Clinical phenotypes of comorbidities in end-stage knee osteoarthritis: a cluster analysis

BMC Musculoskelet Disord. 2024 Apr 17;25(1):299. doi: 10.1186/s12891-024-07394-1.

Abstract

Objectives: Comorbidities, as components of these heterogeneous features, often coexist with knee osteoarthritis, and are particularly prevalent in end-stage knee osteoarthritis. Here, we attempted to identify the different clinical phenotypes of comorbidities in patients with end-stage knee osteoarthritis by cluster analysis.

Methods: A total of 421 inpatients diagnosed with end-stage knee osteoarthritis who underwent inpatient surgery were included in this cross-sectional study. 23 demographic, comorbidity, inflammatory immune and evaluation scale variables were collected. Systematic clustering after factor analysis and separate two-step cluster analysis were performed for individual comorbidity variables and all variables, respectively, to objectively identify the different clinical phenotypes of the study patients.

Results: Four clusters were finally identified. Cluster 1 had the largest proportion of obese patients (93.8%) and hypertension was common (71.2%). Almost all patients in cluster 2 were depressed (95.8%) and anxiety disorders (94.7%). Cluster 3 combined patients with isolated end-stage knee osteoarthritis and a few comorbidities. Cluster 4 had the highest proportion of patients with rheumatoid arthritis (58.8%).

Conclusions: Patients with end-stage knee osteoarthritis may be classified into four different clinical phenotypes: "isolated end-stage knee osteoarthritis"; "obesity + hypertension"; "depression + anxiety"; and "rheumatoid arthritis", which may help guide individualized patient care and treatment strategies.

Keywords: Actor analysis; Cluster analysis; Comorbidity; Osteoarthritis; Phenotypes.

MeSH terms

  • Cluster Analysis
  • Comorbidity
  • Cross-Sectional Studies
  • Humans
  • Hypertension* / epidemiology
  • Obesity / complications
  • Obesity / diagnosis
  • Obesity / epidemiology
  • Osteoarthritis, Knee* / diagnosis
  • Osteoarthritis, Knee* / epidemiology
  • Osteoarthritis, Knee* / surgery
  • Phenotype