Association Between Preoperative Radiological Findings and Outcomes After Total Knee Arthroplasty

Introduction Total knee arthroplasty (TKA) is a widely accepted surgical intervention for patients with advanced knee osteoarthritis, aimed at reducing pain and improving functional mobility. Preoperative radiological evaluations, including assessments of joint space narrowing, osteophytes, varus/valgus deformities, and subchondral sclerosis, are essential for planning the surgery and predicting postoperative outcomes. Although extensive research has been conducted internationally, data focusing on populations in Saudi Arabia remain limited. This study investigates the association between preoperative radiological findings and postoperative outcomes, including pain, range of motion (ROM), and functional status, in a Saudi retrospective cross-sectional study.  Methods This retrospective cross-sectional study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. A total of 523 patients who underwent TKA were included. Data were collected from medical records through the BESTCare system, focusing on patient demographics, preoperative and postoperative radiological findings, and surgical outcomes. Statistical analyses were performed using IBM SPSS Statistics software (IBM Corp., Armonk, NY), and the significance was determined at p < 0.05.  Results The study population had a median age of 64 years, and 72% were female. Preoperative radiological findings included varus deformity (65.39%), joint space narrowing (47.61%), and osteophytes (31.17%). Postoperative outcomes showed 19% of patients reported pain, 85% regained normal ROM, and 74% returned to normal functional status. Significant associations were found between postoperative limited ROM and preoperative osteophytes (p = 0.021), subchondral sclerosis (p = 0.033), and osteopenia (p = 0.017). Subchondral sclerosis was also linked to postoperative functional impairment (p = 0.009). No significant association was observed between preoperative radiological findings and postoperative pain or thromboembolism.  Conclusion Preoperative radiological markers, particularly osteophytes and subchondral sclerosis, were significant predictors of postoperative ROM and functional status in TKA patients. Identifying these markers can enhance preoperative planning, enable targeted rehabilitation strategies, and improve patient outcomes in the Saudi population. Further studies are warranted to confirm these findings and explore additional predictive factors.