Predictors of Poor Long Term Outcome following Total Knee Replacement for Osteoarthritis

  • Vikram Swaminathan

Student thesis: Master of Philosophy


PURPOSE: Osteoarthritis (OA) is a chronic progressive degenerative disease, associated with significant morbidity and also healthcare utilisation. The disease is multifactorial, age-dependent, and characterised by articular cartilage loss, osteophyte formation and subchondral sclerosis of the bone. can lead to debilitating pain and dependence in affected people. . Management of Knee OA can be considered as non-surgical (or conservative) and surgical. Although Total Knee Replacement (TKR) remains the only curative procedure currently available for OA, a significant proportion of patients experience poor outcomes with chronic pain and functional limitations in both short (12 months) periods post-operatively. METHODS: This study focused on those who had a TKR during their participation in the Multicentre Osteoarthritis study (MOST), and had baseline data prior to TKR and follow-up data of at least 12 months following TKR. The primary outcome measure in the study was the Patient Acceptable Symptom State (PASS) criterion. PASS is a concept based on patient wellbeing or remission of symptoms, thus an important clinically relevant outcome measure. A PASS criterion was set using a threshold of ≥25 or greater on a 0-100 scaled Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain score and applied to subjects included from the MOST study, splitting the group into those who achieved PASS or not post TKR. Preoperative (baseline) variables were identified with subjects in both groups. Using univariate and multivariate analyses, factors which increased the likelihood of a poor long term outcome following TKR (≥1 year) were investigated. RESULTS: The univariate analysis showed Widespread pain in all 5 body regions was associated with increased odds of unsatisfactory outcome ≥12 months following surgery compared to the presence of no other pain except the knee related symptoms (odds 5.06, 95% CI 1.85, 13.86, p =
Date of Award1 Aug 2019
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorTerence O'Neill (Supervisor) & Michael Callaghan (Supervisor)


  • total knee replacement
  • outcomes
  • knee
  • osteoarthritis

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