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Titolo:
The role of knee alignment in disease progression and functional decline in knee osteoarthritis
Autore:
Sharma, L; Song, J; Felson, DT; Cahue, S; Shamiyeh, E; Dunlop, DD;
Indirizzi:
Northwestern Univ, Sch Med, Chicago, IL 60611 USA Northwestern Univ Chicago IL USA 60611 iv, Sch Med, Chicago, IL 60611 USA Boston Univ, Boston, MA 02215 USA Boston Univ Boston MA USA 02215Boston Univ, Boston, MA 02215 USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 2, volume: 286, anno: 2001,
pagine: 188 - 195
SICI:
0098-7484(20010711)286:2<188:TROKAI>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
RADIOGRAPHIC ASSESSMENT; MEDICAL CONDITIONS; CLINICAL-TRIALS; JOINT LOAD; MALALIGNMENT; ARTHRITIS; LAXITY; MENISCECTOMY; STABILITY; DYNAMICS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
62
Recensione:
Indirizzi per estratti:
Indirizzo: Sharma, L Northwestern Univ, Sch Med, 303 E Chicago Ave,Ward Bldg 3-315, Chicago, IL60611 USA Northwestern Univ 303 E Chicago Ave,Ward Bldg 3-315 Chicago IL USA 60611
Citazione:
L. Sharma et al., "The role of knee alignment in disease progression and functional decline in knee osteoarthritis", J AM MED A, 286(2), 2001, pp. 188-195

Abstract

Context Knee osteoarthritis (OA) is a leading cause of disability in olderpersons. 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 atbaseline. 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/04/20 alle ore 02:51:21