Evidence map›Paper›PMID 31094979›Full record

Trial reportThe Journal of bone and joint surgery. American volume2019

Preoperative Radiographic Osteoarthritis Severity Modifies the Effect of Preoperative Pain on Pain/Function After Total Knee Arthroplasty: Results at 1 and 2 Years Postoperatively.

Ricky B van de Water, Claudia S Leichtenberg, Rob G H H Nelissen, Herman M Kroon, Herman H Kaptijn, Ron Onstenk, Suzan H M Verdegaal, Thea P M Vliet Vlieland, Maaike G J Gademan

Registry-linked trialAbstract readClinical TrialMulticenter Study
PubMed Publisher
In one paragraph

Trial report in The Journal of bone and joint surgery. American volume, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05105646 (Are Preoperative Perception of Pain and Psychological Distress Before Primary Knee Arthroplasty Associated With Reason for Revision Surgery? Results of an Observational Study From the Dutch Arthroplasty Register.), which is not on this map. Cited by 18 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05105646 completednot on this map

Are Preoperative Perception of Pain and Psychological Distress Before Primary Knee Arthroplasty Associated With Reason for Revision Surgery? Results of an Observational Study From the Dutch Arthroplasty Register.

TypeobservationalSponsorLeiden University Medical CenterRan2014 to 2019Enrolled70,754ConditionsOsteo Arthritis Knee, Psychological DistressArmsKnee Arthroplasty, knee revision arthoplasty
3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Article
  6. Article
  7. Article
  8. Article
  9. Surgical interventions in Severe Osteoarthritis: Pros and Cons.Journal of orthopaedics and sports medicine · 2025
    Article
  10. Article
  11. Review
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  14. Osteoarthritic Severity in Unresurfaced Patellae Does Not Adversely Affect Patient-reported Outcomes in Contemporary Primary TKA.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2022
    Article
  15. Article
  16. Article
  17. Hard truths about preoperative knee X-rays.Annals of translational medicine · 2020
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  18. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Ricky B van de WaterDepartments of Orthopaedics (R.B.v.d.W., C.S.L., R.G.H.H.N., T.P.M.V.V., and M.G.J.G.), Radiology (H.M.K.), and Clinical Epidemiology (M.G.J.G.), Leiden University Medical Centre, Leiden, the Netherlands.
Claudia S LeichtenbergDepartments of Orthopaedics (R.B.v.d.W., C.S.L., R.G.H.H.N., T.P.M.V.V., and M.G.J.G.), Radiology (H.M.K.), and Clinical Epidemiology (M.G.J.G.), Leiden University Medical Centre, Leiden, the Netherlands.
Rob G H H NelissenDepartments of Orthopaedics (R.B.v.d.W., C.S.L., R.G.H.H.N., T.P.M.V.V., and M.G.J.G.), Radiology (H.M.K.), and Clinical Epidemiology (M.G.J.G.), Leiden University Medical Centre, Leiden, the Netherlands.
Herman M KroonDepartments of Orthopaedics (R.B.v.d.W., C.S.L., R.G.H.H.N., T.P.M.V.V., and M.G.J.G.), Radiology (H.M.K.), and Clinical Epidemiology (M.G.J.G.), Leiden University Medical Centre, Leiden, the Netherlands.
Herman H KaptijnDepartment of Orthopaedics, LangeLand Hospital, Zoetermeer, the Netherlands.
Ron OnstenkDepartment of Orthopaedics, Groene Hart Hospital, Gouda, the Netherlands.
Suzan H M VerdegaalDepartment of Orthopaedics, Alrijne Hospital, Leiderdorp, the Netherlands.
Thea P M Vliet VlielandDepartments of Orthopaedics (R.B.v.d.W., C.S.L., R.G.H.H.N., T.P.M.V.V., and M.G.J.G.), Radiology (H.M.K.), and Clinical Epidemiology (M.G.J.G.), Leiden University Medical Centre, Leiden, the Netherlands.
Maaike G J GademanDepartments of Orthopaedics (R.B.v.d.W., C.S.L., R.G.H.H.N., T.P.M.V.V., and M.G.J.G.), Radiology (H.M.K.), and Clinical Epidemiology (M.G.J.G.), Leiden University Medical Centre, Leiden, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOsteoarthritis (OA) severity as demonstrated by preoperative radiographs and preoperative pain play an important role in the indication for total knee arthroplasty (TKA). We investigated whether preoperative radiographic evidence of OA severity modified the effect of preoperative self-reported pain on postoperative pain and function 1 and 2 years after TKA for OA.

methodsData from the Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study (LOAS), a multicenter cohort study on outcomes after TKA, were used. OA severity was assessed radiographically with the Kellgren and Lawrence (KL) score (range, 0 to 4). Pain and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS). After adjustment for body mass index (BMI), age, sex, and the Mental Component Summary scores from the Short Form-12, multivariate linear regression analyses with an interaction term between the preoperative KL score and preoperative pain were performed.

resultsThe study included 559 patients. The preoperative KL score was independently associated with 1-year postoperative pain and function (β = 5.4, 95% confidence interval [CI] = 1.4 to 9.4, and β = 7.7, 95% CI = 3.2 to 12.2), while preoperative pain was associated only with postoperative pain (β = 0.3, 95% CI = 0.1 to 0.6) and not with postoperative function (β = 0.2, 95% CI = -0.2 to 0.5). Comparable associations were found between 2-year postoperative pain and KL score (β = 8.0, 95% CI = 3.2 to 12.7) and preoperative pain (β = 0.5, 95% CI = 0.1 to 0.8) and between 2-year postoperative function and KL score (β = 7.7, 95% CI = 3.2 to 12.2). The study showed a trend toward the KL score modifying the effect of preoperative pain on 1-year postoperative pain (β = -0.1, 95% CI = -0.1 to 0.0) and 2-year postoperative pain (β = -0.1, 95% CI = -0.2 to 0.0) and on 1 and 2-year function (β = -0.1, 95% CI = -0.2 to 0.0 for both), with the effect of preoperative pain on postoperative pain and function seeming to become less important when there was radiographic evidence of greater preoperative OA severity.

conclusionsPatients with less pain and higher KL grades preoperatively had better function and pain outcomes 1 and 2 years after TKA. However, the effect of preoperative pain on the postoperative outcomes seems to become less important when the patient has radiographic evidence of more severe OA. We believe that analysis of the severity of preoperative pain is an important proxy for optimal postoperative patient outcome. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Indexed as

Arthroplasty, Replacement, KneeRecovery of FunctionSeverity of Illness IndexAdolescentAdultAgedAged, 80 and overFemaleFollow-Up StudiesHumansLinear ModelsMaleMiddle AgedMusculoskeletal PainOsteoarthritis, KneePain Measurement

Identifiers

PMID31094979

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.