End-stage knee osteoarthritis with and without sarcopenia and the effect of knee arthroplasty - a prospective cohort study

Kevin Ki-Wai Ho, Lawrence Chun-Man Lau, Wai-Wang Chau, Queena Poon, Kwong-Yin Chung, Ronald Man-Yeung Wong, Kevin Ki-Wai Ho, Lawrence Chun-Man Lau, Wai-Wang Chau, Queena Poon, Kwong-Yin Chung, Ronald Man-Yeung Wong

Abstract

Background: Sarcopenia often accompanies osteoarthritis (OA), which is managed by total knee arthroplasty (TKA) in the late stage. Recent studies have suggested a higher risk of post-operative complications after TKA in sarcopenic OA subjects, but whether TKA can benefit them similar to non-sarcopenic subjects remains unexplored. This study aimed to examine the dynamic, mutual impact of sarcopenia and TKA in a one-year post-operative period.

Methods: This prospective cohort study was conducted between 2015 to 2018 at our hospital. Patients with end-stage OA of the knee waiting for TKA were recruited into the study. Primary outcome measures were change in muscle strength, mass and function. Secondary outcome measures were quality of life (QOL) measurements for pain, psychological and physical health.

Results: Fifty-eight patients were recruited, of which 79.3% were female and 32.8% already had sarcopenia at baseline. The average age of sarcopenic subjects and non-sarcopenic subjects was comparable (67.89 ± 7.07 vs. 67.92 ± 6.85; p = 0.99), but sarcopenic subjects had a lower body mass index (BMI) (25.64 ± 2.64 vs. 28.57 ± 4.04; p = 0.01). There was a statistically significant improvement in walking speed (10.24 ± 5.35 vs. 7.69 ± 2.68, p < 0.01) and muscle strength in both sarcopenic and non-sarcopenic patients after TKA. This was accompanied by an improvement trend in muscle mass in all subjects. There was no change in handgrip power before and after TKA and subsequent follow-up (19.31 ± 5.92 vs. 18.98 ± 6.37 vs. 19.36 ± 7.66; p = 0.97). QOL measured before, after and at follow-up with WOMAC (total: 42.27 ± 15.98 vs. 20.65 ± 15.24 vs. 16.65 ± 18.13) and SF12v2 (PCS: 33.06 ± 8.55 vs. 38.96 ± 8.01 vs. 40.67 ± 7.93) revealed progressive significant improvement (both comparisons p ≤ 0.01). Further analysis with the IPAQ also found increased engagement of high-intensity activities.

Conclusions: This study showed that sarcopenia among patients with end-stage OA of the knee is not uncommon, but both sarcopenic and non-sarcopenic OA patients achieved significant clinical and functional improvement after TKA. Further studies with a larger sample size and different ethnicities could help ascertain a beneficial role of TKA in sarcopenic OA subjects.

Trial registration: Registry: ClinicalTrials.gov , Registration number: NCT03579329 . Date of registration: 6 July 2018. Retrospectively registered.

Keywords: Cohort study; Knee arthroplasty; Knee osteoarthritis; Sarcopenia; Sarcopenic obesity.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Muscle Mass changes after TKA: Longitudinal changes of a) Appendage Lean Mass Index (ALMI) and b) Lean Mass Index (LMI) scores in sarcopenia patients of different age groups and BMI categories
Fig. 2
Fig. 2
Muscle function changes after TKA: Six-meter gait speed test across the time points
Fig. 3
Fig. 3
Quality of Life changes after TKA: Longitudinal changes of a) SF12v2, b) WOMAC, and c) IPAQ showing a gradual improvement in physical function and decreased pain after total knee arthroplasty

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