Jiranek, W.A.

Kong, X.

Riddle, D.L.

Wade, J.B.

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287
HAND OSTEOARTHRITIS SEVERITY AND SEVERE HIP OA
COMBINE WITH BMI AS MAJOR RISK FACTORS FOR
TOTAL KNEE JOINT REPLACEMENT. THE
AGES-REYKJAVIK STUDY
H. Jonsson1, G.P. Helgadottir2, T. Aspelund3,2, G. Eiriksdottir3,
S. Sigurdsson3, T. Ingvarsson4, T.B. Harris5, L. Launer5,
V. Gudnason3,2
1Landspitalinn, Univ. of Iceland, Reykjavik, Iceland; 2Univ. of
Iceland, Reykjavik, Iceland; 3Icelandic Heart Association,
Reykjavik, Iceland; 4Central Hosp., Akureyri, Iceland; 5Natl.
Institue on Aging, Bethesda, MD
Purpose: To analyse risk factors associated with having total knee
replacement due to osteoarthritis (OA) in a large population based
study of elderly Icelanders.
Methods: Knee and hip joint replacements (TKR,THR) were
recorded on CT scout scans and were presumed to be due
to OA in the absence of history or evidence of fractures or inﬂam-
matory arthritis. Hand OA severity (HOA score) was scored from
digital photographs on a 0-4 scale. All AGES-Reykjavik Study par-
ticipants with this osteoarthritis information were included in the
current analysis (n=5170, 2195 males and 2975 females, mean
age 76±6 years). The prevalence of TKR was 223 (4.3%) and that
of THR 316 (6.1%).
Results: We performed a backwards binary logistic regression
analysis of possible risk factors for TKR including age, gender,
abdominal circumference, BMI, hs-CRP, cholesterol, statin use,
bone mineral density of the spine, education and smoking history
as well as HOA severity and the presence of THR. Age and
gender stayed in the model. Only three factors showed signiﬁcant
associations; BMI (p=3.5×10-17), HOA severity (p=2.9×10-8) and
THR (p=0.0002). The highest quintile of BMI was associated with
a ﬁvefold risk compared with the lowest (8% vs 1.6%), and severe
HOA had a 2.4 fold risk compared with those with no HOA (8%
vs 3.3%). There was no signiﬁcant interaction between BMI and
HOA. Crosstabulations of BMI (quintiles) and HOA severity (0-4)
in relationship with the prevalence of TKR are shown in the ﬁgure
below.
Thus, slim individuals (BMI≤23.5) with no evidence of HOA had
a prevalence of TKR of 1.1%, while obese individuals (BMI>30.4)
with severe HOA had a prevalence of 13.4% indicating a twelwefold
risk of having TKR in the latter group. To investigate the inﬂuence
of THR (n=321) on TKR prevalence, it was included in a model
as one of three major risk factors for TKR along with highest
quintile BMI (n=1033) and severe hand OA (HOAscore 4, n=672).
Subjects with none of the three risk factors (n=3381) had a TKR
prevalence of 2.5%, with one risk factor (n=1559) the prevalence
was 6.9% and two or three risk factors (n=226) meant a prevalence
of 13.3%.
Conclusions: This study shows that osteoarthritis at the hand
and hip combine strongly with BMI as risk factors for total knee
replacements due to osteoarthritis. Together, BMI and hand OA
severity may contribute to over 70% of the total TKR prevalence.
While BMI has long been recognized as the major risk factor for
TKR, the inﬂuence of osteoarthritis at other sites may have been
underestimated, particularly that of hand osteoarthritis severity
which seems to have a linear relationship with the risk for TKR.
288
PREOPERATIVE PAIN CATASTROPHIZING PREDICTS PAIN
OUTCOME FOLLOWING KNEE ARTHROPLASTY
D.L. Riddle1, J.B. Wade1, W.A. Jiranek1, X. Kong2
1Virginia Commonwealth Univ., Richmond, VA; 2Johns Hopkins
Univ., Baltimore, MD
Purpose: Psychological status is associated with poor outcome
after knee arthroplasty yet little is known about which speciﬁc
psychological disorders or pain-related beliefs contribute to poor
outcome. To enhance the therapeutic effect of a psychological
intervention, the speciﬁc disorders or pain-related beliefs that
contributed to poor outcome should be identiﬁed. We therefore
determined whether speciﬁc psychological disorders (ie, depres-
sion, generalized anxiety disorder, panic disorder) or health-related
beliefs (ie, self-efﬁcacy, pain catastrophizing, fear of movement)
are associated with poor outcome after knee arthroplasty.
Methods: We conducted a cohort study of 140 patients undergo-
ing knee arthroplasty at two hospitals. Patients completed a series
of psychological measures provided a variety of sociodemographic
data and were followed for 6 months. Patients were dichotomized
to groups with either a favorable or a poor outcome using WOMAC
pain and function scores and evidence-based approaches. We
used generalized linear mixed effects to model the dichotomized
6-month followup WOMAC pain and function scores. Speciﬁcally,
the logistic regression models were used to model the logit of an
event (for example, change by less than 50% of 6-month WOMAC
pain scores) as a linear function of the clinically important covari-
ates, including age, gender, BMI, having rheumatoid arthritis, race,
comorbidity score, and psychologic variables.
Results: After adjusting for confounding variables, we found pain
catastrophizing was the only consistent psychological predictor of
poor WOMAC pain outcome (odds ratio = 2.67; 95% conﬁdence
interval, 1.2-6.1). No psychological predictors were consistently
associated with poor WOMAC function outcome.
Table 1. Logistic regression models predicting poor outcome in WOMAC Pain
scores
Model n F value P value Odds Ratio
(95% CI)
Model #1:
Change by <50% in WOMAC Pain 136
Pain Catastrphizing Score >15 5.47 0.02 2.7 (1.2, 6.1)
Model #2:
Change <5 WOMAC Pain points 126
Self Efﬁcacy Score 2.96 0.09 0.8 (0.62, 1.03)
Fear of Movement Score 3.19 0.08 0.92 (0.85, 1.01)
Pain Catastrophizing Score >15 8.29 0.005 6.0 (1.8, 20.8)
Table 2. Logistic regression models for predicting poor outcome in WOMAC
Function
Model n F value P value Odds Ratio
(95% CI)
Model #1:
Change by <50% in WOMAC Function 136
Pain Catastrophizing Score >15 3.12 0.08 2.2 (0.91, 5.2)
Model #2:
Change <16 WOMAC Function points 136 – – –
Conclusions: An intervention focusing on pain catastrophizing
and pain coping appears to have potential for improving pain
outcome in patients prone to catastrophizing pain.


288 PREOPERATIVE PAIN CATASTROPHIZING PREDICTS PAIN OUTCOME FOLLOWING KNEE ARTHROPLASTY 

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288 PREOPERATIVE PAIN CATASTROPHIZING PREDICTS PAIN OUTCOME FOLLOWING KNEE ARTHROPLASTY

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