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Mazzotti A, Zielli SO, Artioli E, Astolfi M, Langone L, Faldini C. The Forgotten Joint Score Is a Valid Outcome Measure for Total Ankle Arthroplasty: A Prospective Study. Clin Orthop Relat Res 2024; 482:1813-1821. [PMID: 38686993 PMCID: PMC11419501 DOI: 10.1097/corr.0000000000003083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The success of total ankle arthroplasty (TAA) involves objective and subjective parameters such as joint motion and implant survival. Patient-reported outcome measures provide key context from the patient's perspective so that we can evaluate the results of these procedures. The Forgotten Joint Score (FJS) has demonstrated validity and reliability in other arthroplasties, but the existing evidence on the FJS in TAA is very limited. QUESTION/PURPOSES We aimed to assess the reliability, validity, responsiveness to change, and floor and ceiling effects, as well as to perform a gender analysis, of the FJS in patients who had undergone TAA. METHODS A prospective, observational study enrolled patients who underwent TAA at our institution between June 2021 and May 2023. The three-component TAA was performed through an anterior approach. A total of 120 patients (mean age 62 ± 10 years) participated, which was 83% (120 of 145) of those eligible, and 77% (92 of 120) of those patients underwent follow-up assessments at 12 ± 1 months after surgery. A cross-culturally adapted and validated version of the FJS in our language (Italian) was used. Additionally, three other commonly used patient-reported outcome measures for TAA were administered: the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the Manchester-Oxford Foot Questionnaire (MOXFQ), and the VAS. RESULTS Reliability was demonstrated by excellent internal consistency (Cronbach α coefficient = 0.95) and excellent test-retest reliability (intraclass correlation coefficient = 0.99; standard error of measurement = 2.7). Robust validity was observed, in that the FJS had a strong correlation with the AOFAS ankle-hindfoot score, the MOXFQ, and the VAS (Pearson and Spearman values consistently above 0.7 or below -0.7). Responsiveness to change was observed between 6 and 12 months (Cohen d = 0.37). Low ceiling and floor effects at both 6 months (4% and 3% reached top and bottom scores, respectively) and 12 months (10% and 0% reached top and bottom scores, respectively) were demonstrated, below the recommended 15% interpretability threshold. No association between outcomes and patient gender was observed. CONCLUSION Test properties and validity of the FJS were strong in patients who underwent TAA. It seems suitable for clinical use, although future studies should seek to replicate or refute our findings in other patient populations. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simone Ottavio Zielli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michele Astolfi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Laura Langone
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Roussel T, Dartus J, Pasquier G, Duhamel A, Preda C, Migaud H, Putman S. Can the minimal clinically important difference (MCID) for the Oxford score, KOOS and its derivatives be identified in a French sample of total knee arthroplasties? Orthop Traumatol Surg Res 2024:103965. [PMID: 39089421 DOI: 10.1016/j.otsr.2024.103965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/28/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
CONTEXT To assess the effect of a surgical procedure on a patient, it is conventional to use clinical scores before and after the procedure, but it is increasingly common and recommended to weight the results of these scores with the notion of minimal clinically important difference ("MCID"). This MCID should be determined using either the data distribution method based on score variation, or the anchor method, which uses an external question to categorize the results. MCIDs vary from one population to another, and to our knowledge there has been no investigation in France for total knee arthroplasties (TKAs). We therefore conducted a prospective study on a population of TKAs in order to: 1) Define MCID in France on a population of TKAs for the Oxford score, KOOS (Knee injury and Osteoarthritis Outcome Score) and its derivatives, 2) Determine whether MCID for these scores in France is comparable to results in the literature. HYPOTHESIS Is the MCID for total knee arthroplasty in France comparable to other results in the literature? MATERIAL AND METHOD This was a prospective observational study in which 218 patients (85 men, 133 women) with a mean age of 72 years [27-90] who had undergone a primary TKA out of 300 initially included responded, before and after surgery, to the Oxford-12, KOOS and Forgotten Joint Score (FJS) questions (mean follow-up 24 months). MCID was calculated using the distribution method as well as the anchor method ("improvement 1 to 5" and "improvement yes or no"). RESULTS At a mean follow-up of 24 months [18-36], the Oxford-12 score increased from 16 ± 8 [0-41] to 34 ± 11 [6-48] (p < 0.001), all components of the KOOS score were improved and the FJS at follow-up was 47 ± 32 [0-100]. For the anchor "improvement 1 to 5", there were 14 unimproved patients, 23 patients in identical condition and 179 patients improved by surgery. For the anchor "are you improved yes/no", there were 8 unimproved patients, 22 in identical condition and 187 surgically-improved patients. The mean MCID for all methods (anchor method and distribution) was 10 [7-13] for Oxford-12, 12 [12-12] for KOOS Symptom, 14 [12-17] for KOOS Pain, 12 [11-14] for KOOS Function, 14 [12-16] for KOOS Sport, 15 [15-16] for KOOS Quality of Life (QOL), 11 [10-12] for KOOS 12, 15 [12-18] for KOOS 12 Pa in. 12 [12-13] for KOOS 12 Function, 15 [15-15] for KOOS 12 QOL, 14 [13-14] for KOOS Physical Function Short-form (PS) and 14 [13-16] for KOOS Joint Replacement (JR). DISCUSSION The MCID for the Oxford-12, KOOS and its derivatives scores in a French population is comparable to that observed in other populations in the literature. LEVEL OF EVIDENCE IV; prospective study without control group.
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Affiliation(s)
- Tom Roussel
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France.
| | - Julien Dartus
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France
| | - Gilles Pasquier
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France
| | - Alain Duhamel
- Lille University, 59000, France; Univ. Lille, CHU Lille, ULR2694-METRICS : évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; CHU Lille, Department of Biostatistics, F-59000 Lille, France
| | - Cristian Preda
- Lille University, 59000, France; Laboratory of Mathematics Paul Painlevé, UMR CNRS 8524, University of Lille, France; Lille Catholics Hospitals, Biostatistics Department Delegation for Clinical Research and Innovation, Lille Catholic University, Lille, France
| | - Henri Migaud
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France
| | - Sophie Putman
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France; Univ. Lille, CHU Lille, ULR2694-METRICS : évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; CHU Lille, Department of Biostatistics, F-59000 Lille, France
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Tanariyakul Y, Kanitnate S, Tammachote N. Cementless and Cemented Total Knee Arthroplasties Have Similar Outcomes but Cementless Patellar Component Migration was Observed in a Paired Randomized Control Trial. J Arthroplasty 2024; 39:1266-1272. [PMID: 37924989 DOI: 10.1016/j.arth.2023.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) has become increasingly popular. Some surgeons are concerned about pain, implant stability, and metal-backed patellar component survivorship. This study investigated the outcomes of cementless compared with cemented TKA in bilateral cases. METHODS We randomized 80 knees in 40 osteoarthritic knee patients who underwent bilateral TKA with patellar resurfacing under one anesthesia. All participants received cementless prostheses in one knee and cemented prostheses in the other. The outcomes were knee function measured by the forgotten joint scores, modified Western Ontario and McMaster Universities Osteoarthritis Index, knee ranges of motion, pain levels, operative times, radiographic outcomes, and complications. All knees were followed for a minimum of 2 years (2 to 3 years). RESULTS Cementless and cemented TKA had similar functional outcomes in forgotten joint score (97 ± 5 versus 98 ± 3 points, P = .52), modified Western Ontario and McMaster Universities Osteoarthritis Index score (3 ± 4 versus 3 ± 2 points, P = .96), and ranges of motion (134 ± 7° versus 134 ± 7°, P = .16). The postoperative pain was also similar (P > .05). There were 4 cementless patellar components had superior migration for an average of 3.5 mm (range, 1.77 to 4.16) without loosening. The mean time of migration was 4 (range, 2 to 6) weeks. CONCLUSIONS Cementless TKA had similar functional outcomes and recovery patterns compared with cemented TKA. However, there was concern of cementless component migration at patellae.
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Affiliation(s)
- Yot Tanariyakul
- Department of Orthopaedics, Thammasat University, Pathumthani, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Thammasat University, Pathumthani, Thailand
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Harris LK, Troelsen A, Terluin B, Gromov K, Ingelsrud LH. Minimal important change thresholds change over time after knee and hip arthroplasty. J Clin Epidemiol 2024; 169:111316. [PMID: 38458544 DOI: 10.1016/j.jclinepi.2024.111316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES The minimal important change (MIC) reflects what patients, on average, consider the smallest improvement in a score that is important to them. MIC thresholds may vary across patient populations, interventions used, posttreatment time points and derivation methods. We determine and compare MIC thresholds for the Oxford Knee Score and Oxford Hip Score (OKS/OHS) at 3 months postoperatively to 12- and 24-month thresholds in patients undergoing knee or hip arthroplasty. STUDY DESIGN AND SETTING This cohort study used data from patients undergoing total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), or total hip arthroplasty (THA) at a public hospital between February 2016 and February 2023. At 3, 12, and 24 months postoperatively, patients responded to the OKS/OHS and a 7-point anchor question determining experienced changes in knee or hip pain and functional limitations. We used the adjusted predictive modeling method that accounts for the proportion improved and the reliability of the anchor question to determine MIC thresholds and their mean differences between time points. RESULTS Complete data were obtained from 695/957 (73%), 1179/1703 (69%), and 1080/1607 (67%) patients undergoing TKA, 474/610 (78%), 438/603 (73%), and 355/507 (70%) patients undergoing UKA, and 965/1315 (73%), 978/1409 (69%), and 1059/1536 (69%) patients undergoing THA at 3, 12, and 24 months, respectively. The median age ranged from 68 to 70 years and 55% to 60% were females. The proportions improved ranged between 83% and 95%. The OKS/OHS MIC thresholds were 0.1, 4.2, and 5.1 for TKA, 1.8, 5.6, and 3.4 for UKA, and 1.3, 6.1, and 6.0 for THA at 3, 12, and 24 months postoperatively, respectively. The reliability ranged between 0.64 and 0.82, and the MIC values increased between three and 12 months but not between 12 and 24 months. CONCLUSION Any absence of deterioration in pain and function is considered important at 3 months after knee or hip arthroplasty. Increasing thresholds over time suggest patients raise their standards for what constitutes a minimal important improvement over the first postoperative year. Besides improving our understanding of patients' views on postoperative outcomes, these clinical thresholds may aid in interpreting registry-based treatment outcome evaluations.
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Affiliation(s)
- Lasse K Harris
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Berend Terluin
- Department of General Practice, Amsterdam UMC Location, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lina H Ingelsrud
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Keiller T, Saari T, Sharegi B, Kärrholm J. No difference in clinical outcome but in RSA in total knee arthroplasty with the ATTUNE vs. the PFC Sigma: a randomized trial with 2-year follow-up. Acta Orthop 2023; 94:560-569. [PMID: 38032279 PMCID: PMC10688434 DOI: 10.2340/17453674.2023.24577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Despite usage of the ATTUNE total knee arthroplasty (TKA) for about 10 years, few randomized trials exist. We evaluated whether the ATTUNE CR design showed improved clinical results compared with the PFC Sigma CR after 2 years and if there was a difference in tibial component migration. PATIENTS AND METHODS 96 patients with knee osteoarthritis were randomly treated with cemented ATTUNE or PFC Sigma TKA. 42 patients with the ATTUNE and 48 with the PFC Sigma attended the 2-year follow-up. Patient-reported outcome measurements (PROMs), migration measured with RSA, implant position, and the development of radiolucent zones were studied. Non-parametric tests and repeated measures analysis were used at the statistical evaluation. RESULTS The Oxford Knee Score (OKS) at 2 years (primary outcome) and neither of the secondary PROM outcomes differed between the groups (mean difference OKS ATTUNE - PFC: -0.08, 95% confidence interval [CI] -2.9 to 2.7). RSA showed posterior tilt of the tibial component in the ATTUNE group with proximal lift-off anteriorly and subsidence of the tibial tray posteriorly. In contrast, the PFC Sigma tibial component tilted forward (mean difference ATTUNE - PFC: -0.7°, CI -1.1° to -0.4°) with maximum subsidence in the front and maximum lift-off of the posterior edge. The postoperative implant positions and the extension of radiolucent lines around the tibial component at 2 years did not differ. CONCLUSION We found no significant differences in clinical outcome between the 2 groups but minor differences in migration pattern of the tibial component. The clinical long-term significance of this finding if any is not known.
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Affiliation(s)
- Thom Keiller
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg.
| | - Tuuli Saari
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg
| | - Bita Sharegi
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg; Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Arndt KB, Schrøder HM, Troelsen A, Lindberg-Larsen M. Patient-reported outcomes and satisfaction after revisions of medial unicompartmental knee arthroplasties for unexplained pain vs aseptic loosening. Knee Surg Sports Traumatol Arthrosc 2023; 31:4766-4772. [PMID: 37498328 PMCID: PMC10598095 DOI: 10.1007/s00167-023-07483-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Does patients revised for unexplained pain after mUKA present the same PROM and satisfaction scores 1-3 years after revision as patients revised for aseptic loosening?". METHODS 104 patients undergoing revision of mUKA's for the indications unexplained pain and aseptic loosening were included in the period January 1, 2018 to December 31, 2020. from the Danish Knee Arthroplasty Register. 52 patients were revised for unexplained pain and 52 for aseptic loosening. Patient demographics did not differ between the two groups. PROMs [Oxford Knee Score (OKS), EQ-5D-5L, Forgotten Joint Score (FJS)] and questions about satisfaction with the surgery were sent to digitally secured mailboxes. Pearson's Chi-square test and Wilcoxon Rank Sum test were used to test for statistical differences between groups. RESULTS The median OKS 1-3 years after revision was 26 (IQR 22) for unexplained pain vs 34 (IQR 12) for aseptic loosening, p = 0.033. The median EQ-5D-5L Index after revision was 0.7 (IQR 0.6) for unexplained vs 0.8 (IQR 0.1) for aseptic loosening, p = 0.014. The median FJS after revision was 48 (IQR 10) for unexplained pain vs 52 (IQR 14) for aseptic loosening, p = 0.1. The mean satisfaction with the surgery on a 0-100 scale (100 = not satisfied; 0 = very satisfied) was 55 (IQR 60) for unexplained pain vs 50 (IQR 67) for aseptic loosening, p = 0.087, and patients revised for unexplained pain were less likely to find their knee problem importantly improved (p = 0.032). CONCLUSION Patients undergoing revision of mUKAs for unexplained pain presented poor postoperative PROM scores, and PROM scores were worse compared to those of patients revised for aseptic loosening. Patients revised for unexplained pain were less likely to find their knee problem importantly improved. This study support the evidence against revisions for unexplained pain. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kristine Bollerup Arndt
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Henrik Morville Schrøder
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedic Surgery, Naestved Hospital. Naestved, Ringstedgade 61, 4700 Næstved, Denmark
| | - Anders Troelsen
- Departmentof Orthopaedic Surgery, Copenhagen University Hospital, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense, Denmark
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Itou J, Itoh M, Kuwashima U, Okazaki K. Lateral joint tightness in flexion following cementless mobile-bearing total knee arthroplasty decreases patient-reported outcome measures and postoperative range of motion. J ISAKOS 2023; 8:332-337. [PMID: 37321294 DOI: 10.1016/j.jisako.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this study was to clarify the association between clinical outcomes and the flexion joint gap following rotating concave-convex (Vanguard ROCC) total knee arthroplasty (TKA). METHODS This consecutive retrospective series included 55 knees that underwent ROCC TKA. All the surgical procedures were performed using a spacer-based gap-balancing technique. To evaluate the medial and lateral flexion gaps, axial radiographs of the distal femur were obtained using the epicondylar view with a distraction force to the lower leg at 6 months postoperatively. Lateral joint tightness was defined as the lateral gap being greater than the medial gap. To evaluate clinical outcomes, patients were asked to complete patient-reported outcome measures (PROMs) questionnaires preoperatively and during at least 1 year of follow-up postoperatively. RESULTS The median follow-up duration was 24.0 months. Overall, 16.0% of patients had postoperative lateral joint tightness in flexion. The postoperative range of motion and PROMs were lower in patients with lateral joint tightness than in those with a balanced flexion gap or lateral joint laxity. No serious complications, including bearing dislocations, occurred during the observation period. CONCLUSION Lateral joint tightness in flexion following ROCC TKA decreases PROMs and postoperative range of motion. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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Garval M, Runge C, Holm CF, Mikkelsen LR, Pedersen AR, Vestergaard TAB, Skou ST. Prognostic factors of knee pain and function 12 months after total knee arthroplasty: A prospective cohort study of 798 patients. Knee 2023; 44:201-210. [PMID: 37672912 DOI: 10.1016/j.knee.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Approximately 20% of patients undergoing total knee arthroplasty (TKA) do not experience long-term improvements. Our aim was to identify prognostic factors of knee pain and function 12 months after TKA. METHODS In a prospective cohort study, 1026 patients underwent primary TKA between 2018 and 2020. Main outcome was measured by the Oxford Knee Score (OKS) categorized in five categories (0-9, 10-19, 20-29, 30-39 and 40-48). Potential prognostic factors obtained at baseline included sex, age, baseline OKS, pain catastrophizing scale, EuroQol 5 dimensions, previous surgery, BMI, ASA classification, opioid consumption, living and employment conditions as well as educational level. Ordinal logistic regression analysis was used to identify prognostic factors of OKS. RESULTS A total of 915 patients completed follow up (89%), and patients with complete data were included (n = 798). Patients with a baseline OKS between 10-19 and 20-29 had 2.5 (CI 1.6;4.0) and 1.6 (CI 1.1;2.4) higher odds, respectively, of no improvement or deterioration to a lower post-operative OKS category, compared with patients with a baseline score between 30 and 39. Female patients had 1.5 (CI 1.1;2.0) and patients receiving social benefits compared with retired patients had 2.0 (CI 1.1;3.5) higher odds of no improvement or deterioration to a lower OKS category. CONCLUSION Baseline level of pain and function, sex and employment status were significant prognostic factors of OKS 12 months after TKA. Overall, the regression analysis only explained 4% of the outcome, indicating that it is difficult to predict 12-month TKA outcome prior to surgery.
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Affiliation(s)
- Mette Garval
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.
| | - Charlotte Runge
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Carsten F Holm
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Lone R Mikkelsen
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Asger R Pedersen
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark; University Research Clinic for Innovative Patient Pathways, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | | | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Ringsted-Slagelse Hospital, Slagelse, Denmark
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10
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Mørup-Petersen A, Krogsgaard MR, Laursen M, Madsen F, Winther-Jensen M, Odgaard A. Patients in high- and low-revision hospitals have similar outcomes after primary knee arthroplasty: 1-year postoperative results from the Danish prospective multicenter cohort study, SPARK. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07390-3. [PMID: 37042976 DOI: 10.1007/s00167-023-07390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/04/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE It is well-known that revision rates after primary knee arthroplasty vary widely. However, it is uncertain whether hospital revision rates are reliable indicators of general surgical quality as defined by patients. The SPARK study compared primary knee arthroplasty surgery at three high-volume hospitals whose revision rates differed for unknown reasons. METHODS This prospective observational study included primary knee arthroplasty patients (total, medial/lateral unicompartmental and patellofemoral) in two low-revision hospitals (Aarhus University Hospital and Aalborg University Hospital Farsø) and one high-revision hospital (Copenhagen University Hospital Herlev-Gentofte). Patients were followed from preoperatively (2016-17) to 1-year postoperatively with patient-reported outcome measures including Oxford Knee Score (OKS), EQ-5D-5L and Copenhagen Knee ROM (range of motion) Scale. The surgical outcomes were compared across hospitals for patients with comparable grades of radiographic knee osteoarthritis and preoperative OKS. Statistical comparisons (parametric and non-parametric) included all three hospitals. RESULTS 97% of the 1452 patients who provided baseline data (89% of those included and 56% of those operated) responded postoperatively (90% at 1 year). Hospitals' utilization of unicompartmental knee arthroplasties differed (Aarhus 49%, Aalborg 14%, and Copenhagen 22%, p < 0.001). 28 patients had revision surgery during the first year (hospital independent, p = 0.1) and were subsequently excluded. 1-year OKS (39 ± 7) was independent of hospital (p = 0.1), even when adjusted for age, sex, Body Mass Index, baseline OKS and osteoarthritis grading. 15% of patients improved less than Minimal Important Change (8 OKS) (Aarhus 19%, Aalborg 13% and Copenhagen 14%, p = 0.051 unadjusted). Patients with comparable preoperative OKS or osteoarthritis grading had similar 1-year results across hospitals (OKS and willingness to repeat surgery, p ≥ 0.087) except for the 64 patients with Kellgren-Lawrence grade-4 (Aarhus 4-6 OKS points lower). 86% of patients were satisfied, and 92% were "willing to repeat surgery", independent of hospital (p ≥ 0.1). Hospital revision rates differences diminished during the study period. CONCLUSIONS Patients in hospitals with a history of differing revision rates had comparable patient-reported outcomes 1 year after primary knee arthroplasty, supporting that surgical quality should not be evaluated by revision rates alone. Future studies should explore if revision rate variations may depend as much on revision thresholds and indications as on outcomes of primary surgery. LEVEL OF EVIDENCE Level II (Prospective cohort study).
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Affiliation(s)
- Anne Mørup-Petersen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark.
| | - Michael Rindom Krogsgaard
- Department of Orthopaedic Surgery, Section for Sports Traumatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
| | - Matilde Winther-Jensen
- Center for Clinical Research and Prevention, Department of Data, Biostatistics and Pharmacoepidemiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, University of Copenhagen, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Harris LK, Troelsen A, Terluin B, Gromov K, Overgaard S, Price A, Ingelsrud LH. Interpretation Threshold Values for the Oxford Hip Score in Patients Undergoing Total Hip Arthroplasty: Advancing Their Clinical Use. J Bone Joint Surg Am 2023; 105:797-804. [PMID: 36947604 DOI: 10.2106/jbjs.22.01293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Patient-reported outcome measures such as the Oxford Hip Score (OHS) can capture patient-centered perspectives on outcomes after total hip arthroplasty (THA). The OHS assesses hip pain and functional limitations, but defining interpretation threshold values for the OHS is warranted so that numerical OHS values can be translated into whether patients have experienced clinically meaningful changes. Therefore, we determined the minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) threshold values for the OHS at 12 and 24-month follow-up in patients undergoing THA. METHODS This cohort study used data from patients undergoing THA at 1 public hospital between July 2016 and April 2021. At 12 and 24 months postoperatively, patients provided responses for the OHS and for 3 anchor questions about whether they had experienced changes in hip pain and function, whether they considered their symptom state to be satisfactory, and if it was not satisfactory, whether they considered the treatment to have failed. The anchor-based adjusted predictive modeling method was used to determine interpretation threshold values. Baseline dependency was evaluated using a new item-split method. Nonparametric bootstrapping was used to determine 95% confidence intervals (CIs). RESULTS Complete data were obtained for 706 (69%) of 1,027 and 728 (66%) of 1,101 patients at 12 and 24 months postoperatively, respectively. These patients had a median age of 70 years, and 55% to 56% were female. Adjusted OHS MIC values were 6.3 (CI, 4.6 to 8.1) and 5.2 (CI, 3.6 to 6.7), adjusted OHS PASS values were 30.6 (CI, 29.0 to 32.2) and 30.5 (CI, 29.3 to 31.8), and adjusted OHS TF values were 25.5 (CI, 22.9 to 27.7) and 27.0 (CI, 25.2 to 28.8) at 12 and 24 months postoperatively, respectively. MIC values were 5.4 (CI, 2.1 to 9.1) and 5.0 (CI, 1.9 to 8.7) higher at 12 and 24 months, respectively, in patients with a more severe preoperative state. CONCLUSIONS The established interpretation threshold values advance the interpretation and clinical use of the OHS, and may prove especially beneficial for registry-based evaluations of treatment quality. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lasse K Harris
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Berend Terluin
- Department of General Practice, Amsterdam UMC Location, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Lina H Ingelsrud
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Bagge A, Jensen CB, Mikkelsen M, Gromov K, Nielsen CS, Troelsen A. Obese Patients Achieve Good Improvements in Patient-Reported Outcome Measures After Medial Unicompartmental Knee Arthroplasty Despite a Lower Preoperative Score. J Arthroplasty 2023; 38:252-258.e2. [PMID: 36096272 DOI: 10.1016/j.arth.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In this study, we examined the association between obesity and patient-reported outcome measures after medial unicompartmental knee arthroplasty (MUKA), assessed through score changes, Patient Acceptable Symptom State (PASS), and minimal important change (MIC). Second, the association between obesity and early readmissions was examined. METHODS A total of 450 MUKAs (mean body mass index [BMI] 30.3, range, 19.6-53.1), performed from February 2016 to December 2020, were grouped using BMI: <30, 30-34.9, and >34.9. Oxford Knee Score (OKS), Forgotten Joint Score (FJS), and Activity and Participation Questionnaire (APQ) were assessed preoperatively and at 3, 12, and 24 months, postoperatively. The 12-month PASS and MIC were also assessed, defining PASS as OKS = 30, MIC-OKS as change in OKS = 8, and MIC-FJS as change in FJS = 14. RESULTS No significant differences in OKS change were found between BMI groups. After 12 months, patients who had a BMI of 30-34.9 had lower change in FJS (estimate -8.1, 95% CI -14.9 to -1.4) and were less likely to reach PASS (odds ratio 0.4, 95% CI 0.2-0.7) as well as MIC-FJS (odds ratio 0.5, 95% CI 0.2-0.9). Both obese groups had lower change in APQ after 12 months. Differences in 90-day readmission rates were nonsignificant between groups. CONCLUSION Our findings of no differences in OKS improvement between BMI groups and achieving MIC for BMI > 34.9 suggest good improvements in obese patients despite lower preoperative scores, supporting contemporary indications for MUKA. Lower APQ development and achievement of 12-month PASS may be used when addressing expectations of recovery.
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Affiliation(s)
- Anders Bagge
- Hvidovre Hospital Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Christian B Jensen
- Hvidovre Hospital Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Mette Mikkelsen
- Hvidovre Hospital Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Kirill Gromov
- Hvidovre Hospital Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Christian S Nielsen
- Hvidovre Hospital Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Anders Troelsen
- Hvidovre Hospital Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark
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Kastrup N, Bjerregaard HH, Laursen M, Valentin JB, Johnsen SP, Jensen CE. An AI-based patient-specific clinical decision support system for OA patients choosing surgery or not: study protocol for a single-centre, parallel-group, non-inferiority randomised controlled trial. Trials 2023; 24:24. [PMID: 36635747 PMCID: PMC9837885 DOI: 10.1186/s13063-022-07039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) affects 20% of the adult Danish population, and the financial burden to society amounts to DKK 4.6 billion annually. Research suggests that up to 75% of surgical patients could have postponed an operation and managed with physical training. ERVIN.2 is an artificial intelligence (AI)-based clinical support system that addresses this problem by enhancing patient involvement in decisions concerning surgical knee and hip replacement. However, the clinical outcomes and cost-effectiveness of using such a system are scantily documented. OBJECTIVE The primary objective is to investigate whether the usual care is non-inferior to ERVIN.2 supported care. The second objective is to determine if ERVIN.2 enhances clinical decision support and whether ERVIN.2 supported care is cost-effective. METHODS This study used a single-centre, non-inferiority, randomised controlled in a two-arm parallel-group design. The study will be reported in compliance with CONSORT guidelines. The control group receives the usual care. As an add-on, the intervention group have access to baseline scores and predicted Oxford hip/knee scores and HRQoL for both the surgical and the non-surgical trajectory. A cost-utility analysis will be conducted alongside the trial using a hospital perspective, a 1-year time horizon and effects estimated using EQ-5D-3L. Results will be presented as cost per QALY gain. DISCUSSION This study will bring knowledge about whether ERVIN.2 enhances clinical decision support, clinical effects, and cost-effectiveness of the AI system. The study design will not allow for the blinding of surgeons. TRIAL REGISTRATION ClinicalTrials.gov NCT04332055 . Registered on 2 April 2020.
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Affiliation(s)
- Nanna Kastrup
- grid.5117.20000 0001 0742 471XDanish Center for Healthcare Improvements, Aalborg University, Frederik Bajers Vej 5, 9220 Aalborg, Denmark
| | - Helene H. Bjerregaard
- The Danish Clinical Quality Program – National Clinical Registries, Hedeager 3, 8200 Aarhus N, Denmark
| | - Mogens Laursen
- grid.27530.330000 0004 0646 7349Orthopaedic Department, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - Jan B. Valentin
- grid.5117.20000 0001 0742 471XDanish Center for Clinical Health Services Research, Aalborg University, Frederik Bajers Vej 5, 9220 Aalborg, Denmark
| | - Søren P. Johnsen
- grid.5117.20000 0001 0742 471XDanish Center for Clinical Health Services Research, Aalborg University, Frederik Bajers Vej 5, 9220 Aalborg, Denmark
| | - Cathrine E. Jensen
- grid.5117.20000 0001 0742 471XDanish Center for Healthcare Improvements, Aalborg University, Frederik Bajers Vej 5, 9220 Aalborg, Denmark
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14
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Hoffmann J, Jansen JA, Bénard MR, Gademan MGJ, G H H Nelissen R. Mid-term effect of total knee arthroplasty with and without tourniquet use on prosthesis survival, complications and functional outcome: A prospective cohort study of 511 total knee arthroplasties. Knee 2023; 41:18-28. [PMID: 36608359 DOI: 10.1016/j.knee.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/07/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND A tourniquet is often used to create a bloodless surgical field during total knee arthroplasty (TKA). It is still debated whether tourniquet use improves durability of cemented implant fixation and thereby prosthesis survival. Some studies showed tourniquet application has a negative impact on post-operative wound healing, pain and function, whilst other publications contradict this. However, no previous studies evaluated the effect of tourniquet use on prosthesis survival and mid-term functional outcome specifically. METHODS In this longitudinal observational cohort study 115 patients (116 knees) undergoing TKA without tourniquet use were compared with 374 patients (395 knees) with a tourniquet. Prosthesis survival, revision risks and complications were analysed through chart review after ameanfollow-up period of5.3 years.Additionally, patient reported outcome measures regarding knee functionality and health status (PROMs; KOOS, OKS, EQ-5D, SF-12) werecollected prospectively. RESULTS Both groups had an equal overall re-operation rate of 4.3% and showed similar revision rates for aseptic loosening as well as for other causes. In the tourniquet group a higher complication rate (14.7% vs 10.3%) was observed. The majority was urinary retention requiring bladder catheterization. Both groups showed comparable, improved post-operative functional results compared to the pre-operative state for all PROMs atall timepoints. CONCLUSIONS In this study TKA without tourniquet use yielded similar mid-term results as TKA with tourniquet use with regard to prosthesis survival, reoperations, complications, knee functionality and health status.
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Affiliation(s)
- Jim Hoffmann
- Department of Orthopaedics, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, the Netherlands.
| | - Joris A Jansen
- Department of Orthopaedics, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, the Netherlands
| | - Menno R Bénard
- Department of Orthopaedics, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, the Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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15
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Guta D, Santini AJ, Gornall M, Phillipson A, Davidson JS, Banks J, Pope JA, Yorke J. Short-Term functional comparison of three total knee arthroplasties-Journey II, Genesis II and Profix. J Orthop Surg (Hong Kong) 2023; 31:10225536231169572. [PMID: 37088733 DOI: 10.1177/10225536231169572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
AIM OF THE STUDY To compare the outcomes of three knee arthroplasty design philosophies and surface tribology.• A zirconium-surfaced, bicruciate-stabilised implant designed to mimic kinematic movement and improve flexion and outcomes;• A cobalt-chrome surfaced, multi-radius design with built-in femoral external rotation to aid balancing and patella tracking through a deeper trochlea groove;• A zirconium-surfaced, single-radius implant designed on surface conformity, particularly within the patello-femoral joint. METHODS 313 knee replacements - 103 Journey II, 103 Genesis II and 107 Profix - were statistically assessed at a minimum of 2 years using WOMAC, Oxford and SF-12 scores, and range of movement. RESULTS There was no difference between the actual or unit change in WOMAC scores (p = 0.140 and p = 0.287), SF-12 physical (p = 0.088) or mental scores (p = 0.975) between the three implants; or between the actual or unit change in Oxford score (p = 0.912 and p = 0.874) for the Journey II or Genesis II. The Journey II produced more flexion and range of movement than the Genesis II (p < 0.001 and p = 0.018) and Profix (p < 0.001 and <0.001) with no difference between the latter two (p = 0.402 and 0.568); with no difference in extension between the three implants (p = 0.086). There was no difference between those with or without a resurfaced patella. CONCLUSION The three design philosophies and surfaces yielded no difference in outcome scores at 2 years post-operatively. The Journey II demonstrated better post-operative flexion. Resurfacing the patella did not alter the outcome scores or flexion.
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Affiliation(s)
- Daniel Guta
- Department of Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Alasdair Ja Santini
- Department of Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Matt Gornall
- Liverpool Cancer Trials Unit, The University of Liverpool, Liverpool, UK
| | - Andrew Phillipson
- Department of Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - John S Davidson
- Department of Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Joanne Banks
- Department of Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jill A Pope
- Department of Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Joanne Yorke
- Department of Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Kato M, Warashina H, Mitamura S, Kataoka A. Medial pivot-based total knee arthroplasty achieves better clinical outcomes than posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:998-1010. [PMID: 36089624 PMCID: PMC9464619 DOI: 10.1007/s00167-022-07149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Stability in the sagittal plane, particularly regarding anterior cruciate ligament compensation, and postoperative functionality and satisfaction remain issues in total knee arthroplasty. Therefore, this prospective study compared the clinical outcomes between medial-pivot-based and posterior-stabilised total knee arthroplasty based on anterior translation and clinical scores. METHODS To assess outcomes of total knee arthroplasty for varus osteoarthritis, the anterior translation distance of the tibia relative to the femur was measured at 30 and 60° of flexion using a KS measure Arthrometer at 6 months postoperatively. The 2011 Knee Society Score, Forgotten Joint Score, visual analogue scale for pain, and range of motion were assessed at 6 months and 1 year postoperatively. The correlations among each score, anterior translation distance, range of motion, and visual analogue scale score for pain were investigated. RESULTS The medial-pivot and posterior-stabilised groups comprised 70 and 51 patients, respectively. The medial-pivot group exhibited a significantly shorter anterior translation distance at 60° flexion than the posterior-stabilised group. Furthermore, the medial-pivot group achieved significantly better outcomes regarding the visual analogue scale for pain, 2011 Knee Society Score, and Forgotten Joint Score than the posterior-stabilised group. A significant negative correlation was observed between the anterior translation distance and the function score of the 2011 Knee Society Score, whereas a significant positive correlation was found between the anterior translation distance and flexion angle, and between the extension angle and score of the Forgotten Joint Score or 2011 Knee Society Score. Significant negative correlations were also found between the pain visual analogue scale and both the 2011 Knee Society Score and Forgotten Joint Score. CONCLUSION In total knee arthroplasty for osteoarthritis, the medial-pivot group displayed a shorter anterior translation distance than the posterior-stabilised group at 6 months postoperatively. The visual analogue scale score for pain was also significantly lower in the medial-pivot group than that in the posterior-stabilised group at both 6 months and 1 year postoperatively. Because a correlation was observed between the anterior translation distance and the function score, medial-pivot-based total knee arthroplasty was considered to significantly improve postoperative function compared to posterior-stabilised total knee arthroplasty.
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Affiliation(s)
- Michitaka Kato
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi, 481-0011, Japan.
| | - Hideki Warashina
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Shingo Mitamura
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Akito Kataoka
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
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Badge H, Churches T, Naylor JM, Xuan W, Armstrong E, Gray L, Fletcher J, Gosbell I, Christine Lin CW, Harris IA. Association between VTE and antibiotic prophylaxis guideline compliance and patient-reported outcomes after total hip and knee arthroplasty: an observational study. J Patient Rep Outcomes 2022; 6:110. [PMID: 36224453 PMCID: PMC9556685 DOI: 10.1186/s41687-022-00502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/02/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) and venous thromboembolism (VTE) are associated with high burden and cost and are considered largely preventable following total knee or hip arthroplasty (TKA, THA). The risk of developing VTE and SSI is reduced when prophylaxis is compliant with evidence-based clinical guidelines. However, the association between VTE and antibiotic prophylaxis clinical guideline compliance and patient-reported outcome measures (PROMs) after THA/TKA is unknown. This study aims to explore whether care that is non-compliant with VTE and antibiotic guideline recommendations is associated with PROMs (Oxford Hip/Knee Score and EQ-5D Index scores) at 90- and 365-days after surgery. METHODS This prospective observational study included high-volume arthroplasty public and private sites and consenting eligible participants undergoing elective primary THA/TKA. We conducted multiple linear regression and linear mixed-effects modelling to explore the associations between non-compliance with VTE and antibiotic guidelines, and PROMs. RESULTS The sample included 1838 participants. Compliance with VTE and antibiotic guidelines was 35% and 13.2% respectively. In adjusted modelling, non-compliance with VTE guidelines was not associated with 90-day Oxford score (β = - 0.54, standard error [SE] = 0.34, p = 0.112) but was significantly associated with lower (worse) 365-day Oxford score (β = - 0.76, SE = 0.29, p = 0.009), lower EQ-5D Index scores at 90- (β = - 0.02 SE = 0.008, p = 0.011) and 365-days (β = - 0.03, SE = 0.008, p = 0.002).. The changes in Oxford and EQ-5D Index scores were not clinically important. Noncompliance with antibiotic guidelines was not associated with either PROM at 90- (Oxford: β = - 0.45, standard error [SE] = 0.47, p = 0.341; EQ-5D: β = - 0.001, SE = 0.011, p = 0.891) or 365-days (Oxford score: β = - 0.06, SE = 0.41, p = 0.880 EQ-5D: β = - 0.010, SE = 0.012, p = 0.383). Results were consistent when complications were included in the model and in linear mixed-effects modelling with the insurance sector as a random effect. CONCLUSIONS Non-compliance with VTE prophylaxis guidelines, but not antibiotic guidelines, is associated with statistically significant but not clinically meaningful differences in Oxford scores and EQ-5D Index scores at 365 days.
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Affiliation(s)
- Helen Badge
- Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071 Australia ,grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia ,grid.411958.00000 0001 2194 1270Australian Catholic University, 8-20 Napier Street, North Sydney, 2060 Australia
| | - Tim Churches
- grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia
| | - Justine M. Naylor
- Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071 Australia ,grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia
| | - Wei Xuan
- grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia
| | - Elizabeth Armstrong
- grid.1005.40000 0004 4902 0432School of Population Health, The University of New South Wales, High St Kensington, Kensington, NSW 2052 Australia
| | - Leeanne Gray
- grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, 1 Elizabeth Street, Liverpool, 2071 Australia
| | - John Fletcher
- grid.1013.30000 0004 1936 834XUniversity of Sydney, Fisher Road, Camperdown, NSW 2006 Australia ,grid.413252.30000 0001 0180 6477Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145 Australia
| | - Iain Gosbell
- grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia ,grid.1029.a0000 0000 9939 5719Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Chung-Wei Christine Lin
- grid.1013.30000 0004 1936 834XSydney School of Public Health, The University of Sydney, Edward Ford Building (A27) Fisher Road, Camperdown, NSW 2006 Australia
| | - Ian A. Harris
- Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071 Australia ,grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071 Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, 2071 Australia ,grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, 1 Elizabeth Street, Liverpool, 2071 Australia
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Comparison of postoperative knee flexion and patient satisfaction between newly and conventionally designed medial pivot total knee arthroplasty: a 5-year follow-up matched cohort study. Arch Orthop Trauma Surg 2022; 142:2057-2064. [PMID: 34390387 DOI: 10.1007/s00402-021-04121-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The medial pivot total knee arthroplasty (TKA) has good patients' satisfaction; however, there is likely the restriction of postoperative knee flexion. The 2nd generation medial pivot TKA prosthesis was designed to improve postoperative knee flexion. This study aimed to compare the clinical outcomes and patient satisfaction between the 2nd generation and 1st generation medial pivot TKA prostheses. MATERIALS AND METHODS We conducted a retrospective study of 472 consecutive TKAs, performed using either the 2nd generation (EVOLUTION™), having smaller posterior femoral condyle and asymmetrical tibial tray, or 1st generation (ADVANCE™) prosthesis. The use of each system was historically determined. Patient age, sex and body mass index were matched between the two groups, with 157 cases ultimately included in each group. Measured clinical outcomes included: knee range of motion, the Knee Society Score, the rate of re-operation, and radiological parameters. Patient satisfaction was evaluated using the 12-item Forgotten Joint Score (FJS-12). RESULTS The average follow-up period was 5.0 (3.7-6.3) years for the 2nd generation group and 8.7 (6.1-12.8) years for the 1st generation group (p < 0.01). The postoperative knee flexion range was 127° (80°-140°) for the 2nd generation and 118° (90°-135°) for the 1st generation at final follow-up (p < 0.01). On multivariate regression analysis, use of the 2nd generation prosthesis predicted greater postoperative knee flexion. The average FJS-12 score was 64 (0-100) for the 2nd generation and mean 57 (0-100) for the 1st generation (p < 0.01). Other clinical outcomes were similar between the two groups. CONCLUSIONS Compared to the 1st generation, the 2nd generation medial pivot prosthesis provides greater postoperative knee flexion and patient satisfaction.
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19
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Singh V, Fiedler B, Huang S, Oh C, Karia RJ, Schwarzkopf R. Patient Acceptable Symptom State for the Forgotten Joint Score in Primary Total Knee Arthroplasty. J Arthroplasty 2022; 37:1557-1561. [PMID: 35346809 DOI: 10.1016/j.arth.2022.03.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In order to better understand the clinical benefits of total knee arthroplasty (TKA) and improve the interpretability of the Forgotten Joint Score (FJS-12), the establishment of a meaningful change in score is necessary. The purpose of this study is to determine the threshold of the FJS-12 for detecting the patient acceptable symptom state (PASS) following primary TKA. METHODS We retrospectively reviewed all patients who underwent elective, primary TKA and answered both the FJS-12 and the Knee Injury Osteoarthritis Outcome Survey, Joint Replacement KOOS, JR surveys 1-year postoperatively. The questionnaires were administered via a web-based electronic application. KOOS, JR score was used as the anchor. The anchor for PASS calculation should relate pain, physical function, and patient satisfaction. Two statistical methods were employed: (1) the receiver operating characteristic (ROC) curve point; (2) 75th percentile of the cumulative percentage curve of patients who had the KOOS, JR score difference larger than the cut-off value. RESULTS This study included 457 patients. The mean 1-year FJS-12 score was 42.6 ± 27.8. The mean 1-year KOOS, JR score was 68.0 ± 17.2. A high positive correlation between FJS-12 and KOOS, JR was found (r = 0.72, P < .001) making the KOOS, JR a valid external anchor. The threshold score of the FJS-12 which maximized the sensitivity and specificity for detecting a PASS was 33.3 (AUC = 0.78, 95% CI [0.74, 0.83]). The cut-off value computed with the 75th percentile approach was 77.1 (95% CI [73.9, 81.5]). CONCLUSION The PASS threshold for the FJS-12 was 33.3 and 77.1 at 1-year follow-up after primary TKA using the receiver operating characteristic (ROC) curve and 75th percentile approaches, respectively. These values can be used to assess the successful achievement of a forgotten joint. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Shengnan Huang
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Cheongeun Oh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Raj J Karia
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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20
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Joo PY, Chen AF, Richards J, Law TY, Taylor K, Marchand K, Clark G, Collopy D, Marchand RC, Roche M, Mont MA, Malkani AL. Clinical results and patient-reported outcomes following robotic-assisted primary total knee arthroplasty : a multicentre study. Bone Jt Open 2022; 3:589-595. [PMID: 35848995 PMCID: PMC9350694 DOI: 10.1302/2633-1462.37.bjo-2022-0076.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims The aim of this study was to report patient and clinical outcomes following robotic-assisted total knee arthroplasty (RA-TKA) at multiple institutions with a minimum two-year follow-up. Methods This was a multicentre registry study from October 2016 to June 2021 that included 861 primary RA-TKA patients who completed at least one pre- and postoperative patient-reported outcome measure (PROM) questionnaire, including Forgotten Joint Score (FJS), Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR), and pain out of 100 points. The mean age was 67 years (35 to 86), 452 were male (53%), mean BMI was 31.5 kg/m2 (19 to 58), and 553 (64%) cemented and 308 (36%) cementless implants. Results There were significant improvements in PROMs over time between preoperative, one- to two-year, and > two-year follow-up, with a mean FJS of 17.5 (SD 18.2), 70.2 (SD 27.8), and 76.7 (SD 25.8; p < 0.001); mean KOOS JR of 51.6 (SD 11.5), 85.1 (SD 13.8), and 87.9 (SD 13.0; p < 0.001); and mean pain scores of 65.7 (SD 20.4), 13.0 (SD 19.1), and 11.3 (SD 19.9; p < 0.001), respectively. There were eight superficial infections (0.9%) and four revisions (0.5%). Conclusion RA-TKA demonstrated consistent clinical results across multiple institutions with excellent PROMs that continued to improve over time. With the ability to achieve target alignment in the coronal, axial, and sagittal planes and provide intraoperative real-time data to obtain balanced gaps, RA-TKA demonstrated excellent clinical outcomes and PROMs in this patient population. Cite this article: Bone Jt Open 2022;3(7):589–595.
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Affiliation(s)
- Peter Y Joo
- University of Rochester Medical Center, Rochester, New York, USA
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jarod Richards
- Department of Orthopaedics, University of Louisville, Louisville, Kentucky, USA
| | - Tsun Y Law
- Department of Orthopaedics, Holy Cross Hospital, Fort Lauderdale, Florida, USA
| | - Kelly Taylor
- Orthopedics Rhode Island, Providence, Rhode Island, USA
| | - Kevin Marchand
- Department of Orthopaedics, Lenox Hill Hospital, New York, New York, USA
| | | | | | | | - Martin Roche
- Department of Orthopaedics, Holy Cross Hospital, Fort Lauderdale, Florida, USA
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedic Surgery, Baltimore, Maryland, USA
| | - Arthur L Malkani
- Department of Orthopaedics, University of Louisville, Louisville, Kentucky, USA
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21
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Defining the minimal clinically important difference for the knee society score following revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:2744-2752. [PMID: 34117505 DOI: 10.1007/s00167-021-06628-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND No previous study has evaluated the MCID for revision total knee arthroplasty (TKA). This study aimed to identify the MCID for the Knee Society Score (KSS), for revision TKA. METHODS Prospectively collected data from 270 patients who underwent revision TKA at a single institution was analysed. Clinical assessment was performed preoperatively, at 6 months and 2 years using Knee Society Function Score (KSFS) and Knee (KSKS) Scores, and Oxford Knee Score (OKS). MCID was evaluated with a three-pronged methodology, using (1) anchor-based method with linear regression, (2) anchor-based method with receiver operating characteristic (ROC) and area under curve (AUC), (3) distribution-based method with standard deviation (SD). The anchors used were improvement in OKS ≥ 5, patient satisfaction, and implant survivorship following revision TKA. RESULTS The cohort comprised 70% females, with mean age of 69.0 years, that underwent unilateral revision TKA. The MCID determined by anchor-based linear regression method using OKS was 6.3 for KSFS, and 6.6 for KSKS. The MCID determined by anchor-based ROC was between 15 and 20 for KSFS (AUC: satisfaction = 71.8%, survivorship = 61.4%) and between 33 and 34 for KSKS (AUC: satisfaction = 76.3%, survivorship = 67.1%). The MCID determined by distribution-based method of 0.5 SD was 11.7 for KSFS and 11.9 for KSKS. CONCLUSION The MCID of 6.3 points for KSFS, and 6.6 points for KSKS, is a useful benchmark for future studies looking to compare revision against primary TKA outcomes. Clinically, the MCID between 15 and 20 for KSFS and between 33 and 34 for KSKS is a powerful tool for discriminating patients with successful outcomes after revision TKA. Implant survivorship is an objective and naturally dichotomous outcome measure that complements the subjective measure of patient satisfaction, which future MCID studies could consider utilizing as anchors in ROC. LEVEL OF EVIDENCE II.
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22
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Young SW, Zeng N, Tay ML, Fulker D, Esposito C, Carter M, Bayan A, Farrington B, Van Rooyen R, Walker M. A prospective randomised controlled trial of mechanical axis with soft tissue release balancing vs functional alignment with bony resection balancing in total knee replacement-a study using Stryker Mako robotic arm-assisted technology. Trials 2022; 23:580. [PMID: 35858944 PMCID: PMC9296895 DOI: 10.1186/s13063-022-06494-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background Improving the functional outcome following total knee arthroplasty (TKA) by using different alignment techniques remains controversial. The surgical techniques and technologies used so far to obtain these alignments have all suffered from inaccuracies. The use of robotic technology to plan and execute the bony resection provides increased accuracy for these various alignment techniques and may determine which will deliver superior function. Functional alignment (FA) is a newer surgical technique that aims to position the prosthesis with respect to each patients’ specific bony anatomy whilst minimising disruption to the soft tissue envelope. This trial aims to compare the patient and surgical outcomes of FA to the current gold standard surgical technique, mechanical alignment (MA), under randomised and blinded conditions. Methods Patients with symptomatic knee osteoarthritis will be prospectively recruited. Following informed consent, 240 patients will be randomised to either a MA surgical technique (the control group) or a FA surgical technique (the intervention group) at a ratio of 4:1 using a random number generator. All patients will undergo computer tomography (CT) based robotic arm-assisted surgery to execute planned implant positioning and alignment with high levels of accuracy. The primary outcome is the forgotten joint score (FJS) at 2 years post-operation. Secondary outcome measures include patient reported outcome measures of post-operative rehabilitation, pain, function and satisfaction, as well as limb alignment, implant revisions and adverse events. Intention-to-treat and per-protocol population analysis will also be conducted. Standardisation of the surgical system and care pathways will minimise variation and assist in both patient and physiotherapist blinding. Ethical approval was obtained from the Northern B Health and Disability Ethics Committee (20/NTB/10). Discussion Currently, MA remains the gold standard in knee replacement due to proven outcomes and excellent long-term survivorship. There are many alternative alignment techniques in the literature, all with the goal of improving patient outcomes. This study is unique in that it leverages an advanced analytics tool to assist the surgeon in achieving balance. Both alignment techniques will be executed with high precision using the CT-based robotic arm-assisted surgery system which will minimise surgical variation. This trial design will help determine if FA delivers superior outcomes for patients. Trial registration Australia and New Zealand Clinical Trials Registry (ANZCTR), ACTRN12620000009910. Registered on 9 January 2020. ClinicalTrials.gov, NCT04600583. Registered on 29 September 2020.
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Affiliation(s)
- Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nina Zeng
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Mei Lin Tay
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - David Fulker
- Stryker Australia Pty Ltd, St Leonards, NSW, Australia.
| | | | | | - Ali Bayan
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Bill Farrington
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Rupert Van Rooyen
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Matthew Walker
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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HARRIS LK, TROELSEN A, TERLUIN B, GROMOV K, PRICE A, INGELSRUD LH. Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty. Acta Orthop 2022; 93:634-642. [PMID: 35819794 PMCID: PMC9275498 DOI: 10.2340/17453674.2022.3909] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Developing meaningful thresholds for the Oxford Knee Score (OKS) advances its clinical use. We determined the minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) values as meaningful thresholds for the OKS at 3-, 12-, and 24-month follow-up in patients undergoing unicompartmental knee arthroplasty (UKA). PATIENTS AND METHODS This is a cohort study with data from patients undergoing UKA collected at a hospital in Denmark between February 2016 and September 2021. The OKS was completed preoperatively and at 3, 12, and 24 months postoperatively. Interpretation threshold values were calculated with the anchor-based adjusted predictive modeling method. Non-parametric bootstrapping was used to derive 95% confidence intervals (CI). RESULTS Complete 3-, 12-, and 24-month postoperative data was obtained for 331 of 423 (78%), 340 of 479 (71%), and 235 of 338 (70%) patients, median age of 68-69 years (58-59% females). Adjusted OKS MIC values were 4.7 (CI 3.3-6.0), 7.1 (CI 5.2-8.6), and 5.4 (CI 3.4- 7.3), adjusted OKS PASS values were 28.9 (CI 27.6-30.3), 32.7 (CI 31.5-33.9), and 31.3 (CI 29.1-33.3), and adjusted OKS TF values were 24.4 (CI 20.7-27.4), 29.3 (CI 27.3-31.1), and 28.5 (CI 26.0-30.5) at 3, 12, and 24 months postoperatively, respectively. All values statistically significantly increased from 3 to 12 months but not from 12 to 24 months. INTERPRETATION The UKA-specific measurement properties and clinical thresholds for the OKS can improve the interpretation of UKA outcome and assist quality assessment in institutional and national registries.
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Affiliation(s)
- Lasse K HARRIS
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen Denmark
| | - Anders TROELSEN
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen Denmark
| | - Berend TERLUIN
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kirill GROMOV
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen Denmark
| | - Andrew PRICE
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Lina H INGELSRUD
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen Denmark
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24
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Larrainzar-Garijo R, Molanes-López EM, Cañones-Martín M, Murillo-Vizuete D, Valencia-Santos N, Garcia-Bogalo R, Corella-Montoya F. Computer-Assisted Surgery Enables Beginner Surgeons, Under Expert Guidance, to Achieve Long-Term Clinical Results not Inferior to Those of a Skilled Surgeon in Knee Arthroplasty. Indian J Orthop 2022; 56:1439-1448. [PMID: 35923307 PMCID: PMC9283583 DOI: 10.1007/s43465-022-00666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to determine whether the use of a surgical navigation system in total knee replacement (TKR) enables beginner and intermediate surgeons to achieve clinical PROM outcomes as good as those conducted by expert surgeons in the long term. METHODS We enrolled 100 consecutive patients whose total navigated knee arthroplasty (TKA) was performed in our institution from 2008 to 2010. According to the principal surgeon's surgical experience, the patients were divided into three groups: (1) beginner surgeons, with no more than 30 previous knee replacement performances, (2) intermediate surgeons, with more than 30 but not more than 300, and (3) expert surgeons, with more than 300 knee replacements. Demographic data collected on the cohort included gender, laterality, age, and body mass index (BMI). The outcome measures assessed were Forgotten Joint Score (FJS), implant positioning, limb alignment, and prosthesis survival rate. A margin of equivalence of ± 18.5 points in the FJS scale was prespecified in terms of the minimal clinically important difference (MCID) to compare the FJS results obtained in the long period between the groups of interest. RESULTS The mean follow-up was 11.10 ± 0.78, 10.86 ± 0.66, and 11.30 ± 0.74 years, respectively, for each of the groups. The long-term FJS mean score was 80.86 ± 21.88, 81.36 ± 23.87, and 90.48 ± 14.65 for each group. The statistical analysis proved noninferiority and equivalence in terms of the FJS results reported in the long term by patients in Groups 1 or 2 compared to those in Group 3. More specifically, it has been proved that the mean difference between groups is within the interval of equivalence defined in terms of the MCID. The overall prostheses survival rate was 93.7%. CONCLUSION Navigated assisted TKA, under expert guidance, can be as effective when performed by beginner or intermediate surgeons as performed by senior surgeons regarding the accuracy of implant positioning, limb alignment, and long-term clinical outcome.
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Affiliation(s)
- Ricardo Larrainzar-Garijo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain ,Departamento Cirugía, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Elisa M. Molanes-López
- Unidad Departamental de BioestadísticaDepartamento de Estadística e Investigación Operativa, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Miguel Cañones-Martín
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | - David Murillo-Vizuete
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | | | - Raul Garcia-Bogalo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | - Fernando Corella-Montoya
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain ,Departamento Cirugía, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
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25
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Oikonomidis L, Santini AJA, Davidson JS, Banks JV, Phillipson A, Pope J. The Journey Bicruciate Knee Replacement: Design Modifications Yield Better Early Functional Results and Reduce Complications. J Knee Surg 2022; 35:767-775. [PMID: 33111275 DOI: 10.1055/s-0040-1718599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Journey-I total knee replacement was designed to improve knee kinematics but had several complications including early dislocation. The Journey-II modification was introduced to reduce these while maintaining high function. To assess whether the modified Journey-II prosthesis has succeeded in its designers aims, we undertook an observational study of prospectively recorded data to analyze and compare the two knees. A total of 217 Journey-I and 129 Journey-II knees were identified from the department's prospectively collated registry and were assessed at 1 year by a comparative statistical analysis using numerous factors including pain, functional activity, physical assessment, Short Form-12 (SF-12), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Oxford scores. The statistical tests included Chi-square, Wilcoxon's rank and Mann-Whitney U-tests with the level of significance set at p < 0.05. There was a variation in primary patella resurfacing between the two groups with 14.3% in the Journey-I cohort and 66.7% in the Journey-II cohort. Both replacements demonstrated excellent postoperative function, but the Journey II performed significantly better than Journey I with fewer complications (37 vs. 10) and better improvement in almost all clinical scores including pain (p < 0.01), mobility outcomes (p = 0.018), Oxford (p = 0.004), and WOMAC (p = 0.039) scores but not with flexion improvement and SF-12 score. There was significant improvement in patellofemoral pain postoperatively in both the Journey I (p = 0.011) and Journey II (p = 0.042) arthroplasty; however the primarily resurfaced patella in a Journey-II implant had better postoperative scores. The main complication of dislocation in the Journey I was not seen in the modified Journey-II implant with stiffness requiring intervention reduced in Journey II. These results suggest that the Journey II has improved short-term clinical outcomes compared with Journey I with reduction of dislocation and other complications.
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Affiliation(s)
- Lazaros Oikonomidis
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Alasdair J A Santini
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - John S Davidson
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Joanne V Banks
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew Phillipson
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Jill Pope
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Abstract
Isolated patellofemoral osteoarthritis (PFOA) is a common cause of anterior knee pain in patients over the age of 40 years. Patellofemoral arthroplasty (PFA) is an option to address PFAO when the non-operative or joint preserving management has failed.The goals of PFA are to reduce pain and increase function of the knee in a bone and ligament preserving fashion while maintaining or optimizing its kinematics. Over the last decades advances have been made in optimizing implants designs, addressing complications and improving functional and patient reported outcomes. Appropriate patient selection has proven to be imperative. Proper surgical technique and knowledge of pearls and pitfalls is essential.The indications and surgical technique for patellofemoral arthroplasty will be reviewed here.Level of evidence: Therapeutic Level V.
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Affiliation(s)
- Paul Hoogervorst
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Ave Suite R200, Minneapolis, MN, 55454, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Ave Suite R200, Minneapolis, MN, 55454, USA.
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Campbell B, Schultz L, Bryant E, Tsung JD, Lynam B, Stephens AS. A 'joint. Aust J Prim Health 2022; 28:164-171. [PMID: 35190023 DOI: 10.1071/py20309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 11/12/2021] [Indexed: 11/23/2022]
Abstract
Australia is facing a growing burden of knee and hip osteoarthritis (OA). To address this demand in northern New South Wales, a community health-based conservative OA joint management service was established in the Tweed Valley. This paper describes the design, implementation and initial evaluation of the service. Following the principles of clinical redesign, a diagnostic phase involving consultation with key stakeholders revealed several issues. OA patients could wait up to 9 months for review by orthopaedic specialist following GP referral and received limited information on how to conservatively manage their conditions. GPs were constrained by short consultations and had limited knowledge of the latest recommendations for the conservative treatment of OA. GPs also highlighted the limitations of outdated fax systems for communication, noting their preference for secure electronic messaging. Based on these findings, the Tweed Knee and Hip Arthritis Service was established. For patients not on a waiting list for surgery, the service provides evidence-based conservative management for knee or hip OA involving standardised assessment, education, exercise, self-management strategies and regular review. An analysis of a foundational cohort of patients demonstrated improvements in a suite of validated and standardised measures for pain and function, with improvements seen as early as 1 month and sustained for 6 months. The study findings support the introduction of integrated conservative OA management models of care directly available to primary healthcare providers.
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Affiliation(s)
- Brayden Campbell
- Northern New South Wales Local Health District, Tweed Heads, NSW 2485, Australia
| | - Luke Schultz
- Northern New South Wales Local Health District, Lismore, NSW 2480, Australia
| | - Evan Bryant
- Northern New South Wales Local Health District, Tweed Heads, NSW 2485, Australia
| | - Jason D Tsung
- Northern New South Wales Local Health District, Tweed Heads, NSW 2485, Australia
| | - Brett Lynam
- Healthy North Coast, North Coast Primary Health Network, Tweed Heads, NSW 2485, Australia
| | - Alexandre S Stephens
- Northern New South Wales Local Health District, Lismore, NSW 2480, Australia; and School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; and School of Health and Human Sciences, Southern Cross University, Lismore, NSW 2480, Australia; and Corresponding author
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28
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Tibial joint line orientation has no effect on joint awareness after mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:389-396. [PMID: 34417835 DOI: 10.1007/s00167-021-06696-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Joint line orientation (JLO) plays an important role in total knee arthroplasty (TKA), but its influence on patient-reported outcomes (PROs) is unclear. The purpose of this study was to examine JLO impact as measured by the forgotten joint score (FJS-12). The hypothesis was that restoring the joint line (JL) parallel to the floor would influence joint awareness favorably, i.e., allow the patient to forget about the joint in daily living. METHODS All computer-navigated primary TKAs using a cemented, cruciate-retaining (CR) design implanted between January 2018 and September 2019 were reviewed in this retrospective single-center analysis. Primary endpoints were: clinical [range of motion (ROM)], and patient-reported (FJS-12) and radiographical outcomes [tibia joint line angle (TJLA), hip knee axis (HKA), mechanical medial proximal tibia angle (mMPTA) as well as mechanical lateral distal femoral angle (mLDFA)]. RESULTS Seventy-six patients (mean age: 70.3 ± 9.7 years, mean BMI: 29.7 ± 5.2 kg/m2) were included. Postoperative ROM averaged 118.7 ± 9.6°. The mean FJS-12 improved from 16.4 ± 15.3 (preoperatively) to 89.4 ± 16.9 (1-year follow-up; p < 0.001). Clinical outcomes and PROs did not correlate with JLO (p = n.s.). Cluster analysis using six measures revealed that a medially opened TJLA was associated with significantly better postoperative FJS-12. CONCLUSION Tibial JLO was found to have no effect on PROs. Considering the JLO in the coronal plane alone probably has questionable clinical relevance. Lower limb alignment should be assessed in all three planes and correlated with the clinical outcome. LEVEL OF CLINICAL EVIDENCE Level IV.
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29
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HEIJBEL S, W-DAHL A, NILSSON KG, HEDSTRÖM M. Substantial clinical benefit and patient acceptable symptom states of the Forgotten Joint Score 12 after primary knee arthroplasty. Acta Orthop 2022; 93:158-163. [PMID: 34984472 PMCID: PMC8815411 DOI: 10.2340/17453674.2021.887] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Knowing how to interpret values obtained with patient reported outcome measures (PROMs) is essential. We estimated the substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) for Forgotten Joint Score 12 (FJS) and explored differences depending on methods used for the estimates. Patients and methods - The study was based on 195 knee arthroplasties (KA) performed at a university hospital. We used 1 item from the Knee injury and Osteoarthritis Outcome Score domain quality of life and satisfaction with surgery, obtained 1-year postoperatively, to assess SCB and PASS thresholds of the FJS with anchor-based methods. We used different combinations of anchor questions for SCB and PASS (satisfied, satisfied with no or mild knee difficulties, and satisfied with no knee difficulties). A novel predictive approach and receiver-operating characteristics curve were applied for the estimates. Results - 70 and 113 KAs were available for the SCB and PASS estimates, respectively. Depending on method, SCB of the FJS (range 0-100) was 28 (95% CI 21-35) and 22 (12-45) respectively. PASS was 31 (2-39) and 20 (10-29) for satisfied patients, 40 (31-47) and 38 (32-43) for satisfied patients with no/mild difficulties, and 76 (39-80) and 64 (55-74) for satisfied patients with no difficulties. The areas under the curve ranged from 0.82 to 0.88. Interpretation - Both the SCB and PASS thresholds varied depending on methodology. This may indicate a problem using meaningful values from other studies defining outcomes after KA. This study supports the premise of the FJS as a PROM with good discriminatory ability in patients undergoing KA.
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Affiliation(s)
- Siri HEIJBEL
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm
| | - Annette W-DAHL
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Department of Orthopedics, Lund,The Swedish Knee Arthroplasty Register
| | - Kjell G NILSSON
- Department of Surgical and Perioperative Sciences, Orthopedics, Umeå University, Umeå
| | - Margareta HEDSTRÖM
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Trauma & Reparative Medicine Theme, Karolinska University Hospital Huddinge, Stockholm, Sweden
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RILBY K, MOHADDES M, NAUCLÉR E, KÄRRHOLM J. Similar outcome with a new anteverted or a straight standard stem: a randomized study of 72 total hip arthroplasties evaluated with clinical variables, radiostereometry, and DXA up to 2 years. Acta Orthop 2022; 93:59-67. [PMID: 34678118 PMCID: PMC8815675 DOI: 10.1080/17453674.2021.1993606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - The anatomical uncemented stem, SP-CL (Static Physiologicus - CementLess), designed to facilitate insertion and to avoid stress concentration at solitary contact points, has been on the market since 2014 but is not well documented. We studied its clinical performance, migration, and associated bone remodeling in a randomized controlled trial, with the Corail stem as control. Patients and methods - 79 patients (80 hips) were primarily recruited and 71 patients (72 hips, 36 SP-CL, 36 Corail) attended the last follow-up at 2 years. The Oxford Hip Score (OHS) was the primary outcome. In addition, we assessed stem migration, changes in bone mineral density, and development of radiolucencies by RSA, DXA, and conventional radiography. Results - At 2 years Oxford Hip Score was similar between the SP-CL and Corail stem. At 2 years the SP-CL stems showed a median distal migration of 0.23 mm (-0.1 to 5.2) and the Corail stems of 0.11 mm (-0.4 to 4.4). The SP-CL stems showed slightly more loss of bone mineral density in Gruen region 7 (p = 0.003). Interpretation - We found no difference in clinical results between the SP-CL and the well-documented Corail stem. The same stem stability was reached between 1 and 2 years postoperatively for both stems. As a next step we think that the SP-CL stem should be studied in a multi-center setting, before being accepted for general use.
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Affiliation(s)
- Karin RILBY
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
| | - Maziar MOHADDES
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Emma NAUCLÉR
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Johan KÄRRHOLM
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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31
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Courage O, Strom L, van Rooij F, Lalevée M, Heuzé D, Papin PE, Butnaru M, Müller JH. Higher rates of surgical and medical complications and mortality following TKA in patients aged ≥ 80 years: a systematic review of comparative studies. EFORT Open Rev 2021; 6:1052-1062. [PMID: 34909224 PMCID: PMC8631241 DOI: 10.1302/2058-5241.6.200150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The purpose of this systematic review was to synthesize studies published since the last systematic review in 2015 that compare outcomes of primary total knee arthroplasty (TKA) in older patients (≥ 80 years) and in younger patients (< 80 years), in terms of complication rates and mortality. An electronic literature search was conducted using PubMed, Embase®, and Cochrane Register. Studies were included if they compared outcomes of primary TKA for osteoarthritis in patients aged 80 years and over to patients aged under 80 years, in terms of complication rates, mortality, or patient-reported outcomes (PROs). Thirteen studies were eligible. Surgical complications in older patients ranged from 0.6–21.1%, while in younger patients they ranged from 0.3–14.6%. Wound complications in older patients ranged from 0.5–20%, while in younger patients they ranged from 0.8–22.0%. Medical complications (cardiac, respiratory, thromboembolic) in older patients ranged from 0.4–17.3%, while in younger patients they ranged from 0.2–11.5%. Mortality within 90 days in older patients ranged between 0–2%, while in younger patients it ranged between 0.0–0.03%. Compared to younger patients, older patients have higher rates of surgical and medical complications, as well as higher mortality following TKA. The literature also reports greater length of stay for older patients, but inconsistent findings regarding PROs. The present findings provide surgeons and older patients with clearer updated evidence, to make informed decisions regarding TKA, considering the risks and benefits within this age group. Patients aged over 80 years should therefore not be excluded from consideration for primary TKA based on age alone.
Cite this article: EFORT Open Rev 2021;6:1052-1062. DOI: 10.1302/2058-5241.6.200150
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Affiliation(s)
| | | | | | - Matthieu Lalevée
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Donatien Heuzé
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Pierre Emanuel Papin
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Michael Butnaru
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
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Sabah SA, Alvand A, Beard DJ, Price AJ. Minimal important changes and differences were estimated for Oxford hip and knee scores following primary and revision arthroplasty. J Clin Epidemiol 2021; 143:159-168. [PMID: 34920113 DOI: 10.1016/j.jclinepi.2021.12.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To create estimates for clinically meaningful changes and differences in pain and joint function for the Oxford Hip and Knee Scores (OHS/OKS) in primary and revision joint replacement. STUDY DESIGN AND SETTING 694,487 primary and revision joint replacement procedures were analysed from the NHS PROMs dataset between 2012-2020. Minimal important changes (MIC) and differences (MID) were calculated using distribution and anchor-based methods (including receiver-operating characteristic (ROC) curve and predictive-modelling techniques). RESULTS For comparison of two or more groups (such as in a clinic trial), MID estimates were ∼5 points. For cohort studies investigating changes over time in a single group of patients, MICgroup estimates were 12.4 points (primary hip replacement), 8.6 points (revision hip replacement), 10.5 points (primary knee replacement) and 9.4 points (revision knee replacement). For studies investigating changes over time at the individual patient level, MICadjusted estimates were ∼8 points, ∼6 points, ∼7 points and ∼6 points respectively. CONCLUSION This study has calculated contemporary estimates of clinically important changes and differences for the OHS/OKS for primary and revision hip and knee replacement. These estimates can be used to inform sample size calculations and to interpret changes in joint function over time and differences between groups.
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Affiliation(s)
- S A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
| | - A Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; Nuffield Orthopaedic Centre, Oxford.
| | - D J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; Nuffield Orthopaedic Centre, Oxford.
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33
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Robinson PG, MacDonald DJ, Macpherson GJ, Patton JT, Clement ND. Changes and thresholds in the Forgotten Joint Score after total hip arthroplasty : minimal clinically important difference, minimal important and detectable changes, and patient-acceptable symptom state. Bone Joint J 2021; 103-B:1759-1765. [PMID: 34847716 DOI: 10.1302/0301-620x.103b12.bjj-2021-0384.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIMS The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total hip arthroplasty (THA) in a UK population. METHODS During a one-year period, 461 patients underwent a primary THA and completed preoperative and six-month FJS, with a mean age of 67.2 years (22 to 93). At six months, patient satisfaction was recorded as very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 31) and satisfied (n = 101) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS. Distribution-based methodology was used to calculate the MDC. RESULTS Using satisfaction as the anchor, the MCID for the FJS was 8.1 (95% confidence interval (CI) 3.7 to 15.9; p = 0.040), which was affirmed when adjusting for confounding. The MIC for the FJS for a cohort of patients was 17.7 (95% CI 13.7 to 21.7) and for an individual patient was 18. The MDC90 for the FJS was eight, meaning that 90% of patients scoring more than this will have experienced a real change that is beyond measurement error. The PASS threshold for the FJS was defined as 29. CONCLUSION The MCID and MIC can be used respectively to assess whether there is a clinical difference between two groups, or whether a cohort or patient has had a meaningful change in their FJS. Both values were greater than measurement error (MDC90), suggesting a real change. The PASS threshold for the postoperative FJS can be used as a marker of achieving patient satisfaction following THA. Cite this article: Bone Joint J 2021;103-B(12):1759-1765.
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Affiliation(s)
| | - Deborah J MacDonald
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Edinburgh Orthopaedics, University of Edinburgh, Edinburgh, UK
| | | | - James T Patton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Mørup-Petersen A, Skou ST, Holm CE, Holm PM, Varnum C, Krogsgaard MR, Laursen M, Odgaard A. Measurement properties of UCLA Activity Scale for hip and knee arthroplasty patients and translation and cultural adaptation into Danish. Acta Orthop 2021; 92:681-688. [PMID: 34530681 PMCID: PMC8635665 DOI: 10.1080/17453674.2021.1977533] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The UCLA Activity Scale (UCLA) is a questionnaire assessing physical activity level from 1 (low) to 10 (high) in patients undergoing hip or knee arthroplasty (HA/KA). After translation and cultural adaptation, we evaluated the measurement properties of the Danish UCLA.Patients and methods - After dual panel translation, cognitive interviews were performed among 55 HA/KA patients. An orthopedic surgeon and a physiotherapist estimated UCLA scores for 80 KA patients based on short interviews. Measurement properties were evaluated in 130 HA and 134 KA patients preoperatively and 1-year postoperatively.Results - To suit Danish patients of today, several adaptations were required. Prior to interviews, 4 patients were excluded, and 11 misinterpreted the answer options. Examiners rated the remaining 65 patients (mean age 67 years) 0.2-1.6 UCLA levels lower than patients themselves. The 130 HA and 134 KA patients (mean age 71/68 years) changed from 4.3 (SD 1.9)/4.5 (1.8) preoperatively to 6.6 (1.8)/6.2 (1.0) at 1-year follow-up. 103 (79%) HA and 89 (66%) KA patients reported increased activity. Effect sizes were large (1.2/0.96). Knee patients reaching minimal important change (MIC, ≥ 8 Oxford Knee Score points) had higher 1-year UCLA scores than patients not reaching MIC.Interpretation - Original scale development was undocumented. Content validity was questionable, and there was discrepancy between patient and examiner estimates. UCLA appears valuable for measuring change in self-reported physical activity on a group level. 4 out of 5 HA patients and 2 out of 3 KA patients were more physically active 1 year after joint replacement surgery.
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Affiliation(s)
- Anne Mørup-Petersen
- Department of Orthopedic Surgery, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense; Research unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand
| | - Christina E Holm
- Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet
| | - Paetur M Holm
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense; Research unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand
| | - Claus Varnum
- Department of Orthopedic Surgery, Lillebaelt Hospital—Vejle, University Hospital of SouthernDenmark; Department of Regional Health Research, Faculty of Health Science, University of SouthernDenmark
| | - Michael R Krogsgaard
- Section for Sports Traumatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, University of Copenhagen
| | - Mogens Laursen
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg & Farsø
| | - Anders Odgaard
- Department of Orthopedic Surgery, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Khow YZ, Liow MHL, Goh GS, Chen JY, Lo NN, Yeo SJ. The oxford knee score minimal clinically important difference for revision total knee arthroplasty. Knee 2021; 32:211-217. [PMID: 34509827 DOI: 10.1016/j.knee.2021.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Minimal clinically important difference (MCID) is crucial for interpreting meaningful improvements in patient-reported outcome measures (PROMs). No previous study has evaluated the MCID for the Oxford Knee Score (OKS) in revision total knee arthroplasty (TKA). This study aimed to propose the OKS MCID for revision TKA. METHODS Prospectively collected data from 191 patients who underwent revision TKA at a single institution was analysed. Clinical assessment was performed preoperatively and at 2 years using OKS and Short-Form 36 Physical Component Score (SF-36 PCS). MCID was evaluated with a three-pronged methodology, using (1) anchor-based method with linear regression, (2) anchor-based method with receiver operating characteristic (ROC) and area under curve (AUC), (3) distribution-based method with standard deviation (SD). The anchors used were improvement in SF-36 PCS ≥ 12, patient satisfaction, and implant survivorship following revision TKA. RESULTS The MCID determined by anchor-based linear regression method using improvements in SF-36 PCS was 4.9 points. The MCID determined by anchor-based ROC was 10.5 points for satisfaction (AUC = 74.8%) and 13.5 points for implant survivorship (AUC = 73.7%). The MCID determined by distribution-based method of 0.5 SD was 4.7. CONCLUSION The proposed MCID for OKS following revision TKA is 4.9 points. Patients who achieve an improvement in OKS of at least 10.5-13.5 points by 2 years are likely to be satisfied with their surgery and not require a subsequent re-revision TKA. Patients undergoing revision TKA should aim for an improvement in OKS of at least 10.5-13.5 points as a target score.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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36
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Itoh M, Itou J, Kuwashima U, Okazaki K. Good Validity and High Internal Consistency of the Forgotten Joint Score-12 in Patients After Medial Opening Wedge High Tibial Osteotomy. J Arthroplasty 2021; 36:2691-2697. [PMID: 33812712 DOI: 10.1016/j.arth.2021.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Forgotten Joint Score-12 (FJS-12) was originally developed to assess awareness of an artificial joint. Medial opening wedge high tibial osteotomy (MOWHTO), an alternative surgical method of knee replacement, is a joint-preservation surgery; therefore, joint awareness should be used to evaluate its clinical results. However, FJS-12 has not been validated as a tool to evaluate the postoperative results of MOWHTO. This study aimed to validate FJS-12 in MOWHTO. METHODS Patients with bilateral knee surgery, previous knee surgery, flexion contracture >15°, varus alignment >20°, and patients without plate removal surgery were excluded. Finally, 71 knees of 71 patients were analyzed, with a mean follow-up of 34.5 months. The FJS-12 score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained, and the floor and ceiling effect of each score was investigated. Cronbach's α was calculated to determine the internal consistency of FJS-12. Spearman's correlation coefficients between FJS-12 and KOOS were calculated to assess convergent validity. RESULTS There were ceiling effects in 3 KOOS subscales (symptoms [25.4%], pain [15.5%], and activities of daily living [25.4%]) but not in FJS-12 (8.5%). No floor effect was noted in any patient-reported outcome measures. The total Cronbach's α was 0.9457 in FJS-12. FJS-12 showed moderate-to-strong positive correlations with all KOOS subscales (r = 0.64-0.72). CONCLUSION FJS-12 showed a lower ceiling effect than KOOS and high internal consistency and convergent validity in patients following MOWHTO. With its low ceiling effect, FJS-12 was found to be useful for evaluating patients following MOWHTO.
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Affiliation(s)
- Masafumi Itoh
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Junya Itou
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Umito Kuwashima
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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37
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Bruhn SM, Ingelsrud LH, Bandholm T, Skou ST, Schroder HM, Reventlow S, Møller A, Kjellberg J, Kallemose T, Troelsen A. Disentangling treatment pathways for knee osteoarthritis: a study protocol for the TREATright study including a prospective cohort study, a qualitative study and a cost-effectiveness study. BMJ Open 2021; 11:e048411. [PMID: 34233992 PMCID: PMC8264876 DOI: 10.1136/bmjopen-2020-048411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/27/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is associated with chronic knee pain and functional disability that negatively affect the ability to carry out normal daily activities. Patients are offered a large variety of non-surgical treatments, often not in accordance with clinical guidelines. This observational study will provide a comprehensive overview of treatment pathways for knee OA during the first 2 years after consulting an orthopaedic surgeon, including timing and order of treatment modalities, predictors of treatment outcomes, cost-effectiveness of treatment pathways and patients' views on different treatment pathways. METHODS AND ANALYSIS Patients with primary referrals to an orthopaedic surgeon due to knee OA are consecutively invited to participate and fill out a questionnaire prior to their consultation with an orthopaedic surgeon. Follow-up questionnaires will be obtained at 6 and 24 months after inclusion. Based on a prospective cohort study design, including questionnaires and register data, we will (1) describe treatment pathways for knee OA during the first 2 years after consulting an orthopaedic surgeon; (2) describe the characteristics of patients choosing different treatment pathways; (3) develop predictive models for patient-self-determined classifications of good and poor treatment outcomes; (4) evaluate the cost-effectiveness of treatment pathways that live up to clinical guidelines versus pathways that do not; based on a qualitative study design using semistructured individual interviews, we will (5) describe the patients' perspectives on treatment pathways for knee OA. ETHICS AND DISSEMINATION The study is approved by the Danish regional ethical committee (journal number H-17017295) and the Danish Data Protection Agency (journal number AHH-2017-072). Data will be anonymised and handled in line with the General Data Protection Regulation and the Danish Data Protection Act. The study results will be submitted to international open-access peer-reviewed journals and disseminated at conferences. TRIAL REGISTRATION NUMBER NCT03746184, pre-results.
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Affiliation(s)
- Simon Majormoen Bruhn
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lina Holm Ingelsrud
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
- Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), Department Physical and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
| | - Søren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Henrik M Schroder
- Department of Orthopaedic Surgery, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Susanne Reventlow
- Center for Research and Education in General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Center for Research and Education in General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anders Troelsen
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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Clement ND, Scott CEH, Hamilton DF, MacDonald D, Howie CR. Meaningful values in the Forgotten Joint Score after total knee arthroplasty. Bone Joint J 2021; 103-B:846-854. [PMID: 33934639 DOI: 10.1302/0301-620x.103b5.bjj-2020-0396.r1] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) threshold in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total knee arthroplasty (TKA). METHODS During a one-year period 484 patients underwent a primary TKA and completed preoperative and six-month FJS and OKS. At six months patients were asked, "How satisfied are you with your operated knee?" Their response was recorded as: very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 44) and satisfied (n = 153) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS threshold. Distribution-based methodology was used to calculate the MDC. RESULTS Using satisfaction as the anchor question, the MCID for the FJS was 16.6 (95% confidence interval (CIs) 8.9 to 24.3; p < 0.001) and when adjusting for confounding this decreased to 13.7 points (95% CI 4.8 to 22.5; p < 0.001). The MIC for the FJS for a cohort of patients was 17.7 points and for an individual patient was 10 points. The MDC90 for the FGS was 12 points; where 90% of patients scoring more than this will have experienced a real change that is beyond measurement error. The PASS was defined as 22 points or more in the postoperative FJS. CONCLUSION The estimates for MCID and MIC can be used to assess whether there is clinical difference between two groups and whether a cohort/patient has had a meaningful change in their FJS, respectively. The MDC90 of 12 points suggests a value lower than this may fall within measurement error. A postoperative FJS of 22 or more was predictive of achieving PASS. Cite this article: Bone Joint J 2021;103-B(5):846-854.
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Affiliation(s)
- Nick D Clement
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - David F Hamilton
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Ediburgh, UK
| | - Deborah MacDonald
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Colin R Howie
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
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Goyal T, Sethy SS, Paul S, Choudhury AK, Das SL. Good validity and reliability of forgotten joint score-12 in total knee arthroplasty in Hindi language for Indian population. Knee Surg Sports Traumatol Arthrosc 2021; 29:1150-1156. [PMID: 32602037 DOI: 10.1007/s00167-020-06124-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Commonly used patient-reported outcome measurement (PROM) tools for knee joint have a ceiling effect and may not be able to differentiate between patients achieving outcomes better than the upper limit of the score. Forgotten joint score-12 (FJS-12) is said to be free of this limitation. FJS-12 has been translated and validated in different languages. This study aims to translate and validate FJS-12 in Hindi (Hindi FJS-12). METHODS Hindi FJS-12 was tested for comprehensibility in a pilot study in 20 patients. This was followed by a prospective cohort study including 140 patients of bilateral total knee arthroplasty, with a minimum follow-up of 12 months. The mean age of the patients was 62.0 ± 14.5 years. There were 77 (55.2%) males and remaining were females. All patients were asked to fill up questionnaires of Hindi FJS-12, WOMAC, KSS and OKS. Hindi FJS-12 was tested for validity, reliability, responsiveness, floor effect and ceiling effect. Construct validity was expressed as the Pearson correlation coefficient. Internal consistency was expressed as Cronbach's alpha and test-retest reliability as the intra-class correlation coefficient (ICC). RESULTS In the pilot study, it was seen that all the questions were well answered by most of the participants. The main study showed good construct validity with Hindi FJS-12 showing moderate correlation with WOMAC, KSS and OKS (Pearson coefficients 0.45, 0.32, 0.37, respectively). Hindi FJS-12 had excellent internal consistency with Cronbach's alpha of 0.93 (95% CI 0.90, 0.97). ICC was 0.95 (95% CI 0.90, 0.99). No floor or ceiling effect was observed. CONCLUSION Hindi FJS-12 has high validity, reliability and reproducibility for knee function after TKA. It is devoid of floor or ceiling effect. Thus, it can be successfully used for studying knee function in the Indian population. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Siddharth S Sethy
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - S Lakshmana Das
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Longo UG, De Salvatore S, Candela V, Berton A, Casciaro C, Sciotti G, Cirimele G, Marchetti A, Piergentili I, De Marinis MG, Denaro V. Unicompartmental Knee Arthroplasty: Minimal Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score. ACTA ACUST UNITED AC 2021; 57:medicina57040324. [PMID: 33915704 PMCID: PMC8065647 DOI: 10.3390/medicina57040324] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Unicompartmental knee arthroplasty (UKA) is a valid alternative to total knee arthroplasties (TKAs) in selected cases. After surgery, patients' experience and satisfaction were traditionally evaluated by pre- and postsurgical scores and Patient-Reported Outcome Measures (PROMs). Otherwise, a statistically significant change does not necessarily correlate to a clinically meaningful improvement when measured using PROMs. To evaluate the real effect of a specific treatment and understand the difference between groups in a clinical trial, it is necessary to use a meaningful quantum of change on the score assessed. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) can provide this meaningful change. This paper aimed to calculate the MCID and the PASS of the Forgotten Joint Score (FJS-12) after UKA. Materials and Methods: A total of 40 patients with a mean age 72.5 ± 6.4 years undergoing UKA were assessed preoperatively and six months postsurgery using the FJS-12 and the Oxford Knee Score (OKS). The baseline and 6-month postoperative scores were compared using the Wilcoxon signed ranks test. The correlation was calculated with Spearman's rho. Both distribution-based approaches and anchor approaches were used to estimate MCID for the FJS-12. The 75th percentile and the Receiver operating characteristic (ROC) curve methods were used to calculate the PASS of FJS-12. Results: MCID estimates for normalized FJS-12 for UKA ranged from 5.68 to 19.82. The threshold of the FJS-12 with ROC method was 72.92 (AUC = 0.76). The cut-off value computed with the 75th percentile approach was 92.71. Conclusions: The MCID and PASS represent valid tools to assess the real perception of clinical improvement in patients who underwent UKA. The MCID value of FJS-12 was 12.5 for patients who underwent UKA. The value of the PASS for the FJS-12 in patients who underwent UKA was 72.92.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (V.C.); (A.B.); (C.C.); (I.P.); (V.D.)
- Correspondence: ; Tel.: +39-06-225411613
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (V.C.); (A.B.); (C.C.); (I.P.); (V.D.)
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (V.C.); (A.B.); (C.C.); (I.P.); (V.D.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (V.C.); (A.B.); (C.C.); (I.P.); (V.D.)
| | - Carlo Casciaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (V.C.); (A.B.); (C.C.); (I.P.); (V.D.)
| | - Gaia Sciotti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (G.S.); (G.C.); (A.M.); (M.G.D.M.)
| | - Giada Cirimele
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (G.S.); (G.C.); (A.M.); (M.G.D.M.)
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (G.S.); (G.C.); (A.M.); (M.G.D.M.)
| | - Ilaria Piergentili
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (V.C.); (A.B.); (C.C.); (I.P.); (V.D.)
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (G.S.); (G.C.); (A.M.); (M.G.D.M.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (V.C.); (A.B.); (C.C.); (I.P.); (V.D.)
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Eckhard L, Munir S, Wood D, Talbot S, Brighton R, Walter WL, Baré J. Minimal important change and minimum clinically important difference values of the KOOS-12 after total knee arthroplasty. Knee 2021; 29:541-546. [PMID: 33761418 DOI: 10.1016/j.knee.2021.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 01/11/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The minimal important change (minimal amount of change vs. baseline that a patient recognizes as a clinical change) and minimum clinically important difference (smallest difference between two measurements that are deemed important by patients) are important values to evaluate the clinical relevance of changes over time and differences between groups. This study aims to establish these values for the KOOS-12 at 1 year postoperatively. METHODS KOOS-12 scores were calculated from the full-length KOOS completed by patients undergoing primary TKA preoperatively and at 1 year follow up. Minimal important change (MIC) values were estimated using the anchor-based predictive modeling approach and adjustment for the large proportion of improved patients in the study cohort was performed. The MCID was defined as the difference in the mean change in the KOOS-12 between the 'no improvement' and 'little improvement' groups. RESULTS A total of 352 patients (161 male:191 female) with an overall mean age of 67.9 years (standard deviation (SD) 8.2) and a mean body mass index of 31.4 kg/m2 (SD 6.3) were included: 97.1% of patients reported an important improvement, 1.1% reported being about the same and 1.7% reported being importantly worse. The MIC improvement values were 11.5 for Pain, 13.7 for Function, 5.5 for Quality of Life (QoL) and 14.9 for the total KOOS-12 score. MCID values were 13.5 for Pain, 15.2 for Function, 8.0 for QoL and 11.1 for the total KOOS-12 score. CONCLUSION MIC of 14.9 and MCID of 11.1 established in this study can assist clinicians and researchers in the interpretation of within-group changes (MIC) and differences between groups (MCID) at 1 year after TKA.
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Affiliation(s)
- Lukas Eckhard
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany; Australian Institute of Musculoskeletal Research, Sydney, Australia.
| | - Selin Munir
- Australian Institute of Musculoskeletal Research, Sydney, Australia
| | - David Wood
- North Sydney Orthopedics and Sport Medicine Centre, Sydney, Australia
| | - Simon Talbot
- Orthopaedic Department, Western Health, Melbourne, Australia
| | | | - William L Walter
- University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia
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Total Hip Arthroplasty: Minimal Clinically Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score 12. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052267. [PMID: 33668868 PMCID: PMC7956707 DOI: 10.3390/ijerph18052267] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
The Forgotten Joint Score-12 (FJS-12) is a valid patient-reported outcome measures (PROMs) used to assess prosthesis awareness during daily activities after total hip arthroplasty (THA). The minimum clinically important difference (MCID) can be defined as the smallest change or difference that is evaluated as beneficial and could change the patient’s clinical management. The patient acceptable symptom state (PASS) is considered the minimum PROMs cut-off value that corresponds to a patient’s satisfactory state of health. Despite the validity and reliability of the FJS-12 having been already demonstrated, the MCID and the PASS of this score have not previously been defined. Patients undergoing THA from January 2019 to October 2019 were assessed pre-operatively and six months post-surgery using the FJS-12, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Oxford Hip Score (OHS). Pre-operative and follow-up questionnaires were completed by 50 patients. Both distribution-based approaches and anchor approaches were used to estimate MCID. The aim of this paper was to assess the MCID and PASS values of FJS-12 after total hip replacement. The FJS-12 MCID from baseline to 6 months post-operative follow-up was 17.5. The PASS calculated ranged from 69.8 to 91.7.
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Tso R, Smith J, Doma K, Grant A, McEwen P. Clinical and Patient-Reported Outcomes of Medial Stabilized Versus Non-Medial Stabilized Prostheses in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2021; 36:767-776.e2. [PMID: 32978025 DOI: 10.1016/j.arth.2020.07.086] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/19/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to compare the clinical and patient-reported outcome measures (PROMs) of medial stabilized total knee arthroplasty (TKA) with non-medial stabilized TKAs. METHODS A systematic search of multiple databases was conducted in October 2019. A meta-analysis was conducted for the Knee Society Score (KSS), Knee Society Functional Score (KFS), range of motion (ROM), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Score (FJS). RESULTS A total of 857 articles yielded 21 studies eligible for inclusion with 13 studies used for quantitative analysis. The meta-analysis revealed that the medial stabilized group had a mean FJS that was 13.8 points higher than that of the non-medial stabilized TKA (mean difference [MD]: 13.83, P ≤ .0001, 95% confidence interval [CI]: 8.90-18.76, I2 = 0%) which was less than the minimal clinically important difference of 14. The medial stabilized group also demonstrated a statistically significant difference in the postoperative ROM (MD = 2.52, P = .05, 95% CI: -0.03 to 5.07, I2 = 85%) and OKS when compared with the non-medial stabilized group (MD = 1.25, P = .02, 95% CI: 0.17-2.33, I2 = 27%), but these were not clinically significant. There was no statistically or clinically significant difference in the KSS, KFS, and WOMAC scores. CONCLUSION Medial stabilized knee prostheses demonstrated no clinically significant differences for the ROM, OKS, WOMAC, KSS, and KFS. The FJS demonstrated the greatest MD and warrants further investigation. Future research is required using patient-reported outcome measures with a lower ceiling effect such as the FJS.
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Affiliation(s)
- Reece Tso
- Townsville University Hospital, Townsville, QLD, Australia; Orthopaedic Research Institute of Queensland (ORIQL), Townsville, QLD, Australia
| | - Justin Smith
- Townsville University Hospital, Townsville, QLD, Australia
| | - Kenji Doma
- James Cook University, College of Healthcare Sciences, Townsville, QLD, Australia; Orthopaedic Research Institute of Queensland (ORIQL), Townsville, QLD, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, QLD, Australia
| | - Peter McEwen
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, QLD, Australia; James Cook University, College of Medicine and Dentistry, Townsville, QLD, Australia
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Abstract
PURPOSE Estimates of the minimally important change (MIC) can be used to evaluate whether group-level differences are large enough to be important. But responders to treatment have been based upon group-level MIC thresholds, resulting in inaccurate classification of change over time. This article reviews options and provides suggestions about individual-level statistics to assess whether individuals have improved, stayed the same, or declined. METHODS Review of MIC estimation and an example of misapplication of MIC group-level estimates to assess individual change. Secondary data analysis to show how perceptions about meaningful change can be used along with significance of individual change. RESULTS MIC thresholds yield over-optimistic conclusions about responders to treatment because they classify those who have not changed as responders. CONCLUSIONS Future studies need to evaluate the significance of individual change using appropriate individual-level statistics such as the reliable change index or the equivalent coefficient of repeatability. Supplementing individual statistical significance with retrospective assessments of change is desirable.
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Kurihara Y, Ohsugi H, Choda K, Endo Y, Tosaka T, Matsuda T, Tsuneizumi Y, Tsukeoka T. Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty. Knee 2021; 28:354-361. [PMID: 33494017 DOI: 10.1016/j.knee.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated. METHODS Twenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined. RESULTS The maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores. CONCLUSION The early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.
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Affiliation(s)
- Yasushi Kurihara
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture 283-8555, Japan.
| | - Hironori Ohsugi
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture 283-8555, Japan
| | - Kohei Choda
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Yuki Endo
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tomonari Tosaka
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 2-1-1 Hongou Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshikazu Tsuneizumi
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture 266-0005, Japan
| | - Tadashi Tsukeoka
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture 266-0005, Japan
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Robinson PG, Rankin CS, Murray IR, Maempel JF, Gaston P, Hamilton DF. The forgotten joint score-12 is a valid and responsive outcome tool for measuring success following hip arthroscopy for femoroacetabular impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2021; 29:1378-1384. [PMID: 32691092 PMCID: PMC8038977 DOI: 10.1007/s00167-020-06138-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022]
Abstract
PURPOSE The forgotten joint score-12 (FJS-12) is an outcome questionnaire designed to evaluate joint awareness. The responsiveness and validity of the English language version of the FJS-12 in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) is not known. METHODS Consecutive patients undergoing hip arthroscopy for a diagnosis of FAI were prospectively followed up over a 1 year period. Patients completed preoperative and postoperative FJS-12, EuroQol 5 Dimension (EQ-5D-5L), and the 12-item international hip outcome tool (iHOT-12). We evaluated construct validity with Spearman correlation coefficients for the FJS-12, and responsiveness by way of effect size and ceiling effects. RESULTS Forty-six patients underwent hip arthroscopy, of which 42 (91%) completed post-operative PROMs at 1 year follow-up. Construct validity was strong with the iHOT-12 (r = 0.87) and also the EQ-5D-5L (r = 0.83). The median postoperative FJS score was 50.2 (IQR 64). The mean change in score for the FJS-12 was 31 points (SD 31) (p < 0.001), with an effect size (Cohen's d) of 1.16. Preoperatively, three patients scored the lowest possible value resulting in a floor effect of 7.1%. Similarly, only three patients (7.1%) scored the best possible score post-operatively. CONCLUSION This is the first evaluation of the joint awareness concept in the English language version of the FJS-12 following hip arthroscopy for FAI. The FJS-12 is a valid and responsive tool for the assessment of this cohort of patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Patrick G. Robinson
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - C. S. Rankin
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - I. R. Murray
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - J. F. Maempel
- grid.413249.90000 0004 0385 0051Department of Trauma and Orthopaedics, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - P. Gaston
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - D. F. Hamilton
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
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Mikkelsen M, Gao A, Ingelsrud LH, Beard D, Troelsen A, Price A. Categorization of changes in the Oxford Knee Score after total knee replacement: an interpretive tool developed from a data set of 46,094 replacements. J Clin Epidemiol 2020; 132:18-25. [PMID: 33301905 DOI: 10.1016/j.jclinepi.2020.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The objective of the study was to create an interpretive categorical classification for the transition in the Oxford Knee Score (OKS) change score (ΔOKS) using the anchor-based method. STUDY DESIGN AND SETTING Registry data from 46,094 total knee replacements from the year 2014/15, were accessed via the Health and Social Care Information Center official website. Data included preoperative and 6-month follow-up OKS and response to the transition anchor question. Categories were determined using Gaussian approximation probability and k-fold cross-validation. RESULTS Four categories were identified with the corresponding ΔOKS intervals: "1. much better" (≥16), "2. a little better" (7-15), "3. about the same" (1-6), and "4. much worse" (≤0) based on the anchor questions' original five categories. The mean 10-fold cross-validation error was 0.35 OKS points (95% confidence interval 0.12 to 0.63). Sensitivity ranged from 0.34 to 0.68; specificity ranged from 0.74 to 0.95. CONCLUSION We have categorized the change score into a clinically meaningful classification. We argue it should be an addition to the continuous OKS outcome to contextualize the results in a way more applicable to the shared decision-making process and for interpreting research results.
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Affiliation(s)
- Mette Mikkelsen
- Dept. of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
| | - Anqi Gao
- Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - Lina Holm Ingelsrud
- Dept. of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - David Beard
- Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - Anders Troelsen
- Dept. of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Andrew Price
- Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
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Freigang V, Rupp M, Pfeifer C, Worlicek M, Radke S, Deckelmann S, Alt V, Baumann F. Patient-reported outcome after patient-specific unicondylar knee arthroplasty for unicompartmental knee osteoarthritis. BMC Musculoskelet Disord 2020; 21:773. [PMID: 33234122 PMCID: PMC7686700 DOI: 10.1186/s12891-020-03776-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background Unicondylar knee arthroplasty was introduced in the late 1960s and remains a topic of controversial discussion. Patient-specific instruments and patient-specific implants are not yet the standard of care. The question remains whether this time-consuming and costly technique can be beneficial for the patient. The aim of this study was to evaluate whether a custom-made unicondylar knee arthroplasty leads to improved patient-reported outcome. Methods This retrospective study evaluates the patient-reported outcome after custom-made unicondylar knee arthroplasty (CM-UKA, ConforMIS™ iUni® G2, ConforMIS Inc., Billerica, MA, USA). We evaluated 29 patients (31 knees) at an average of 2.4 years (range 1.2–3.6 years) after operation for unicondylar osteoarthritis of the knee. The target zone for the postoperative leg axis was a slight under-correction of 0–2° varus. Follow-up evaluation included the Forgotten Joint Score (FJS), the Knee Society Score (KSS), a Visual Analogue Scale (VAS) and a radiographic evaluation including a long-leg radiograph. Primary outcome measure was patient satisfaction based on the Forgotten Joint Score. Results We found an excellent postoperative health-related quality of life with a mean FJS of 76.8 (SD 17.9) indicating a low level of joint awareness after CM-UKA. The mean preoperative KSS was 66.0 (SD 13.71) and 59.4 (17.9) for the KSS function score. The increase was 22.8 points for the KSS knee score (p < 0.0001) and 34.8 points for the KSS function score (p < 0.0001). The VAS for pain decreased from a mean of 5.4 (SD 1.8) to 1.1 (SD 1.2) (p < 0.0001). The malalignment rate with a postoperative deviation of more than 2° in the leg axis was 29%. There was no evidence of component loosening after a mean follow-up of 2.4 years. Conclusions Custom-made unicondylar knee arthroplasty (CM-UKA) can provide improved clinical and functional outcomes for patients with isolated knee osteoarthritis of the medial compartment. We found excellent results regarding patient satisfaction and a low malalignment rate for CM-UKA. Further studies are needed to investigate long-term survivorship of the implant. Level of evidence Level IV. Trial registration Trial Registration number: Z-2014-0389-10 Regensburg Clinical Studies Center (REGCSC) 09/07/2014.
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Affiliation(s)
- Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Michael Worlicek
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Stefan Radke
- Department of Orthopaedic Surgery, Rotkreuzklinikum Munich, Munich, Germany
| | - Stephan Deckelmann
- Department of Orthopaedic Surgery, Rotkreuzklinikum Munich, Munich, Germany
| | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany.
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Wang Z, Deng W, Shao H, Zhou Y, Li H. Forgotten Joint Score Thresholds for Forgotten Joint Status and Patient Satisfaction after Unicompartmental Knee Arthroplasty in Chinese Patients. J Arthroplasty 2020; 35:2825-2829. [PMID: 32482475 DOI: 10.1016/j.arth.2020.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/19/2020] [Accepted: 05/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Patient Acceptable Symptom State (PASS) and "forgotten joint" represent 2 treatment goals that arthroplasty surgeons often pursue. However, the actual Forgotten Joint Score (FJS-12) that corresponds to the PASS and forgotten joint in unicompartmental knee arthroplasty (UKA) patients remains unknown. METHODS One hundred ninety-three patients who underwent a medial UKA for knee osteoarthritis with a minimum of 1-year follow-up were included. Patients were asked to complete the FJS-12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. We used patient-reported satisfaction and the Patient's Joint Perception questions as anchors to determine the achievement of PASS and the forgotten joint, respectively. FJS-12 thresholds for PASS and the forgotten joint were calculated using the anchor-based receiver operating characteristic curve analysis. The ability of the FJS-12 and WOMAC scores to detect the PASS and forgotten joint was compared with DeLong's test. RESULTS Based on the answers to the anchor questions, 176 (91.2%) of the 193 total patients achieved the PASS and 34 (17.6%) patients achieved a forgotten joint after UKA. The FJS-12 outperformed the WOMAC with respect to detecting a forgotten joint (P = .008), but they performed equally well in terms of detecting PASS (P = .950). The FJS-12 threshold for PASS was 40.63 (sensitivity: 84.1%, specificity: 76.5%) and for the forgotten joint was 84.38 (sensitivity: 97.1%, specificity: 88.1%). CONCLUSION For UKA patients, the FJS-12 score has a superior ability to detect a forgotten joint when compared to the WOMAC. The FJS-12 threshold for the PASS is 40.63, while a score above 84.38 can be interpreted as having achieved a forgotten joint.
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Affiliation(s)
- Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hua Li
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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Are There Differences in Micromotion on Radiostereometric Analysis Between Bicruciate and Cruciate-retaining Designs in TKA? A Randomized Controlled Trial. Clin Orthop Relat Res 2020; 478:2045-2053. [PMID: 32023233 PMCID: PMC7431269 DOI: 10.1097/corr.0000000000001077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bicruciate-retaining TKA has been proposed to improve clinical outcomes by maintaining intrinsic ACL function. However, because the unique design of the bicruciate-retaining tibial component precludes a tibial stem, fixation may be compromised. A radiostereometric analysis permits an evaluation of early migration of tibial components in this setting, but to our knowledge, no such analysis has been performed. QUESTIONS/PURPOSES We performed a randomized controlled trial using a radiostereometric analysis and asked, at 2 years: (1) Is there a difference in tibial implant migration between the bicruciate-retaining and cruciate-retaining TKA designs? In a secondary analysis, we asked: (2) Is there a difference in patient-reported outcomes (Oxford Knee Score [OKS] and Forgotten Joint Score [FJS] between the bicruciate-retaining and cruciate-retaining TKA designs? (3) What is the frequency of reoperations and revisions for the bicruciate-retaining and cruciate-retaining TKA designs? METHODS This parallel-group trial (ClinicalTrials.gov: NCT01966848) randomized 50 patients with an intact ACL who were eligible to undergo TKA to receive either a bicruciate-retaining or cruciate-retaining TKA. Patients were blinded to treatment allocation. The primary outcome was the maximum total point motion (MTPM) of the tibial component measured with model-based radiostereometric analysis (RSA) at 2 years postoperatively. The MTPM is a translation vector defined as the point in the RSA model that has the greatest combined translation in x-, y- and z-directions. A 1-year postoperative mean MTPM value of 1.6 mm has been suggested as a threshold for unacceptable increased risk of aseptic loosening after both 5 and 10 years. The repeatability of the MTPM was found to be 0.26 mm in our study. Patient-reported outcome measures were assessed preoperatively and at 2 years postoperatively with the OKS (scale of 0-48, worst-best) and FJS (scale of 0-100, worst-best). Baseline characteristics did not differ between groups. At 2 years postoperatively, RSA images were available for 22 patients who underwent bicruciate-retaining and 23 patients who underwent cruciate-retaining TKA, while patient-reported outcome measures were available for 24 patients in each group. The study was powered to detect a 0.2-mm difference in MTPM between groups (SD = 0.2, significance level = 5%, power = 80%). RESULTS With the numbers available, we found no difference in MTPM between the bicruciate-retaining and cruciate-retaining groups. The median (interquartile range [IQR]) MTPM was 0.52 mm (0.35 to 1.02) and 0.42 mm (0.34 to 0.70) in the bicruciate-retaining and cruciate-retaining groups, respectively (p = 0.63). There was no difference in the magnitude of improvement in the OKS from preoperatively to 2 years postoperative between the groups (median delta [IQR] for bicruciate-retaining 18 [14 to 23] versus cruciate-retaining 18 [15 to 21], difference of medians 0; p = 0.96). Likewise, there was no difference in the magnitude of improvement in the FJS score from preoperatively to 2 years postoperative between the groups (mean ± SD for bicruciate-retaining 46 ± 32 versus cruciate-retaining 48 ± 16, mean difference, 2; p = 0.80). Three patients in the bicruciate-retaining group underwent arthroscopically assisted manipulation at 3 to 4 months postoperatively, and one patient in the bicruciate-retaining group sustained a tibial island fracture during primary surgery and underwent a revision procedure after 6 months. There were no reoperations or revisions in the cruciate-retaining group. CONCLUSIONS With the numbers available, we found no differences between the bicruciate-retaining and the cruciate-retaining implants in terms of stable fixation on RSA or patient-reported outcome measure scores at 2 years, and must therefore recommend against the routine clinical use of the bicruciate-retaining device. The complications we observed with the bicruciate-retaining device suggest it has an associated learning curve and the associated risks of novelty with no demonstrable benefit to the patient; it is also likely to be more expensive in most centers. Continued research on this implant should only be performed in the context of controlled trials. LEVEL OF EVIDENCE Level II, therapeutic study.
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