Forgotten Joint Score-12 Scores Research Articles

Comparison of joint awareness after total knee arthroplasty, medial unicompartmental knee arthroplasty, and high tibial osteotomy: a retrospective study

IntroductionThis study aimed to compare the Forgotten Joint Score-12(FJS) outcomes and the minimum clinically important difference (MCID) of the FJS after high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA) with short-term follow-up (at least 2 years). Another objective of the study is to investigate the factors influencing FJS. It is hypothesized that there are differences in FJS outcomes among the three procedures.MethodsPatients who underwent HTO, UKA, and TKA from January 2016 to December 2020 and were followed up for a minimum of 2 years were included in the study. The FJS were analyses from a cohort of people who submitted data to two years. The preoperative and postoperative clinical outcomes were compared and evaluated the patient-related factor. The FJS scores were predicted using multiple linear regression analysis. Additionally, Patient's Joint Perception (PJP) questions were used as anchors to determine the achievement of the forgotten joint, and FJS MCID were calculated using the receiver operating characteristic curve (ROC).ResultsThree hundred eighty-nine patients were included in the final study, and there were 111 patients in HTO groups,128patients in UKA groups, and 150 patients in TKA groups. The mean follow-up was 47.0 months. There was a significant difference in the total FJS, between the HTO, UKA, and TKA groups (FJS:59.38 ± 7.25, 66.69 ± 7.44 and 56.90 ± 6.85, p < 0.001. We found the MCID of the FJS of HTO, UKA, and TKA were 63.54, 69.79, and 61.45, respectively. In multiple linear regression, younger age, and higher FS were significant predictors of better FJS.ConclusionMedial UKA demonstrated lower patient awareness in comparison to HTO and TKA, as assessed by the FJS. Younger age and higher FS were identified as significant predictors of improved FJS, providing valuable guidance for surgical decision-making.

Reliability and validity of the Forgotten Joint Score-12 for total ankle replacement and ankle arthrodesis.

This study evaluated the reliability and validity of the Forgotten Joint Score-12 (FJS-12)-a measure of patients' ability to forget their joints in daily life-in patients who underwent total ankle replacement (TAR) or ankle arthrodesis (AA). Patients who underwent TAR or AA were recruited from seven hospitals. The patients completed the Japanese version of FJS-12 twice, at an interval of two weeks, at a minimum of one year postoperatively. Additionally, they answered the Self-Administered Foot Evaluation Questionnaire and EuroQoL 5-Dimension 5-Level as comparators. The construct validity, internal consistency, test-retest reliability, measurement error, and floor and ceiling effects were evaluated. A total of 115 patients (median age, 72 years), comprising 50 and 65 patients in the TAR and AA groups respectively, were evaluated. The mean FJS-12 scores were 65 and 58 for the TAR and AA groups, respectively, with no significant difference between groups (P = 0.20). Correlations between the FJS-12 and Self-Administered Foot Evaluation Questionnaire subscale scores were good to moderate. The correlation coefficient ranged from 0.39 to 0.71 and 0.55 to 0.79 in the TAR and AA groups, respectively. The correlation between the FJS-12 and EuroQoL 5-Dimension 5-Level scores was poor in both groups. The internal consistency was adequate, with Cronbach's α greater than 0.9 in both groups. The intraclass correlation coefficients of test-retest reliability was 0.77 and 0.98 in the TAR and AA groups, respectively. The 95% minimal detectable change values were 18.0 and 7.2 points in the TAR and AA groups, respectively. No floor or ceiling effect was observed in either group. The Japanese version of FJS-12 is a valid and reliable questionnaire for measuring joint awareness in patients with TAR or AA. The FJS-12 can be a useful tool for the postoperative assessment of patients with end-stage ankle arthritis.

Open-wedge high tibial osteotomy with a slight valgus correction from neutral limb alignment achieves clinical improvements comparable with those for knees with varus deformity

PurposeThe effect of open-wedge high tibial osteotomy (OWHTO) on the preoperative neutral alignment of the knee is unknown. The purpose of this study was to clarify the clinical outcome of OWHTO with neutral alignment, defined as within 4 degrees of varus.MethodsThis retrospective study included 72 knees with varus that underwent medial OWHTO. The knees were divided according to the preoperative hip-knee-ankle angle into a neutral alignment group (≤ 4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score-12 (FJS-12) were evaluated preoperatively and during at least 2 years of follow-up postoperatively.ResultsThere were no significant differences between the preoperative FJS-12 (17.9 versus 23.7; p = 0.16) and postoperative FJS-12 (57.3 versus 60.6; p = 0.52) or KOOS subscale scores (p > 0.05) in the neutral alignment group or the varus alignment group. Each group had a mean change in the KOOS subscale scores that exceeded the minimum clinically important difference.ConclusionThe short-term clinical results of OWHTO for neutral alignment were as favourable as those for varus malalignment.Level of evidenceIV.

Direct Anterior Approach Provides Superior Prosthesis Adaptability in the Early Postoperative Period of Total Hip Arthroplasty.

Prosthesis awareness is the perception of foreign bodies, which has a critical effect on the function of the prosthetic joint. In total hip arthroplasty (THA), the direct anterior approach (DAA) has more advantages than the posterior approach (PA), including superior rehabilitation outcomes. This study was to evaluate the recovery of "prosthesis awareness" through these two approaches. Three hundred and seventy-six patients who received THA with either DAA (n=41) or PA (n=335) from January 2016 to December 2017 were retrospectively analyzed. The Forgotten Joint Score-12 (FJS-12), Harris hip score (HHS), and visual analog scale (VAS) analyses were used to evaluate the recovery of "prosthesis awareness" in these patients 2 weeks, 1, 3, 6, and 12months after surgery. The student t-test, Wilcoxon rank sum test, chi-square test, and MANOVA were used to compare the differences among groups. We found that DAA patients had higher FJS-12 scores than PA patients at 2 weeks (42.15 ± 3.36 vs. 38.09 ± 3.28, p =0.042), 1 month (49.06 ± 5.14 vs. 41.11 ± 5.21, p =0.038), and 3 months (53.23 ± 4.07 vs. 48.09 ± 3.71, t=3.152, p=0.045). And the recovery rates of FJS-12 scores in DAA and PA groups at 2 weeks, 1 month, and 3 months after surgery were 75.46% ± 6.04%, 84.05% ± 6.57%, 91.37% ± 7.13%, and 74.14% ± 5.54%, 78.16% ± 6.01%, 88.23% ± 6.42%, respectively. To compare the recovery effects of the two procedures in more detail, we classified the 12 items in FJS-12 that evaluate different types of gravity center motions into three categories: low-movement group (LG), middle-movement group (MG), and high-movement group (HG). Interestingly, DAA patients had significantly higher HG than PA patients at 2 weeks, 1 month, and 3 months after operation (t=3.225, p=0.022 at 2 weeks, t=3.081, p=0.041 at 1 month and t=2.783, p=0.046 at 3 months), whereas no significant differences were observed in LG- and MG-related items. In addition, there were no significant differences in HHS and VAS scores between DAA and PA patients at 2 weeks (p=0.102, p =0.093), or from 1 month to 12months (each p > 0.05). DAA-mediated THA is superior to PA in terms of prosthesis adaptability and recovery of hip joint motion in the first 3 months after surgery, especially concerning high-movement gravity center motions.

The Minimal Clinically Important Difference, Patient Acceptable Symptom State, and Clinical Outcomes of Anterior Cruciate Ligament Repair Versus Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

Background: There has been increasing interest in anterior cruciate ligament (ACL) repair because of theoretical advantages over ACL reconstruction; however, the contemporary literature has failed to provide high-quality evidence to demonstrate these advantages. Purpose: To compare the clinical and functional outcomes of ACL repair versus ACL reconstruction at a minimum follow-up of 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACL repair were propensity matched (based on demographics, time between injury and surgery, knee laxity parameters, presence of meniscal lesions, preoperative activity level, and sport participation), in a 1:1 ratio, to those who underwent ACL reconstruction during the same period. Isokinetic testing was used to evaluate strength deficits at 6 months postoperatively. Knee laxity parameters were evaluated at 12 months. Complications, return to sport, and patient-reported outcome scores were recorded at final follow-up. Results: In total, 75 matched pairs (150 patients) were evaluated. The repair group had significantly better mean hamstring muscle strength at 6 months compared with the reconstruction group (1.7% ± 12.2% vs −10.0% ± 12.8%, respectively; P < .0001). At a mean final follow-up of 30.0 ± 4.8 months, the repair group had a significantly better mean Forgotten Joint Score–12 (FJS-12) score compared with the reconstruction group (82.0 ± 15.1 vs 74.2 ± 21.7, respectively; P = .017). Noninferiority criteria were met for ACL repair, compared with ACL reconstruction, with respect to the subjective International Knee Documentation Committee score (86.8 ± 9.0 vs 86.7 ± 10.1, respectively; P < .0001) and side-to-side anteroposterior laxity difference (1.1 ± 1.4 vs 0.6 ± 1.0 mm, respectively; P < .0001). No significant differences were found for other functional outcomes or the pivot-shift grade. There were no significant differences in the rate of return to the preinjury level of sport (repair group: 74.7%; reconstruction group: 60.0%; P = .078). A significant difference was observed regarding the occurrence of ACL reruptures (repair group: 5.3%; reconstruction group: 0.0%; P = .045). Patients who experienced a failure of ACL repair were significantly younger than those who did not (26.8 vs 40.7 years, respectively; P = .013). There was no significant difference in rupture rates between the repair and reconstruction groups when only patients aged >21 years were considered (2.9% vs 0.0%, respectively; P = .157). The minimal clinically important difference and Patient Acceptable Symptom State (PASS) thresholds were defined for the ACL repair group. A significantly greater proportion of patients in the repair group achieved the PASS for the FJS-12 compared with their counterparts in the reconstruction group (77.3% vs 60.0%, respectively; P = .034). Conclusion: ACL repair was associated with some advantages over ACL reconstruction including superior hamstring muscle strength at 6 months and significantly better FJS-12 scores. However, the failure rate was significantly higher after ACL repair, and younger patients were particularly at risk.

The Impact of Psychological Health on Patient Recovery After Arthroplasty.

PurposeThe purpose of this study was to determine the relationship between psychological health and postoperative recovery and satisfaction in patients undergoing total joint arthroplasty (TJA).MethodsWe prospectively enrolled patients undergoing TJA from July 2019 to December 2020. A psychological evaluation was conducted according to the Hospital Anxiety and Depression Scale (HADS). Based on the preoperative HADS scores, we grouped the patients into two groups: the symptomatic group and the asymptomatic group. Data on the Harris Hip Score (HHS), Knee Society Knee Scoring System (KSS), Forgotten Joint Score-12 (FJS-12), Short Form-12 (SF-12), and Numeric Rating Scale (NRS) for pain in these two groups were collected preoperatively and postoperatively. Then, these data were analyzed by Statistical Package for Social Sciences (SPSS) version 19.ResultsThe final cohort consisted of 80 patients. Patients undergoing TJA had significantly decreased HADS and NRS scores and improved HHS, KSS, SF-12, and FJS-12 scores (all p < 0.001). Compared with the symptomatic group, the asymptomatic group showed better postoperative recovery (p < 0.05), especially after total knee arthroplasty (TKA) (p < 0.05). Good postoperative recovery positively impacted the patients’ postoperative psychological state.ConclusionFinally, the psychological state can affect recovery after TJA, and successful TJA can help improve patients’ psychological states, especially after TKA.

Total Knee Arthroplasty Function at 25 Years Following Proximal Tibial Osteotomy: Paired Outcomes of Bilateral TKAs Following Unilateral Osteotomy.

Proximal tibial osteotomy (PTO) is a well-established treatment for coronal deformity and focal cartilage defects. However, the utility of joint-preserving interventions must be weighed against potential effects on subsequent total knee arthroplasty (TKA). The purpose of this study was to determine the effect of PTO on subsequent TKA by comparing outcomes in patients with bilateral TKAs following unilateral PTO. Patients who underwent bilateral TKAs from 2000 to 2015 at a single institution and had previously undergone a unilateral valgus-producing PTO were reviewed. We evaluated 140 TKAs performed in 70 patients (24 female, 46 male) with a mean age at PTO of 50 ± 8 years. The patients underwent conversion to TKA at a mean of 14 ± 7 years following ipsilateral PTO and were followed for a mean of 25 ± 7 years (range, 6 to 40 years) following PTO. The Knee Society Score (KSS), Forgotten Joint Score-12 (FJS-12), subjective knee preference, and revision were compared between the PTO-TKA and contralateral TKA-only sides. The PTO side demonstrated similar KSS Knee subscores (41 ± 16) compared with the contralateral side (39 ± 16, p = 0.67) immediately prior to arthroplasty. Patients had significant improvements in KSS (p < 0.001) after TKA, with clinically similar KSS values at 2 to 15 years of follow-up when knees were compared in a pairwise fashion (p = 0.10 to 0.83). Five PTO-TKA knees (7%) and 4 control TKA-only knees (6%) underwent revision at a mean of 5 years postoperatively (p = 0.76). The number of all-cause reoperations was approximately twice as high in PTO-TKA knees (13% compared with 6% in TKA-only knees, p = 0.24). At the time of final follow-up, PTO-TKA knees demonstrated similar FJS-12 scores (72 ± 26) compared with the contralateral knees (70 ± 28, p = 0.57). Nineteen percent of patients preferred the PTO-TKA knee, 19% preferred the contralateral TKA-only knee, and 62% stated that their knees were equivalent (p > 0.99). The final Tegner activity score was 2.5 ± 1.4. Long-term clinical function of TKA following PTO was excellent, with patients demonstrating comparable subjective outcomes and equivalent knee preference compared with the contralateral TKA-only knees. Further, well-matched studies are needed to evaluate long-term revision and reoperation rates following PTO-TKA. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Normative FJS-12 scores for the knee in an Asian population: a cross-sectional study

BackgroundThe Forgotten Joint Score is a patient-reported outcome measure validated in assessing patients post knee arthroplasty, anterior cruciate ligament (ACL) reconstruction surgery and patellar dislocation. A previous study had established the normative scores of a population in the USA but included knees with pathology. The aim of our study is to obtain normative Forgotten Joint Scores in young Asian adults without any pre-existing knee pathologies to increase the interpretability of the Forgotten Joint Score-12 (FJS-12) score.MethodsWe conducted a cross-sectional study across young healthy Asian adults via electronic platforms. Participants who had sought either Western medical consultation, physiotherapy or traditional medical therapies were excluded. Demographic data, occupation, type of sport played, and FJS-12 scores were collected. Scores were stratified into subgroups and analysed.ResultsThere were 172 participants who met our inclusion criteria for this study. The average age of participants in our study was 28.1 ± 10.5 years (range 14–70 years), with 83 (47.7%) participants falling into the ages 21–25 years. Average body mass index (BMI) was 21.9 ± 3.3 kg/m2 (range 14.7–36.3 kg/m2). The average FJS-12 score was 62.8 ± 25.6. The median FJS-12 was 63.5 with a range of 4.2–100. Nine participants (5.2%) scored the maximum score possible, and 56 (32.6%) participants scored below the midpoint score of 50. The percentiles for each subgroup of participants were tabulated and reported. Notably, males aged 46–70 years old scored the highest average FJS-12 score of 73.4 ± 5.5, and females aged 31–45 years old scored the lowest FJS-12 score of 57.1 ± 25.1. Females scored lower than males, although the difference was not statistically significant (p = 0.157). There were no significant correlations between BMI, age, or type of sport played with FJS-12; however, interestingly, we observed that women reported similar FJS-12 scores across all age groups, while men reported better scores with increasing age.Interestingly,we observed that women reported similar FJS-12 scores across all age groups,while men reported better scores with increasing age. ConclusionHaving normative values provides opportunities for benchmarking and comparing individuals against age- and gender-matched peers in the general population. Knowledge of normative values for FJS-12 scores would aid evaluating and tracking progress in patients recovering from injuries or undergoing post-surgery rehabilitation. This would help clinicians determine if they return to ‘normal’ post intervention.

Presence of back pain prior total knee arthroplasty and its effects on short-term patient-reported outcome measures.

Back pain may both decrease patient satisfaction after TKA and confound outcome assessment in satisfied patients. Our primary objective was to determine whether preoperative back pain is associated with differences in postoperative patient-reported outcome measures (PROMs). We retrospectively reviewed 234 primary TKA patients who completed PROMs preoperatively and 12 weeks postoperatively, which included a back pain questionnaire, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and the Forgotten Joint Score-12 (FJS-12). Cohorts were defined based on the severity of preoperative back pain (none, mild, moderate and severe) and compared. Demographics were compared using ANOVA and Chi-square analysis. Univariate ANCOVA analysis was utilized to compare PROMs while accounting for significant demographic differences. Both preoperative KOOS JR scores (none: 47.90, mild: 47.61, moderate: 44.61 and severe: 38.70; p = 0.013) and 12-week postoperative KOOS JR scores (none: 61.24, mild: 64.94, moderate: 57.48 and severe: 57.01; p = 0.012) had a statistically significant inverse relationship with regard to the intensity of preoperative back pain. Although FJS-12 scores at the 12-week postoperative period trended lower with increasing levels of preoperative back pain (p = 0.362), it did not reach statistical significance. Patients who reported severe back pain preoperatively achieved the largest delta improvement from baseline compared to those with lesser pain intensity (p = 0.003). Patients who had a 2-grade improvement in their back pain achieved significantly higher KOOS JR scores 12 weeks postoperatively compared to patients with either 1-grade or no improvement (63.53 vs. 55.98; p = 0.042). Both preoperative (47.99 vs. 41.11; p = 0.003) and 12-week postoperative (64.06 vs. 55.73; p < 0.001) KOOS JR scores were statistically higher for those who reported mild or no back pain pre-and postoperatively than those who reported moderate or severe back pain pre-and postoperatively. Knee pain and back pain both exert negative effects on outcome instruments designed to measure pain and function. Although mean improvement from pre- to postoperative KOOS JR scores for patients with severe pre-existing back pain was higher than their counterparts, this statistical difference is likely not clinically significant. This implies that all patients may experience similar benefits from TKA despite the presence or absence of back pain. Attempts to measure TKA outcomes using PROMs should seek to control for lumbago and other sources of body pain. Level of Evidence IIIRetrospective Cohort Study.

The influence of obesity on achievement of a 'forgotten joint' following total knee arthroplasty.

Obesity has been associated with poorer outcomes following total knee arthroplasty (TKA); however, data remain sparse on its impact on patients' joint awareness following surgery. This study aims to investigate the impact of body mass index (BMI) on improvement in outcomes following TKA as assessed by the Forgotten Joint Score-12 (FJS-12). We retrospectively reviewed 1075 patients who underwent primary TKA from 2017 to 2020 with available postoperative FJS-12 scores. Patients were stratified based on their BMI (kg/m2): < 30, 30.0-34.9 (obese class I), 35.0-39.9 (obese class II), and ≥ 40 (obese class III). FJS-12 and KOOS, JR scores were collected at various time points. Demographic differences were assessed with Chi-square and ANOVA tests. Mean scores between BMI groups were compared using univariate ANCOVA, controlling for observed demographic differences. Of the 1075 patients included, there were 457 with a BMI < 30, 331 who were obese class I, 162 obese class II, and 125 obese class III. There were no statistical differences in FJS-12 scores between the BMI groups at 3months (27.24 vs. 25.33 vs. 23.57 vs. 22.48; p = 0.99), 1year (45.07 vs. 41.86 vs. 40.51 vs. 36.22; p = 0.92) and 2years (51.31 vs. 52.86 vs. 46.17 vs. 44.97; p = 0.94). Preoperative KOOS, JR scores significantly differed between the various BMI categories (49.33 vs. 46.63 vs. 44.24 vs. 39.33; p < 0.01); however, 3-month (p = 0.20) and 1-year (p = 0.13) scores were not statistically significant. Mean improvement in FJS-12 scores from 3 months to 2years was statistically greatest for obese class I patients and lowest for obese class III patients (24.07 vs. 27.53 vs. 22.60 vs. 22.49; p = 0.01). KOOS, JR score improvement from baseline to 1year was statistically greatest for obese class III patients and lowest for non-obese patients (22.34 vs. 25.49 vs. 23.77 vs. 27.58; p < 0.01). While all groups demonstrated postoperative improvement, those with higher BMI reported lower mean FJS-12 scores but these differences were not found to be significant. Our study showed no significant impact of BMI on postoperative joint awareness, which implies that obese patients, in all obesity classes, experience similar functional improvement following TKA. Retrospective Cohort Study.

Robotic Arm-Assisted Lateral Unicompartmental Knee Arthroplasty: How Are Components Aligned?

The purpose of this multicenter, retrospective, observational study was to investigate the association between intraoperative component positioning and soft tissue balancing, as reported by robotic technology for a cohort of patients who received robotic arm-assisted lateral unicompartmental knee arthroplasty (UKA) as well as short-term clinical follow-up of these patients. Between 2013 and 2016, 78 patients (79 knees) underwent robotic arm-assisted lateral UKAs at two centers. Pre- and postoperatively, patients were administered the Knee Injury and Osteoarthritis Score (KOOS) and the Forgotten Joint Score-12 (FJS-12). Clinical results were dichotomized based upon KOOS and FJS-12 scores into either excellent or fair outcome, considering excellent KOOS and FJS-12 to be greater than or equal to 90. Intraoperative, postimplantation robotic data relative to computed tomography-based components placement were collected and classified. Following exclusions and loss to follow-up, a total of 74 subjects (75 knees) who received robotic arm-assisted lateral UKAs were taken into account with an average follow-up of 36.3 months (range: 25.0-54.2 months) postoperative. Of these, 66 patients (67 knees) were included in the clinical outcome analysis. All postoperative clinical scores showed significant improvement compared with the preoperative evaluation. No association was reported between three-dimensional component positioning and soft tissue balancing throughout knee range of motion with overall KOOS, KOOS subscales, and FJS-12 scores. Lateral UKA three-dimensional placement does not seem to affect short-term clinical performance. However, precise boundaries for lateral UKA positioning and balancing should be taken into account. Robotic assistance allows surgeons to acquire real-time information regarding implant alignment and soft tissue balancing.

Does the Use of Intraoperative Technology Yield Superior Patient Outcomes Following Total Knee Arthroplasty?

IntroductionThere is debate regarding whether the use of computer-assisted technology, such as navigation and robotics, has any benefit on outcomes or patient-reported outcome measures (PROMs) following total knee arthroplasty (TKA). This study aims to report on the association between intraoperative use of technology and outcomes in patients who underwent primary TKA. MethodsWe retrospectively reviewed 7096 patients who underwent primary TKA from 2016-2020. Patients were stratified depending on the technology utilized: navigation, robotics, or no technology. Patient demographics, clinical data, Forgotten Joint Score-12 (FJS), and Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) were collected at various time points up to 1-year follow-up. Demographic differences were assessed with chi-square and ANOVA. Clinical data and PROMs were compared using univariate ANCOVA, controlling for demographic differences. ResultsA total of 287(4%) navigation, 367(5%) robotics, and 6442(91%) manual cases were included. Surgical-time significantly differed between the three groups (113.33 vs 117.44 vs 102.11; P < .001). Discharge disposition significantly differed between the three groups (P < .001), with more manual TKA patients discharged to a skilled nursing facility (12% vs 8% vs 15%; P < .001) than those who had technology utilized. FJS scores did not statistically differ at three-months (P = .067) and one-year (P = .221). We found significant statistical differences in three-month KOOS, JR scores (59.48 vs 60.10 vs 63.64; P = .001); however, one-year scores did not statistically differ between all groups (P = .320). ConclusionThis study demonstrates shorter operative-time in cases with no utilization of technology and clinically similar PROMs associated with TKAs performed between all modalities. While the use of technology may aid surgeons, it has not currently translated to better short-term outcomes. Level III EvidenceRetrospective Cohort.

Impact of Obesity on the Forgotten Joint Score Following Primary Total Hip Arthroplasty

BackgroundObesity is a growing public health concern. This study aims to identify the association of body mass index (BMI) on postoperative Forgotten Joint Score-12 (FJS-12) in patients undergoing primary total hip arthroplasty (THA). MethodsWe retrospectively reviewed 2130 patients at a single urban, academic, tertiary institution who underwent primary THA from 2016-2020 with available postoperative FJS-12 scores. Patients were stratified into two groups based on their BMI (kg/m2):<30 (nonobese) and ≥30 (obese). FJS-12 scores were collected postoperatively at 3 months, 1 year, and 2 years. Demographic differences were assessed with chi-square and independent sample t-tests. Mean scores between the groups were compared using multilinear regression analysis, controlling for demographic differences. ResultsOf the 2130 patients included, 1378 were nonobese, and 752 were obese. Although obese patients reported lower FJS-12 scores all time periods, there were no statistical differences between the two groups at 3 months (53.61 vs 49.62;P = .689), 1 year (68.11 vs 62.45; P = .349), and 2 years (73.60 vs 65.58; P = .102). A subanalysis comparing patients who were of normal BMI (<25), overweight (25.0-29.9), and obese (≥30) followed a similar inverse trend in scores but showed no statistical differences at all postoperative time points (3m:P = .612,1y:P = .607,2y:P = .253). Mean improvement in FJS-12 scores from 3 months to 1 year (14.50 vs 12.83; P = .041), 1 year to 2 years (5.49 vs 3.13; P = .004), and from 3 months to 2 years (20.00 vs15.96; P < .001) were significantly greater for nonobese patients compared to obese patients. ConclusionWhile obesity trended toward lower FJS-12 scores, the differences in scores were not statistically significant compared to nonobese patients. BMI did not influence overall FJS-12 scores; however, obese patients achieved a slightly smaller statistical improvement during the first 2 years, though this may not be clinically significant. Level III EvidenceRetrospective Cohort Study.

Robotic arm-assisted unicompartmental knee arthroplasty: high survivorship and good patient-related outcomes at a minimum five years of follow-up.

Robotic arm-assisted unicompartmental knee arthroplasty (RA-UKA) has been shown to improve component placement, reduce intraoperative variability, increase patient satisfaction and improve short-term survivorship results. The aim of this retrospective study was to determine the incidence of revision and the clinical performance at a minimum of 5-year follow-up for a cohort of patients who received a medial RA-UKA. Between April 2011 and July 2013, a total of 254 patients underwent medial RA-UKA at a single centre. Clinical performance was investigated using the Forgotten Joint Score-12 (FJS-12) and a 5-level Likert scale made of five items to assess joint perception and patient satisfaction. Kaplan-Meier implant survivorship was calculated and reasons for revision were collected. The effect of age, gender and body mass index (BMI) on the probability of reporting high FJS-12 and satisfaction were assessed. After considering exclusion criteria and loss to follow-up, a total of 216 patients (224 medial RA-UKAs) were assessed at a mean 5.9years of follow-up. Five RA-UKAs underwent implant revision, resulting in an overall Kaplan-Meier survivorship of 97.8%. Unexplained knee pain (0.9%) was the most common reason for RA-UKA revision. Good-to-excellent FJS-12 scores and high satisfaction levels were reported at mid-term follow-up. Male patients had higher probability of having FJS-12 > 90 (p < 0.05) and high satisfaction levels (p < 0.05). RA-UKAs demonstrated high survivorship and good-to-excellent patient-reported outcome measures and satisfaction levels at minimum 5-year follow-up. Results for male patients had improved clinical performance when compared to female subjects. IV.

A Comparative Analysis of Patient Satisfaction following Total Knee Arthroplasty and Total Hip Arthroplasty Using the Forgotten Joint Score

AbstractMeasuring patient satisfaction and surgical outcomes following total joint arthroplasty remains controversial with most tools failing to account for both surgeon and patient satisfaction in regard to outcomes. The purpose of this study was to use “The Forgotten Joint Score” questionnaire to assess clinical outcomes comparing patients who underwent a total hip arthroplasty (THA) with those who underwent a total knee arthroplasty (TKA). We conducted a retrospective review of patients who underwent primary THA or TKA between September 2016 and September 2019 and responded to the Forgotten Joint Score-12 (FJS-12) questionnaire at least at one of three time periods (3, 12, and 21 months), postoperatively. An electronic patient rehabilitation application was used to administer the questionnaire. Collected variables included demographic data (age, gender, race, body mass index [BMI], and smoking status), length of stay (LOS), and FJS-12 scores. t-test and chi-square were used to determine significance. Linear regression was used to account for demographic differences. A p-value of less than 0.05 was considered statistically significant. Of the 2,359 patients included in this study, 1,469 underwent a THA and 890 underwent a TKA. Demographic differences were observed between the two groups with the TKA group being older, with higher BMI, higher American Society of Anesthesiologists scores, and longer LOS. Accounting for the differences in demographic data, THA patients consistently had higher scores at 3 months (53.72 vs. 24.96; p &lt; 0.001), 12 months (66.00 vs. 43.57; p &lt; 0.001), and 21 months (73.45 vs. 47.22; p &lt; 0.001). FJS-12 scores for patients that underwent THA were significantly higher in comparison to TKA patients at 3, 12, and 21 months postoperatively. Increasing patient age led to a marginal increase in FJS-12 score in both cohorts. With higher FJS-12 scores, patients who underwent THA may experience a more positive evolution with their surgery postoperatively than those who had TKA.

Forgotten Joint Score in THA: Comparing the Direct Anterior Approach to Posterior Approach

BackgroundThe direct anterior approach (DAA) in total hip arthroplasty (THA) has gained popularity because of potential decreased postoperative pain and quicker recovery after surgery in comparison to the posterior approach (PA). With a growing focus on patient-reported outcome (PRO) measurements after surgery, we sought to determine if one approach led to better PRO scores as determined by the Forgotten Joint Score-12 (FJS-12) questionnaire. MethodsA retrospective chart review of primary THAs between September 2016 and September 2019 at a single academic hospital was conducted. Demographic and clinical data in addition to FJS-12 scores were collected. Two groups were created based on THA approach. Frequency rates, means, and standard deviations were used to describe baseline patient characteristics. Differences in demographic data were accounted for using linear regression models. ResultsA total of 1469 cases were identified, with 830 using the DAA and 639 the PA. Significant demographic differences were observed between the 2 groups. However, when controlling for this, there were no differences in FJS-12 scores between approaches at 1 and 1.75 years (P = .232 and P = .486, respectively). At 12 weeks, DAA patients had higher satisfaction (59.21 vs 46.8; P = .006). When controlling for surgeon case volume, no differences in FJS-12 were observed at any of the time points (P = .536, P = .452, and P = .967, respectively) ConclusionDAA THA patients trended toward better PRO scores than their PA counterparts. However, when controlling for surgeon case volume, no differences were observed, which suggests that surgeon case volume and experience have an important effect on patient satisfaction and FJS-12 scores.

Translation, cross-cultural adaptation, and validation of the Italian language Forgotten Joint Score-12 (FJS-12) as an outcome measure for total knee arthroplasty in an Italian population

BackgroundWith ever-increasing numbers of patients undergoing elective total knee arthroplasty (TKA) and as TKA is performed in increasingly younger patients, patient demands and expectations have also increased. With improved patient outcomes, new PROMs with heightened discriminatory power in well-performing patients are needed. The present study aimed to translate and validate the Italian version of the Forgotten Joint Score (FJS-12) as a tool for evaluating pre-operative through longitudinal post-operative outcomes in an Italian population.MethodsIn this prospective study, patients with unilateral osteoarthritis, undergoing TKA surgery between May 2015 and December 2017 were recruited to participate in the study. The FJS-12 and WOMAC were collected pre-operatively and at six and 12 months post-operatively. According to the COSMIN checklist, reliability, internal consistency, validity, responsiveness, effect size, and ceiling effects and floor effects were evaluated.ResultsOne hundred twenty patients completed the study, 66 of which participated in the evaluation of test-retest reliability. Good test-retest reliability was found (ICC = 0.90). The FJS-12 also showed excellent internal consistency (Cronbach α = 0.81). Construct validity with the WOMAC, as a measure of the Pearson correlation coefficient, was moderate (r = 0.45 pre-operatively; r = 0.46 at 6 months and r = 0.42 at 12 months post-operatively). From six to 12 months, the change was slightly greater for the WOMAC than for the FJS-12 patients (effect size d = 0.94; d = 0.75, respectively). At 12-months follow-up, the ceiling effects reflecting the maximum score were 12% for the FJS-12 and 6% for the WOMAC; however, scores within 10% of the maximum score were comprised 30% of the FJS-12 scores and 59% for the WOMAC.ConclusionThe Italian FJS-12 demonstrated strong measurement properties in terms of reliability, internal consistency, and construct validity in TKA patients. Furthermore, a more detailed look at ceiling effects shows a superior discriminatory capacity when compared to the WOMAC at 12-months follow-up, particularly in better-performing patients.Trial registrationclinicaltrials.gov NCT03805490. Registered 18 January 2019 (retrospectively registered).

The Forgotten Joint Score-12 as a valuable patient-reported outcome measure for patients after first-time patellar dislocation

BackgroundThe aim of this study is to assess joint awareness after first-time patellar dislocation using the Forgotten Joint Score-12 (FJS-12) and to compare performance of this measurement tool to acknowledged patient-reported outcome scores. MethodsA retrospective analysis of patients with confirmed first-time patellar dislocation was performed. Patients were assessed with the FJS-12, the Kujala and the WOMAC scores. Reference values for the FJS-12 were obtained from a matched healthy control group with no history of previous knee joint pathology. We calculated Cronbach's alpha, assessed the ceiling effect for all scores, and calculated the Spearman correlation coefficient between them ResultsFifty-six patients (mean follow-up 8.2 years, range 1.6–14.1) with a mean age of 26.4 years were analysed. Compared with the age- and gender-matched control group, the patellar dislocation group showed significantly lower (worse) mean FJS-12 scores (88 vs. 71, P < 0.001). Inter-score correlation between the FJS-12 and the Kujala was high (r = 0.74) and significant (P < 0.001), as well as between FJS-12 and WOMAC (r = 0.81, P < 0.001). Cronbach's alpha of the FJS-12 was 0.92 (95% confidence interval 0.90–0.94). The FJS-12 showed less ceiling effect (16%) compared with the Kujala score (23%) and the WOMAC score (32%). ConclusionsThe concept of joint awareness has been successfully applied to a patient population after patellar dislocation. The FJS-12 showed less ceiling effect compared with the Kujala and the WOMAC scores, suggesting the score was able to capture subtle knee problems in patients after patellar dislocation

Normative Values for the Forgotten Joint Score-12 for the US General Population

BackgroundThe Forgotten Joint Score-12 (FJS-12) is a patient-reported outcome questionnaire of joint awareness in patients with hip and knee pathologies. To improve interpretability of values derived from this measure, we collected normative values for the US general population. MethodsA sample of 2000 participants, representative of US general population, was sought via an online panel. Quota sampling was used to obtain age-specific and sex-specific groups of 200 participants each. The FJS-12 is a 12-item questionnaire assessing the ability to forget the hip or knee joint during activities of daily living. To match US national census data from 2010, raking was used for determining data weights. ResultsNormative data for the FJS-12 could be established based on a data set from 2017 respondents (50.1% men; mean age, 54.0 years; 66.3% white/Caucasian). Median FJS-12 scores in the total sample were 75.0 points for knees and 87.5 points for hips. In the age-specific and sex-specific groups, the lowest median score for knees was 54.2 points (men aged 18-39 years) and the highest median was 97.0 (men aged above 70 years). Similarly, median scores for hips were lowest in men aged 18-39 years (60.9 points) and highest in men aged above 70 years (100 points). ConclusionNormative values have been established for the FJS-12 for hips and knees in US general population. Age-specific and sex-specific differences require relying on normative values from the respective groups when interpreting FJS-12 data.

Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patients\u2019 body mass index

PurposeThis study investigated the impact of body mass index (BMI) on improvement in patient outcomes (pain, function, joint awareness, general health and satisfaction) following total knee arthroplasty (TKA).MethodsData were obtained for primary TKAs performed at a single centre over a 12-month period. Data were collected pre-operatively and 12-month postoperatively with the Oxford Knee Score (OKS) measuring pain and function, the EQ-5D-3L measuring general health status, the Forgotten Joint Score-12 (FJS-12) measuring joint awareness and a single question on treatment satisfaction. Change in scores following surgery was compared across the BMI categories identified by the World Health Organization (< 25.0, 25.0–29.9, 30.0–34.9, 35.0–39.9 and ≥ 40.0). Differences in postoperative improvement between the BMI groups were analysed with an overall Kruskal–Wallis test, with post hoc pairwise comparisons between BMI groups with Mann–Whitney tests.ResultsOf 402 patients [mean age 70.7 (SD 9.2); 55.2% women] 15.7% were normal weight (BMI < 25.0), 33.1% were overweight (BMI 25.0–29.9), 28.2% had class I obesity (BMI 30.0–34.9), 16.2% had class II obesity (BMI 35.0–39.9), and 7.0% had class III obesity (BMI ≥ 40.0). Postoperative change in OKS (n.s.) and EQ-5D-3L (n.s.) was not associated with BMI. Higher BMI group was associated with less improvement in FJS-12 scores (p = 0.010), reflecting a greater awareness of the operated joint during activity in the most obese patients. Treatment satisfaction was associated with BMI category (p = 0.029), with obese patients reporting less satisfaction.ConclusionsIn TKA patients, outcome parameters are influenced differently by BMI. Our study showed a negative impact of BMI on postoperative improvement in joint awareness and satisfaction scores, but there was no influence on pain, function or general health scores. This information may be useful in terms of setting expectations expectation in obese patients planning to undergo TKA.Level of evidenceLevel 1.