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The Kellgren-Lawrence score: not always a slam-dunk
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Veröffentlicht: | 6. November 2018 |
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Objectives: The Kellgren-Lawrence Score helps the orthopaedic surgeon to classify the severity of knee osteoarthritis (OA) prior to total knee arthroplasty (TKA). There might be a discrepancy between subjective complaints of the patients and radiologically visible changes of the knee joint in many cases. In this context, we performed a prospective clinical study to analyze the preoperative extent of bone and cartilage damage using the Kellgren-Lawrence score. The findings were compared with the intraoperative extent of bone and cartilage damage.
Methods: A total of 251 patients, who underwent a TKA at our institution between November 2016 and March 2017 were included in the prospective study. In all knees, preoperative Kellgren-Lawrence score was determined using standardized preoperative anteroposterior and lateral plain radiographs of the knee and the axial view of the patella by senior radiologists. In all patients, photographic documentations of the medial, lateral, and retropatellar joint compartments were taken. The degree of chondromalacia was assessed according to the International Cartilage Repair Society (ICRS). Correlation analysis was performed using Pearson-Clopper 95-CI in compartments with the highest Kellgren-Lawrence score.
Results and conclusion: The patient collective consists of 251 patients (n=163 female, n=88 male) with a mean age of 66.8 years (range from 41 to 88 years; SD=9.2). In 160 cases, intraoperatively determined score was greater than the preoperative finding (63.7% of 251, 95% confidence interval [CI] = 57.5% to 69.7%). A mismatch of two score grade points was found in 8.4 % (95% CI=5.3% to 12.5%). The highest mismatch was noted in patients with preoperative Kellgren-Lawrence score of 3 and intraoperative score of 4 in 48.2% (95% CI=41.9% to 54.6%). Based on our study results, there was a mismatch of preoperative radiological and true intraoperative findings in determining the severity of knee OA. In patients undergoing primary TKA, the correlation of clinical symptoms with radiological findings is crucial to make a decision prior to TKA.