Translation and Validation of the Korean Version of the Forgotten Joint Score

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

Purpose

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

Methods

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

Results

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

Conclusion

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

Level of Eidence

Level III.

Item Response Theory Validation of the Forgotten Joint Score for Persons Undergoing Total Knee Replacement

BACKGROUND

The Forgotten Joint Score (FJS), a commonly used patient-reported outcome measure, was developed without fully confirming assumptions such as unidimensionality (all items reflect 1 underlying factor), appropriate weighting of each item in scoring, absence of differential item functioning (in which different groups, e.g., men and women, respond differently), local dependence (pairs of items are measuring only 1 underlying factor), and monotonicity (persons with higher function have a higher score). We applied item response theory (IRT) to perform validation of the FJS according to contemporary standards, and thus support its ongoing use. We aimed to confirm that the FJS reflects a single latent trait. In addition, we aimed to determine whether an IRT model could be fitted to the FJS.

METHODS

Participants undergoing primary total knee replacement provided responses to the FJS items preoperatively and at 6 and 12 months postoperatively. An exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Mokken analysis were conducted. A graded response model (GRM) was fitted to the data.

RESULTS

A total of 1,774 patient responses were analyzed. EFA indicated a 1-factor model (all 12 items reflecting 1 underlying trait). CFA demonstrated an excellent model fit. Items did not have equal weighting. The FJS demonstrated good monotonicity and no differential item functioning by sex, age, or body mass index. GRM parameters are reported in this paper.

CONCLUSIONS

The FJS meets key validity assumptions, supporting its use in clinical practice and research. The IRT-adapted FJS has potential advantages over the traditional FJS: it provides continuous measurements with finer granularity between health states, includes individual measurement error, and can compute scores despite more missing data (with only 1 response required to estimate a score). It can be applied retrospectively to existing data sets or used to deliver individualized computerized adaptive tests.

LEVEL OF EVIDENCE

Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Preserving coronal knee alignment of the knee (CPAK) in unicompartmental knee arthroplasty correlates with superior patient-reported outcomes

BACKGROUND

The optimal alignment target for unicompartmental knee arthroplasty (UKA) remains controversial, and literature suggests that its impact on patient-reported outcome measures (PROMs) varies. The purpose of this study was to identify the relationship between changes in the coronal plane alignment of the knee (CPAK) and PROMs in patients who underwent UKA.

METHODS

A retrospective analysis of 164 patients who underwent UKA was conducted. The types of CPAK types categorized into unchanged, minor (shift to an adjacent CPAK type, e.g., type I to II or type I to IV), and major changes (transitioning to a nearby diagonal CPAK type or two types across, such as type I to V or type I to III). PROMs were assessed preoperatively and 1 year postoperatively using the Hospital for Special Surgery (HSS) scores, Knee Society (KS) scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Scores (FJS). Comparison was performed between patients who experienced and who did not experience any changes in the CPAK.

RESULTS

Patients with preserved native CPAK alignment demonstrated significantly superior 1 year postoperative outcomes, with higher HSS, KS knee, and WOMAC pain scores (p = 0.042, p = 0.009, and p = 0.048, respectively). Meanwhile, the degree of change in CPAK did not significantly influence the PROMs, and patients who experienced minor and major changes in the CPAK showed comparable outcomes.

CONCLUSION

Preserving the native CPAK in UKA procedures is important for achieving favorable clinical outcomes at 1 year postoperative. The extent of change in the CPAK type exerted a limited impact on PROMs, thus emphasizing the importance of change in alignment itself.

Cross-cultural adaptation, validity and reliability of the Arabic version of the Forgotten Joint Score for knee arthroplasty

PURPOSE

To evaluate the validity and reliability of the Arabic version of this questionnaire in Arabic patients who underwent total knee arthroplasty (TKA).

METHODS

The Arabic version of the English FJS (Ar-FJS) was modified according to cross-cultural adaptation best practices. The study included 111 patients who underwent TKA 1-5 years ago and completed the Ar-FJS. The reduced Western Ontario and McMaster Universities Osteoarthritis Index (rWOMAC) and 36-Item Short Form (SF-36) were used to assess the construct validity of the study. Fifty-two individuals took the Ar-FJS test twice to evaluate the test-retest reliability.

RESULTS

The reliability of the Ar-FJS demonstrated a Cronbach's α value of 0.940 and an intraclass correlation coefficient of 0.951. The ceiling effect of the Ar-FJS was 5.4% (n = 6), whereas the floor effect was 1.8% (n = 2). Additionally, the Ar-FJS showed correlation coefficients of 0.753 and 0.992 for the rWOMAC and SF-36, respectively.

CONCLUSION

The Ar-FJS-12 demonstrated excellent internal consistency, repeatability, construct validity, and content validity and can be recommended for patients in Arabic-speaking communities who have undergone knee arthroplasty.

Ankle Pain After Medial Opening-Wedge High Tibial Osteotomy in Patients With Knee Osteoarthritis and Concurrent Ankle Osteoarthritis

BACKGROUND

Medial opening-wedge high tibial osteotomy (MOWHTO) in patients with varus knee osteoarthritis (OA) causes changes to ankle and hindfoot alignment. However, the compensatory ability of the ankle and hindfoot varies according to the severity of ankle OA.

PURPOSE

To investigate whether the changes in ankle symptoms and ankle and hindfoot alignments differ after MOWHTO according to the severity of preoperative ankle OA.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

The data of 130 patients who were followed for ≥4 years were reviewed. Patients were classified into 2 groups according to their severity of ankle OA: group 1, modified Kellgren-Lawrence grade 0 and 1; group 2, grade ≥2. Four radiographic parameters were examined to evaluate ankle alignment: tibial plafond inclination, talar tilt, talar inclination, and tibial surface angle. The hindfoot alignment was evaluated using the varus-valgus angle (VVA) of the calcaneus. A visual analog scale (VAS) was used to evaluate ankle pain. The patient-reported outcome measure of the knee joint was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score.

RESULTS

There were 110 patients in group 1 and 20 patients in group 2. In group 2, the change in talar inclination after MOWHTO was significantly greater and the changes in tibial plafond inclination, talar tilt, and VVA were significantly smaller compared with in group 1 (all P < .05). Ankle pain VAS scores were more severe in group 2 than in group 1 pre- and postoperatively (all P < .05), and group 2 reported that ankle pain worsened postoperatively (P < .05). In both groups, knee WOMAC scores improved, and there were no differences between groups pre- or postoperatively (all P > .05). A multivariate regression analysis demonstrated that a small VVA change (odds ratio, 0.775; P = .027) and severe OA grade of the ankle joint preoperatively (Kellgren-Lawrence grades 2-4 vs 0 and 1; odds ratio, 4.241 [P = .046]) predicted increased ankle pain VAS scores after MOWHTO.

CONCLUSION

Although the patient-reported outcome measures for the knee joint improved irrespective of the presence of ankle OA, ankle pain worsened after MOWHTO in patients with ankle OA. Inadequate compensatory change in hindfoot alignment increased ankle pain in these patients.

Psychometric properties of the Italian version of the Forgotten Joint Score in patients with total hip arthroplasty

Total hip arthroplasty (THA) surgeries are increasing; to assess quality of life after THA, an instrument that considers patient's perspective on surgical outcomes is necessary. The objective of this study is to assess the psychometric properties of the Italian version of the Forgotten Joint Score (FJS-I) in patients with THA. The FJS-I was administered to 111 patients with THA, as well as the Western Ontario and McMaster Universities (WOMAC), Numerical Pain Rating Scale (NPRS), and the EuroQol 5D-5L (EQ-5D-5L). Structural validity [confirmatory factor analysis (CFA)], internal consistency (Cronbach's alpha), test-retest reliability [intraclass correlation coefficient (ICC 2,1 )], measurement error [standard error of the measurement (SEM)], and construct validity (hypothesis testing with correlation of the WOMAC, NPRS, and EQ-5D-5L) were assessed. In addition, the minimal detectable change (MDC) was computed. The result of CFA confirmed the one-factor structure. Internal consistency was supported (α = 0.944). A high test-retest reliability (ICC = 0.958; 95% confidence interval, 0.914-0.980) was found with an SEM and an MDC of 5.3 and 16.6 points, respectively. The a-priori hypotheses were fully met, determining the construct validity to be satisfactory. Psychometric properties of the FJS-I were confirmed, and it can be used for single-person assessment. Further research is suggested to refine its structural validity.