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Survival analysis on subchondral bone length for total knee replacement.

Tejus Surendran1, Lisa K Park1, Meagan V Lauber1

  • 1Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.

Skeletal Radiology
|February 22, 2024
PubMed
Summary

Subchondral bone length (SBL) effectively predicts total knee replacement (TKR) risk, showing performance comparable to bone marrow lesions and joint space narrowing in knee osteoarthritis. This imaging biomarker aids in assessing TKR progression.

Keywords:
Bone marrow lesionJoint space narrowingKnee osteoarthritisMagnetic resonance imagingTotal knee replacement

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Area of Science:

  • Orthopedics and Sports Medicine
  • Radiology and Medical Imaging
  • Rheumatology

Background:

  • Knee osteoarthritis (OA) is a leading cause of disability, often necessitating total knee replacement (TKR).
  • Accurate prediction of TKR progression is crucial for timely intervention and patient management.
  • Existing imaging biomarkers like joint space narrowing (JSN) and bone marrow lesions (BMLs) have limitations in predicting OA progression.

Purpose of the Study:

  • To evaluate subchondral bone length (SBL), a novel MRI-derived measure, as a predictor of TKR risk in individuals with knee OA.
  • To compare the predictive performance of SBL against established biomarkers such as BMLs and JSN.

Main Methods:

  • Baseline MRI data from the Osteoarthritis Initiative (OAI) cohort, including 760 men and 1214 women, were analyzed.
  • Kaplan-Meier survival curves and Cox proportional hazards models were used to assess the association between SBL, BML, and JSN with TKR progression.
  • Model performance was quantified using time-dependent area under the curve (AUC), Brier score, and Concordance index.

Main Results:

  • The SBL model demonstrated predictive performance for TKR risk comparable to BML scores and JSN grades.
  • The Concordance index for SBL was 0.764, closely matching BML (0.759) and slightly below JSN (0.788).
  • AUC values for SBL (0.803) were nearly identical to BML (0.802) and slightly lower than JSN (0.827), indicating strong predictive power.

Conclusions:

  • Subchondral bone length (SBL) shows significant potential as an effective imaging biomarker for predicting TKR risk in knee OA.
  • SBL offers a valuable tool for assessing disease progression and guiding treatment decisions in patients with knee osteoarthritis.