7):1130–4. PubMed
Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombardier C, Felson D, Hochberg M, van der Heijde D, et al. Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis. 2005;64(1):34–7. CrossRefPubMed
Stefanik JJ, Gross KD, Guermazi A, Felson DT, Roemer FW, Zhang Y, Niu J, Segal NA, Lewis CE, Nevitt M, et al. The relation of MRI-detected structural damage in the medial and lateral patellofemoral joint to knee pain: the Multicenter and Framingham Osteoarthritis Studies. Osteoarthritis Cartilage. 2015;23(4):565–70. CrossRefPubMedPubMedCentral
Holla JF, van der Leeden M, Knol DL, Roorda LD, Hilberdink WK, Lems WF, Steultjens MP, Dekker J. Predictors and outcome of pain-related avoidance of activities in persons with early symptomatic knee osteoarthritis: a five-year followup study. Arthritis Care Res (Hoboken). 2015;67(1):48–57. CrossRef
Johnson SR, Archibald A, Davis AM, Badley E, Wright JG, Hawker GA. Is self-reported improvement in osteoarthritis pain and disability reflected in objective measures? J Rheumatol. 2007;34(1):159–64. PubMed
de Rooij M, van der Leeden M, Heymans MW, Holla JF, Hakkinen A, Lems WF, Roorda LD, Veenhof C, Sanchez-Ramirez DC, de Vet HC, et al. Prognosis of pain and physical functioning in patients with knee osteoarthritis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2016;68(4):481–92. CrossRef
Stefanik JJ, Neogi T, Niu J, Roemer FW, Segal NA, Lewis CE, Nevitt M, Guermazi A, Felson DT. The diagnostic performance of anterior knee pain and activity-related pain in identifying knees with structural damage in the patellofemoral joint: the Multicenter Osteoarthritis Study. J Rheumatol. 2014;41(8):1695–702. CrossRefPubMedPubMedCentral
- Changes in clinical symptoms and functional disability in patients with coexisting patellofemoral and tibiofemoral osteoarthritis: a 1-year prospective cohort study
- BioMed Central
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