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Abstract Number: 1209

Time to Knee Replacement by Kellgren-Lawrence Grade and Presence of Frequent Knee Pain in Two Large and Diverse Longitudinal Cohorts: Data from MOST and OAI

Kent Kwoh1, Rongrong Tang2, Edward Bedrick3, Jeffery Duryea4, Zong-Ming Li2, Jean Liew5, Xiaoxiao Sun6 and Tuhina Neogi5, 1University of Arizona, Tucson, AZ, 2University of Arizona Arthritis Center, University of Arizona College of Medicine - Tucson, Tucson, AZ, 3Department of Epidemiology andBiostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, 4Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 5Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 6Department of Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ

Meeting: ACR Convergence 2024

Keywords: Arthroplasty, Cohort Study, Orthopedics, Osteoarthritis, Total joint replacement

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Session Information

Date: Sunday, November 17, 2024

Title: Osteoarthritis – Clinical Poster I

Session Type: Poster Session B

Session Time: 10:30AM-12:30PM

Background/Purpose:  Receipt of knee replacement has been proposed by the FDA as a structural and symptom outcome for clinical trials of Disease Modifying Osteoarthritis Drugs (DMOADs). DMOAD trials have traditionally focused on enrolling knees that are Kellgren-Lawrence grade  2 and 3, but there has recently been consideration of enrolling Kellgren-Lawrence grade 4 knees with knee replacement as the outcome. Frequent knee pain (i.e., pain on more than half the days of the past 30 days) has often been an enrollment criterion in DMOAD trials, but patient report of frequent knee pain can be inconsistent and variable over time. Our objective was to compare time to knee replacement for knees with and without frequent knee pain by Kellgren-Lawrence grade.

Methods: We identified knees with and without frequent knee pain from the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI). Participants underwent fixed flexion posterior-anterior knee radiography at baseline and central reading of KLG by the same experienced readers. We evaluated time to knee replacement by categories defined by Kellgren-Lawrence grade and frequent knee pain presence with a Cox proportional hazards model, using Kellgren-Lawrence grade 2 without frequent knee pain as the reference group. All models were adjusted for age, sex, race and BMI. We tested an interaction between frequent knee pain and Kellgren-Lawrence grade.

Results: The sample consisted of 4,031 participants who contributed 6,148 knees (MOST: 1,550 participants, 2,355 knees; OAI: 2,481 participants, 3,793 knees). The demographic characteristics (i.e., age, sex, race, and BMI) are summarized in Table 1.  Kellgren-Lawrence grade distribution of the two cohorts are summarized in Table 2.  Figure 1 is a Forest plot that summarizes of the Hazard Ratios and 95% confidence intervals (CI) by Kellgren-Lawrence grade and frequent knee pain. There is a suggestion of a significant interaction between frequent knee pain and Kellgren-Lawrence grade (Wald Test, p=0.05).

Conclusion: The hazard ratios of knee replacement are higher for those with frequent knee pain at baseline compared to those without frequent knee pain at baseline, with increasing rates of knee replacement by Kellgren-Lawrence grade. Even without the presence of frequent knee pain at baseline, knees with Kellgren-Lawrence 3 or Kellgren-Lawrence 4 at baseline had clinically and statistically signficant Hazard Ratios for KR. These data may provide information for the planning of knee osteoarthritis intervention trials where knee replacement is an outcome of interest.

Supporting image 1

MOST = Multicenter Osteoarthritis Study; OAI = Osteoarthritis Initiative

Supporting image 2

KL = Kellgren-Lawrence grade; FKP = frequent knee pain; MOST = Multicenter Osteoarthritis Study; OAI = Osteoarthritis Initiative

Supporting image 3

Female sex, non_Hispanic WHites, normal weight and Kellgren-Lawrence grade 2 without frequent knee pain are the referent groups; KL = Kellgren-Lawrence grade; FKP = frequent knee pain;


Disclosures: K. Kwoh: Cumberland, 5, Express Scripts, 2, Kiniska, 5, Kolon Tissue Gene, 12, Independent Data Monitoring Committee, Mindera, 5; R. Tang: None; E. Bedrick: None; J. Duryea: None; Z. Li: None; J. Liew: None; X. Sun: None; T. Neogi: Amgen, 2, Eli Lilly, 2, GlaxoSmithKlein(GSK), 2, Novartis, 2, Sobi, 2.

To cite this abstract in AMA style:

Kwoh K, Tang R, Bedrick E, Duryea J, Li Z, Liew J, Sun X, Neogi T. Time to Knee Replacement by Kellgren-Lawrence Grade and Presence of Frequent Knee Pain in Two Large and Diverse Longitudinal Cohorts: Data from MOST and OAI [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/time-to-knee-replacement-by-kellgren-lawrence-grade-and-presence-of-frequent-knee-pain-in-two-large-and-diverse-longitudinal-cohorts-data-from-most-and-oai/. Accessed .
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