Objective Investigate the relationship between radiographic JSW and cartilage quality Hypothesis: JSW is not an accurate indicator of the severity of.

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Presentation transcript:

Objective Investigate the relationship between radiographic JSW and cartilage quality Hypothesis: JSW is not an accurate indicator of the severity of cartilage damage in cases of OA of the knee

Materials and Methods Prospective study 60 patients TKA for idiopathic OA One orthopedic surgeon Mean age 69 years (48-87) 45 varus / 15 valgus 35 left / 25 right AP and lateral view radiographs

Materials and Methods Variables – Collins Grading (gross tibial plateau image) Score from 1 to 4 – Mankin Grading (fresh core samples 5mm) Score from 0 to 12 Samples were taken from the non affected side – JSW Measurement (mesure medial and lateral side) 5mm or more considered normal – Kellgren and Lawrence Score from 1 to 4

Statistics SPSS X 2 (Collins vs JSW and KL vs Collins) Spearman rank (Mankin vs Collins) P<0,05

Results Valgus cases (5/15 with grade III Collins) – Average medial JSW 3,1mm – Average in grade II Collins 4,0mm – Average KL 2,4 Varus cases (12/45 with grade III Collins) – Average lateral JSW 5,3mm – Average in grade II Collins 5,5mm – Average KL 1,4

Results No significant statist correlation JSW/Collins, KL/Collins Varus knees with degradated contralateral compartments manteined JSW more than valgus knees Collins is correlated with Mankin (0,885 p<0,01) Poor cartilage quality can be found in normal JSW

Discussion Radiographic JSW is not an accurate indicator of cartilage quality Correlation between Collins and Mankin – Impossible to obtain pre-op – Degeneration macro and micro not with Xrays When deciding UKA, more future revisions Older patients more arthritic progression, but – Younger than 65: Mankin 8,7 – Older than 65: Mankin 4,4 ????

Discussion Xrays at 45º of flexion – Further studies investigate relationship between radiographic views and cartilage integrity Sex affect JSW (men wider space / women perimenopausal decrease JSW) Increasing age, decreasing JSW Height and weight, negative correlation with JSW (> valgus knees) – Weight gain no correlated with joint space narrowing

Discussion Race may influence in OA Conclusions may be applicable to HTO – Surgeons must evaluate intra-op to decide No histologic or RNM examination – Increasing cost and morbidity Patients younger than 65 and with varus knees: JSW is not correlated with degradation