What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis

Abstract

Background: A previous systematic review on prognostic factors for knee osteoarthritis (OA) progression showed associations for generalized OA and hyaluronic acid levels. Knee pain, radiographic severity, sex, quadriceps strength, knee injury, and regular sport activities were not associated. It has been a decade since the literature search of that review and many studies have been performed since then investigating prognostic factors for radiographic knee OA progression.

Questions/purposes: The purpose of this study is to provide an updated systematic review of available evidence regarding prognostic factors for radiographic knee OA progression.

Methods: We searched for observational studies in MEDLINE and EMBASE. Key words were: knee, osteoarthritis (or arthritis, or arthrosis, or degenerative joint disease), progression (or prognosis, or precipitate, or predictive), and case-control (or cohort, or longitudinal, or follow-up). Studies fulfilling the inclusion criteria were assessed for methodologic quality according to established criteria for reviews on prognostic factors in musculoskeletal disorders. Data were extracted and results were pooled if possible or summarized according to a best-evidence synthesis. A total of 1912 additional articles were identified; 43 met our inclusion criteria. The previous review contained 36 articles, thus providing a new total of 79 articles. Seventy-two of the included articles were scored high quality, the remaining seven were low quality.

Results: The pooled odds ratio (OR) of two determinants showed associations with knee OA progression: baseline knee pain (OR, 2.38 [95% CI, 1.74-3.27) and Heberden nodes (OR, 2.66 [95% CI, 1.46-8.84]). Our best-evidence synthesis showed strong evidence that varus alignment, serum hyaluronic acid, and tumor necrosis factor-α are associated with knee OA progression. There is strong evidence that sex, former knee injury, quadriceps strength, smoking, running, and regular performance of sports are not associated with knee OA progression. Evidence for the majority of determined associations, however, was limited, conflicting, or inconclusive.

Conclusions: Baseline knee pain, presence of Heberden nodes, varus alignment, and high levels of serum markers hyaluronic acid and tumor necrosis factor-α predict knee OA progression. Sex, knee injury, and quadriceps strength, among others, did not predict knee OA progression. Large variation remains in definitions of knee OA and knee OA progression. Clinical studies should use more consistent definitions of these factors to facilitate data pooling by future meta-analyses.

Fig. 1

A forest plot for the pooled odds ratio (OR) shows the association between the presence of knee pain at baseline and radiographic progression of knee osteoarthritis (OA). The OR can deviate from the OR in Table 4 because pooled ORs were obtained through crude ORs, as opposed to the adjusted OR in Table 4. The results from Dieppe and Wolfe for pooling were not available and were not included in this analysis. The results from the chi-square and I² tests indicate homogeneity between the studies. M–H = Mantel Haenszel test; Fixed = fixed effects model; df = degrees of freedom.

Fig. 2

A forest plot for the pooled odds ratio (OR) shows the association between the presence of Heberden nodes at baseline and radiographic progression of knee osteoarthritis (OA). The OR can deviate from that in Table 4 because pooled ORs were obtained through crude ORs, as opposed to the adjusted OR in Table 4. The results from the chi-square and I² tests indicate homogeneity between the studies. M–H = Mantel Haenszel test; Fixed = fixed effects model; df = degrees of freedom.