The preoperative Oxford Knee Score is an independent predictor of achieving a postoperative ceiling score after total knee arthroplasty

2020 ◽  
Vol 102-B (11) ◽  
pp. 1519-1526
Author(s):  
Nicholas D. Clement ◽  
Irrum Afzal ◽  
Charis Demetriou ◽  
David J. Deehan ◽  
Richard E. Field ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Independent Predictor ◽  
Characteristic Curve ◽  
Oxford Knee Score ◽  
Ceiling Effect ◽  
Knee Score ◽  
Total Knee ◽  
Five Dimension ◽  
One Year

Aims The primary aim of this study was to assess whether the postoperative Oxford Knee Score (OKS) demonstrated a ceiling effect at one and/or two years after total knee arthroplasty (TKA). The secondary aim was to identify preoperative independent predictors for patients that achieved a ceiling score after TKA. Methods A retrospective cohort of 5,857 patients undergoing a primary TKA were identified from an established arthroplasty database. Patient demographics, body mass index (BMI), OKS, and EuroQoL five-dimension (EQ-5D) general health scores were collected preoperatively and at one and two years postoperatively. Logistic regression analysis was used to identify independent preoperative predictors of patients achieving postoperative ceiling scores. Receiver operating characteristic curve was used to identify a preoperative OKS that predicted a postoperative ceiling score. Results The ceiling effect was 4.6% (n = 272) at one year which increased significantly (odds ratio (OR) 40.3, 95% confidence interval (CI) 30.4 to 53.3; p < 0.001) to 6.2% (n = 363) at two years, when defined as those with a maximal score of 48 points. However, when the ceiling effect was defined as an OKS of 44 points or more, this increased to 26.3% (n = 1,540) at one year and further to 29.8% (n = 1,748) at two years (OR 21.6, 95% CI 18.7 to 25.1; p < 0.001). A preoperative OKS of 23 or more and 22 or more were predictive of achieving a postoperative ceiling OKS at one and two years when defined as a maximal score or a score of 44 or more, respectively. Conclusion The postoperative OKS demonstrated a small ceiling effect when defined by a maximal score, but when defined by a postoperative OKS of 44 or more the ceiling effect was moderate and failed to meet standards. The preoperative OKS was an independent predictor of achieving a ceiling score. Cite this article: Bone Joint J 2020;102-B(11):1519–1526.

Venous thromboembolism after total knee arthroplasty is associated with a worse functional outcome at one year

2021 ◽  
Vol 103-B (7) ◽  
pp. 1254-1260
Author(s):  
Lorenzo Calabro ◽  
Nick D. Clement ◽  
Deborah MacDonald ◽  
James T. Patton ◽  
Colin R. Howie ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Venous Thromboembolism ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Significant Independent Predictor ◽  
Total Knee ◽  
Five Dimension ◽  
One Year

Aims The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee-specific functional outcome (Oxford Knee Score (OKS)) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time. Methods A study of 2,393 TKAs was performed in 2,393 patients. Patient demographics, comorbidities, OKS, EuroQol five-dimension score (EQ-5D), and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and compared with those without. Results A total of 37 patients (1.5%) suffered a VTE and were significantly more likely to have associated comorbidities of stroke (p = 0.026), vascular disease (p = 0.026), and kidney disease (p = 0.026), but less likely to have diabetes (p = 0.046). In an unadjusted analysis, patients suffering a VTE had a significantly worse postoperative OKS (difference in mean (DIM) 4.8 (95% confidence interval (CI) 1.6 to 8.0); p = 0.004) and EQ-5D (DIM 0.146 (95% CI 0.059 to 0.233); p = 0.001) compared with patients without a VTE. After adjusting for confounding variables VTE remained a significant independent predictor associated with a worse postoperative OKS (DIM -5.4 (95% CI -8.4 to -2.4); p < 0.001), and EQ-5D score (DIM-0.169 (95% CI -0.251 to -0.087); p < 0.001). VTE was not independently associated with overall satisfaction after TKA (odds ratio 0.89 (95% CI 0.35 to 2.07); p = 0.717). Conclusion Patients who had a VTE within six months of their TKA had clinically significantly worse knee-specific outcome (OKS) and general health (EQ-5D) scores one year postoperatively, but the overall satisfaction with their TKA was similar to those patients who did not have a VTE. Cite this article: Bone Joint J 2021;103-B(7):1254–1260.

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

2020 ◽  
Vol 34 (01) ◽  
pp. 115-120
Author(s):  
Ali Utkan ◽  
Emrah Caliskan ◽  
Batuhan Gencer ◽  
Bulent Ozkurt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Histopathological Analysis ◽  
Knee Score ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractAlthough there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

scholarly journals Validation of the Korean Version of the Oxford Knee Score in Patients Undergoing Total Knee Arthroplasty

2012 ◽  
Vol 471 (2) ◽  
pp. 600-605 ◽  
Author(s):  
Il Soo Eun ◽  
Ok Gul Kim ◽  
Chang Kyu Kim ◽  
Hong Seok Lee ◽  
Jung Sub Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Knee Score ◽  
Korean Version ◽  
Total Knee

scholarly journals Proximal Fibular Osteotomy – Simplest and Most Effective Mean to Delay Total Knee Arthroplasty

2021 ◽  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Joint Space ◽  
Medial Compartment ◽  
Knee Score ◽  
Fibular Osteotomy ◽  
Number Of Patients ◽  
Total Knee

Background: Osteoarthritis involves degeneration of articular cartilage seen with increasing age. The knee joint, the most common joint that falls prey to attacks of osteoarthritis, has 30% incidence in population above 60 years. Total knee arthroplasty (TKA) is the main surgical option for orthopaedics. Though it corrects the deformity and relieves pain, yet it is not the treatment of choice in younger population. This study aimed to validate the effects of proximal fibular osteotomy (PFO) as a newer technique in managing medial compartment knee osteoarthritis. Methods: The diagnosed patients for medial compartment knee joint osteoarthritis were selected for study from Dr. Ziauddin University hospital of Karachi. Excluded were aged less than 40 years, or with BMI more than 30, and patients with tri-compartmental arthritis. Medial and lateral joint spaces along with Oxford knee score were measured and recorded pre- and post-operatively. Patients underwent PFO after giving written and informed consent. Results: Total number of patients selected was 30 for this study; 21 (70%) females, and 9 (30%) males (mean age 58.8 years). Mean pre-operative measured medial joint space on standard antero-posterior (AP) radiograph was 0.442± 0.04 cm. Mean recorded pre-operative Oxford knee score was 23.87±3.74 mm. Improvement was observed in mean postoperative medial joint space to 0.572± 0 .066 cm and mean post-operative Oxford knee score to 40.2±5.8mm. Conclusion: This study concludes that PFO significantly improves joint function in patients with medial compartment osteoarthritis knee and may delay the need for total knee arthroplasty, if carried out at an appropriate stage. Keywords: Osteotomy; Osteoarthritis; Total Knee Arthroplasty.

scholarly journals Higher treatment effect after total knee arthroplasty is associated with higher patient satisfaction

2020 ◽  
Author(s):  
Jörg Lützner ◽  
Franziska Beyer ◽  
Klaus-Peter Günther ◽  
Jörg Huber
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Treatment Effect ◽  
Treatment Effects ◽  
Oxford Knee Score ◽  
Individual Treatment ◽  
Total Knee ◽  
The Mean ◽  
One Year

Abstract Purpose The aim of this study was to investigate what influence the treatment effect after total knee arthroplasty (TKA) had on patient satisfaction. Methods Prospective registry data of a University-based arthroplasty centre were used. 582 patients with unilateral bicondylar TKA were analyzed. Treatment effect (TE) was deduced from Oxford Knee Score (OKS) before and one year after surgery. Positive values correspond to improved symptoms (maximum 1.0 reflect no symptoms at all) and negative values correspond to deterioration of symptoms. Satisfaction on a visual-analogue scale from 0 to 10 and the willingness to undergo TKA surgery again was assessed one year after surgery. Results The mean OKS improved from 22.1 before to 36.7 one year after TKA. Treatment effects ranged from 1.0 to –0.62 with a mean TE of 0.56. Taking an individual treatment effect of 0.2 as a cut-off between responder and non-responder, a total of 85.8% would be classified as responder after TKA. The mean satisfaction score with the TKA was 8.1. There was a significant correlation between the individual treatment effect and satisfaction after TKA (p < 0.001). The majority of patients (84.5%) would undergo surgery again. Patients not willing to undergo surgery again or those uncertain about this had lower satisfaction scores, a lower treatment effect and were more often female compared to patients who would undergo surgery again. Conclusion Higher individual treatment effects resulted in higher patient satisfaction and willingness to undergo surgery again. However, some patients with a relatively low treatment effect were highly satisfied, which indicates the need for both information. Level of evidence II.

scholarly journals The Effect of Comorbidities and Age on Functional Outcomes After Total Knee Arthroplasty in the Octogenarian: A Matched Cohort Study

2018 ◽  
Vol 9 ◽  
pp. 215145931876950 ◽  
Author(s):  
Eric Wei Liang Cher ◽  
Kae Sian Tay ◽  
Karen Zhang ◽  
Seang Beng Tan ◽  
Tet Sen Howe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Oxford Knee Score ◽  
World Health ◽  
Control Group ◽  
Knee Score ◽  
Life Expectancy At Birth ◽  
Total Knee ◽  
The Impact

Introduction: According to the World Health Organization data repository, the average life expectancy at birth for Singapore in 2015 has risen to 83.4 years, and many octogenarians (OG) remain active socioeconomically. The aim of this study is to compare the improvement and the impact of comorbidities on functional recovery after total knee arthroplasty (TKA) between OG and their younger counterparts. Methods: This is a retrospective study of prospectively collected data from a single institution arthroplasty register. Between January 2006 and December 2011, 209 OG with primary knee osteoarthritis underwent TKA. Each OG (mean age 82 ± 2.1) was then carefully matched to a younger control group (YG, mean age 66 ± 4.5). Their postoperative outcomes measured include Oxford Knee Score (OKS), SF36-Physical Function (SF-PF), and knee society rating score comprising of Knee Score (KS) and Function Score (FS). Their respective degrees of improvement were compared and adjusted for their baseline comorbidities, measured using the Deyo-Charlson Comorbidity Index (D-CCI). Results: There were more comorbidities among the OG ( P < .05). Both groups saw the largest improvement ( P < .05) during the first 6 months. There was no statistical significance between their improvement for OKS, KS, and FS between baseline and 6 months and OKS, FS, and SF-PF between 6 and 24 months. Adjusted for D-CCI using linear regression, the above results remained largely unchanged. Discussion: In our study, both groups showed significant improvement across all functional outcomes, especially during the first 6 months. The improvement observed in OG at 6 and 24 months was comparable to that of YG, despite an overall higher baseline D-CCI. Conclusions: Total knee arthroplasty is a viable treatment option for the OG, offering good functional outcomes and results at 6 and 24 months when compared to their younger counterparts.

Revision Total Knee Arthroplasty Causes of failure, bone loss management and outcomes\

2018 ◽  
Vol 69 (8) ◽  
pp. 2222-2227
Author(s):  
George Viscopoleanu ◽  
Bogdan Sendrea ◽  
Emil Haritinian
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Loss ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Bone Defects ◽  
Knee Score ◽  
Cause Of Failure ◽  
Total Knee

The objectives of the current study were to identify the causes leading to revision knee arthroplasty, analyse implant choices and assess the short-term outcome. The current study is a retrospective on including a group of 33 patients operated between Jan 2013-Dec 2016 in a single institution. Data was collected from the Romanian National Arthroplasty Register. The cause for revision surgery was noted, as well as the type of implant used during the surgical procedure. The bony defect was classified according to the Anderson Orthopaedic Research Institute (AORI) Classification and the reconstruction method was analysed. Functional outcome was assessed using Oxford Knee Score preoperatively and at one year follow-up. Infection was the cause of failure in 18 cases, aseptic loosening in 11 cases, malposition of implants in 2 cases, instability in 1 case and periprosthetic fracture in 1 case. Revision implants were chosen based on joint stability and degree bone loss. The preferred implant was a condylar constrained knee type (20 cases), followed by a rotating hinge type (5 cases). An unconstrained implant was used in 2 cases. Six infected cases required an arthrodesis of the knee. Based on the AORI Classification, there were 10 type III defects, 14 type IIB, 8 type IIA and only one type I defect. Metal augments were preferred for reconstruction of bone defects. Bone graft was used in 8 cases. The mean Oxford Knee Score was 15 pre-op (12-20) and 38 post-op (32-45). Implant survival at final follow-up was 100%. The most common cause of failure of primary total knee arthroplasty is prosthetic joint infection. Bone defects can be addressed using metal augments or bone allograft. Postoperative functional outcome is improved irrespective of the type of implant used.

The results of knee arthrodesis with dedicated modular intramedullary nail as a limb salvage procedure in infection complications of knee arthroplasty

2020 ◽  
Vol 86 (2) ◽  
pp. 33-38
Author(s):  
Marcin Para ◽  
◽  
Paweł Bartosz ◽  
Maciej Kogut ◽  
Gracjan Suchodolski ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Intramedullary Nail ◽  
Oxford Knee Score ◽  
Knee Score ◽  
Knee Arthrodesis ◽  
Bone Contact ◽  
Total Knee ◽  
The Mean

Introduction. Complications after arthroplasty often result in irreversible disability. In some cases, for the extremity to be salvaged, permanent knee joint arthrodesis is a last-chance procedure. Modular implant design simplifies surgical technique and knee arthrodesis without bone-on-bone contact, immediately provides full weight bearing and restores limb length and alignment. Puropose. The aim of this article was to perform a clinical evaluation of patients after knee arthrodesis with a dedicated modular intramedullary nail without bone-on-bone contact after a failed infected total knee arthroplasty. Methods. Between 2017 and 2021, 17 patients were treated with knee arthrodesis with a modular nail after a septic complication of total knee arthroplasty. Clinical evaluation of 15 patients was obtained during a follow-up visit, including: the pain severity using the Visual Analog Scale (VAS), physical function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score, gait independence, and the shortening of the affected limb in relation to the other one. Results. The mean follow-up duration was 1.4 years. The group included 11 women and 4 men with an average of 69.3 (57–84) years. All nails were cemented. There was one recurrence of infection. The mean VAS pain score was 2.73, also 4 patients felt no pain at all. The average functional score on the WOMAC scale was 36.4 (14–60) and for the Oxford Knee Score was 26.5 (15–41). Each patient achieved an independent gait. All patients reported the necessity of use of crutches outside home. The average limb shortening was 2.05 cm (0.5–3.0). In addition, 14 of the 15 patients positively evaluated the procedure results and if they had to, they would again decide on this form of treatment. During follow-up, no complication or problems with implants used were observed. Conclusions. Knee arthrodesis with modular nail offers an acceptable functional result and gives a chance of salvaging a limb in complex septic complications of TKA.

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