Unicompartmental knee arthroplasty: the Italian version of the Forgotten Joint Score-12 is valid and reliable to assess prosthesis awareness

High return to sport rate in patients undergoing image-based robotic arm assisted unicompartmental knee arthroplasty

INTRODUCTION

This study was aimed to assess the return to sport (RTS) rate in patients who underwent CT-based robotic-assisted unicompartmental knee arthroplasty (RA-UKA) and to evaluate the clinical performance and the assocition between patients' sport activity levels and Patient Reported Outcome Measures after surgery.

MATERIALS AND METHODS

This retrospective study included 218 patients undergoing medial RA-UKA with fixed-bearing implants, performed at a single center between 2014 and 2019. Patients were allocated into two groups based on sport's practice and were administered the University of California, Los Angeles (UCLA) activity scale, Forgotten Joint Score-12 (FJS-12), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and the 5-Level Likert Scale.

RESULTS

A total of 136 patients were included for assessment. The overall RTS rate after surgery was 93.1%. Six subjects who did not practice sport preoperatively, were able to start sport activities after surgery and all patients performing sports preoperatively, returned to same activity level. The mean UCLA and FJS-12 scores in the group of patients practicing sports were significantly higher than in the no-sport group (p < 0.001 and p < 0.05, respectively). Patients who practiced sports were more likely to attain higher FJS-12 and UCLA scores than those who were not performing physical activity.

CONCLUSIONS

Patients undergoing RA-UKA showed a 93.1% RTS rate after surgery. Differences were detected in terms of postoperative UCLA and FJS-12 scores between patients who performed and who did not practice sport activities after surgery. High levels of postoperative UCLA scores were associated with higher KOOS-JR and patients' satisfaction.

Item-reduced Forgotten Joint Score provides adequate psychometric properties in ACLR patients

Purpose

The purpose of this study was to evaluate content validity, test-retest reliability, internal consistency, construct validity, responsiveness and floor/ceiling effects of Forgotten Joint Score (FJS) for assessing functions in activities of daily living (ADL) following anterior cruciate ligament reconstruction (ACLR) and perform an item reduction of FJS.

Methods

Swedish-speaking ACLR patients in one surgical clinic were eligible. Content validity was evaluated through patient responses and patient and expert clinician relevance ratings, omitting items with low relevance. Principal component factor analysis, Cronbach's ⍺, paired t test, correlations between FJS and Knee Injury and Osteoarthritis Outcome Score (KOOS), Cohen's d effect sizes (ESs) and standardized response mean (SRM) were used to evaluate internal consistency, test-retest reliability, construct validity and responsiveness. Floor/ceiling effects were calculated. FJS was expected to reveal one dominant factor, a Cronbach's ⍺ between 0.70 and 0.95, correlations >0.50 to all KOOS subscores, highest for ADL, moderate ES and SRM, floor/ceiling effects <15%.

Results

One hundred and seventy-six participants (103 for assessing internal consistency, construct validity, responsiveness and floor/ceiling effects; 73 for assessing test-retest reliability and content validity) were included. Item reduction yielded a nine-item FJS (FJS-9). FJS-12 and FJS-9 demonstrated sufficient content validity (95% confidence interval [CI], 2.5-3.1, respectively, 2.9-3.3). FJS-9 was found unidimensional, and FJS-12 was multidimensional. Cronbach's ⍺ was 0.94 for FJS, and the intraclass correlation coefficient > 0.90. FJS showed significant correlations >0.65 to all KOOS subscales, moderate ES and SRM > 0.50. No floor/ceiling effects were found.

Conclusion

FJS-9 demonstrated adequate validity for the evaluation of joint awareness in ACLR patients and can be a valuable tool to assess ADL and joint awareness.

Level of Eidence

Level III.

Image-based robotic-arm assisted unicompartmental knee arthroplasty provides high survival and good-to-excellent clinical outcomes at minimum 10 years follow-up

PURPOSE

The purpose of the present study was to determine the incidence of revision and report on clinical outcomes at a minimum of 10 years follow-up in patients who had received a medial unicompartmental knee arthroplasty (UKA) with an three-dimensional image-based robotic system.

METHODS

A total of 239 patients (247 knees), who underwent medial robotic-arm assisted (RA)-UKA at a single center between April 2011 and June 2013, were assessed. The mean age at surgery was 67.0 years (SD 8.4). Post-operatively, patients were administered the Forgotten Joint Score-12 (FJS-12) and asked about their satisfaction (from 1 to 5). Post-operative complications were recorded. Failure mechanisms, revisions and reoperations were collected. Kaplan-Meier survival curves were calculated, considering revision as the event of interest.

RESULTS

A total of 188 patients (196 knees) were assessed at a mean follow-up of 11.1 years (SD 0.5, range 10.0-11.9), resulting in a 79.4% follow-up rate. Seven RA-UKA underwent revision, resulting in a survivorship rate of 96.4% (CI 94.6%-99.2%). Causes of revision included aseptic loosening (2 cases), infection (1 case), post-traumatic (1 case), and unexplained pain (3 cases). The mean FJS-12 and satisfaction were 82.2 (SD 23.9) and 4.4 (SD 0.9), respectively. Majority of cases (174/196, 88.8%) attained the Patient Acceptable Symptoms State (PASS, FJS-12 > 40.63). Male subjects had a higher probability of attaining a "forgotten joint" (p < 0.001) and high satisfaction (equal to 5, p < 0.05), when compared to females.

CONCLUSIONS

Three-dimensional image-based RA-UKA demonstrated high implant survivorship and good-to-excellent clinical outcomes at minimum 10 years follow-up. Pain of unknown origin represented the most common reason for RA-UKA revision.

LEVEL OF EVIDENCE

III.

A Modified Version of the Forgotten Joint Score-12 in Lower Limb Amputees: Validity and Reliability Study

Adaptation to prosthesis is important for occupation, quality of life, and participation in social life, so it needs to be evaluated. The aim of this study was to determine the validity and reliability of the Forgotten Joint Score-12 (FJS-12) in lower limb amputees. The FJS-12 was applied to 80 amputees. Criterion-referenced validity was assessed using the activity restriction subparameter of Trinity Amputation and Prosthesis Experience Scale (TAPES). The internal consistency of the FJS-12 was high (Cronbach's α = .943). A statistically significant very good negative correlation was determined between the FJS-12 and the activity restriction subparameter of TAPES (r = -.641; p < .001). The results of this study showed that FJS-12 is a valid and reliable measurement tool that can be used to assess the adaptation to prosthesis in amputees. Evaluation of prosthesis awareness in daily living activities of amputees is important in terms of establishing occupational therapy and rehabilitation programs.

Total Hip Replacement: Psychometric Validation of the Italian Version of Forgotten Joint Score (FJS-12)

BACKGROUND

One million Total Hip Replacements (THA) are thought to be performed annually. To measure prosthesis awareness throughout daily activities, the FJS-12 patient-reported outcome scale was developed. This article's goal is to undertake a psychometric validation of the Italian FJS-12 among a sample of related THA patients.

METHODS

Between January and July 2019, data from 44 patients were retrieved. The participants were required to complete the Italian version of FJS-12 and of the WOMAC at preoperative follow-up, after two weeks, 1, 3, and 6 months postoperatively.

RESULTS

The Pearson correlation coefficient between the FJS-12 and WOMAC was 0.287 (p = 0.002) at preoperative follow-up, r = 0.702 (p < 0.001) at 1 month, r = 0.516 (p < 0.001) at 3 months and r = 0.585 (p < 0.001) at 6 months. The ceiling effect surpassed the acceptable range (15%) for FJS-12 in 1 month (25.5%) and WOMAC in 6 months follow-up (27.3%).

CONCLUSIONS

The psychometric validation of the Italian version of this score for THA was executed with acceptable results. FJS-12 and WOMAC reported no ceiling and floor effects. Therefore, to distinguish between patients who had good or exceptional results following UKA, the FJS-12 could be a reliable score. Under the first four months, FJS-12 had a smaller ceiling effect than WOMAC. It is recommended to use this score in clinical research concerning the outcomes of THA.

Supervised versus unsupervised rehabilitation following total knee arthroplasty: A systematic review and meta-analysis

BACKGROUND

Outcomes after total knee arthroplasty (TKA) are strongly influenced by the adequacy of rehabilitation and the consequent functional recovery. The economic impact of rehabilitation it is not negligible. Inpatient rehabilitation can be 5 to 26 times more expensive than the home-based rehabilitation. This topic is extremely relevant as the COVID-19 pandemic has highlighted the importance of unsupervised rehabilitation in orthopedic surgery. The aim of this review and meta-analysis is to investigate the scientific evidence regarding the comparison between supervised and unsupervised rehabilitation following TKA.

MATERIALS AND METHODS

Following PRISMA guideline, a comprehensive search of PubMed, Cochrane and Scopus databases using combinations of keywords and MeSH descriptors: "total "Knee replacement," "Arthroplasty", "Rehabilitation" was performed from inception to December 2021. All relevant articles were retrieved, and their bibliographies were searched for further relevant references. Only English written randomized controlled trials comparing supervised and unsupervised rehabilitation following TKA were included in this systematic review. The outcomes considered were long-term pain, physical function, knee flexion and extension ROM, 6 minute walking test (6MWT) and timed up and go test (TUG).

RESULTS

11 studies (2.181 patients in total) were included in this systematic review. The long-term pain outcome showed no significant differences (Std. Mean Difference [SMD] = 0.00, 95 % confidence interval [CI] -0.16, 0.017) between the supervised (n = 397) and unsupervised (n = 255). Physical function showed no significant differences among the two groups (mean difference [MD] = 0.84, 95 % CI = -1.82, 3.50). Non-significant differences were also found for knee ROM flexion (mean difference [MD] = -0.46, 95 % CI = -2.95, 2.04) and for knee extension (mean difference [MD] = 0.54, 95 % CI = -0.89, 1.97). At the 52-week follow-up, the unsupervised group showed significant better results in 6MWT (mean difference [MD] = -26.10, 95 % CI = -47.62, -4.59) and in Timed up and go test (mean difference [MD] = 1.33, 95 % CI = 0.50, 2.15).

CONCLUSION

This systematic review did not show a significant clinical difference in improving pain, function, and mobility outcomes after TKA between supervised PT and unsupervised PT. Therefore, it would appear that supervised rehabilitation did not had additional benefits compared to unsupervised rehabilitation.

Influence of Depression and Sleep Quality on Postoperative Outcomes after Total Hip Arthroplasty: A Prospective Study

The trend of Total Hip Arthroplasty (THA) is projected to grow. Therefore, it has become imperative to find new measures to improve the outcomes of THA. Several studies have focused attention on the influence of psychological factors and sleep quality on surgical outcomes. The consequences of depressive states may affect outcomes and also interfere with rehabilitation. In addition, sleep quality may be an essential factor in determining surgical outcomes. To our knowledge, few articles focus on the influence of these factors on THA results. The present study investigates a possible correlation between preoperative depression or sleep quality and postoperative outcomes of THA. This study was conducted with 61 consecutive patients undergoing THA from January 2020 to January 2021. Patients were assessed preoperatively using GDS and PSQI, and six months postoperatively using FJS-12, SF-36, WOMAC, PSQI, and GDS. To simplify comparisons, the overall scores were normalized to range from 0 (worst condition) to 100 points (best condition). A total of 37 patients (60.7%) were classified as depressed and 24 as not depressed (39.3 %) in the preoperative assessment. A low–moderate positive correlation between preoperative GDS score and FJS-12 (rho = 0.22, p = 0.011), SF-36-PCS (rho = 0.328, p = 0.01), and SF-36-MCS (rho = 0.293, p = 0.022) scores at six-month follow-up was found. When the normalized preoperative GDS score was high (no depression), the FJS-12, SF-36-PCS, and SF-36-MCS scores tended to increase more compared to the other group. Statistically significant differences between the two groups were found in postoperative FJS-12 (p = 0.001), SF-36-PCS (p = 0.017), and SF-36-MCS scores (p = 0.016). No statistically significant correlation between preoperative PSQI score and postoperative outcome measures was found. Preoperatively depressed patients had a low–moderate positive correlation with postoperative SF-36 and FJS-12 scores. There was no correlation between sleep quality and postoperative outcome measures of THA.