McMaster Universities Osteoarthritis Index Scale Research Articles

The collagen-augmented chondrogenesis technique demonstrates superior cartilage repair compared to microfracture for cartilage defects of the knee joint, regardless of age.

This study investigated whether age affects clinical outcomes and cartilage repair quality in patients who underwent collagen-augmented chondrogenesis. The study included patients who underwent either the collagen-augmented chondrogenesis technique or microfracture for cartilage defects of the knee joint of International Cartilage Repair Society grade 3 or 4. Patients were categorised according to an age threshold of 50 years and the treatment method, whether collagen-augmented chondrogenesis technique or microfracture. Group 1 comprised 31 patients aged 50 years or older who received the collagen-augmented chondrogenesis technique, Group 2 consisted of 32 patients under the age of 50 years who received the collagen-augmented chondrogenesis technique and Group 3 included 243 patients aged 50 years or older who received microfracture. Clinical outcomes were assessed using the walking visual analogue scale (VAS) for pain and the Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC) two years after surgery. For patients with magnetic resonance imaging results 1 year postoperatively (Group 1: 30 patients; Group 2: 31 patients; and Group 3: 31 patients), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) assessment was used to evaluate repaired cartilage lesions. There were no significant differences in the VAS and WOMAC scores between the three groups 2 years after surgery (all n.s.). The MOCART score in patients who underwent MRI at 1 year postoperatively showed significant differences in the degree of defect repair, integration with the border zone, surface of the repaired tissue, adhesion and total score among the three groups (all p < 0.05). Post hoc analysis revealed no difference in the total MOCART scores between Groups 1 and 2. However, Groups 1 and 2 had significantly higher MOCART scores than Group 3 1 year after surgery (all p < 0.05). The collagen-augmented chondrogenesis technique group showed improved quality of cartilage repair compared to the microfracture group, regardless of patient age. Compared with simple microfracture treatment, there were no differences in clinical outcomes between the patient groups, related to age. Level Ⅲ.

Does Generalized Joint Laxity Affect Postoperative Alignment and Clinical Outcomes Following Medial Opening-Wedge High Tibial Osteotomy?

BackgroundThe purpose of this study was to investigate whether generalized joint laxity affects the postoperative alignment and clinical outcomes of medial opening-wedge high tibial osteotomy (MOWHTO). MethodsA total of 198 patients who underwent MOWHTO was divided into two groups according to absence or presence of generalized joint laxity. Generalized joint laxity was measured using the Beighton and Horan criteria, and a score of 4 or more out of 9 was defined as generalized joint laxity. A weight bearing line (WBL) ratio of 55% to 70% was considered an acceptable postoperative lower limb alignment range; WBL over 70% was defined as overcorrection and less than 55% as undercorrection. The WBL ratio was investigated before and 2 years after surgery, and the Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC) was evaluated for patient-reported outcomes (PRO) of MOWHTO. There were 147 (73.7%) patients in the nongeneralized joint laxity group and 51 (26.3%) in the generalized joint laxity group. Preoperatively, there was no difference between the two groups in hip-knee-ankle (HKA) angle or WBL ratio (all P > .05). ResultsAt 2 years postoperatively, the generalized joint laxity group showed significantly higher HKA angle and WBL ratio than the nongeneralized joint laxity group (all P < .05). There was a significant difference in the distribution ratio of undercorrection, normocorrection, and overcorrection patients between the two groups (P < .05). There were no differences between the two groups in preoperative and postoperative WOMAC scores (all, P > .05). ConclusionThe generalized joint laxity significantly affected postoperative over correction of alignment following MOWHTO. However, there was no significant difference in PRO between the patients who did and did not have generalized joint laxity after MOWHTO until 2 years.

Effectiveness and safety of aromatherapy massage for knee osteoarthritis: A protocol for systematic review and meta-analysis.

The purpose of this study was to evaluate the effectiveness and safety of aromatherapy massage in the treatment of knee osteoarthritis. To collect relevant literature, we will research following databases: PubMed, Web of Science, Scopus, Cochrane Library, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database and Wanfang Data the time is from inception to December 30, 2021, and the language is limited to Chinese and English. In addition, we will retrieve other literature resources, including the Chinese Clinical Trial Register, conference papers. Two reviewers will independently complete the literature screen and data extraction, and quality assessment of the included studies will be independently completed by 2 other researchers. The primary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index scale, the visual analog scale, symptom score, Lysholm knee scoring scale, adverse events, and adverse reactions as secondary outcomes would be assessed. RevMan V.5.4.1 software will be used for meta-analysis, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality of evidence. This systematic review will be showed a high-quality synthesis to evaluate the efficacy and safety of aromatherapy massage in the treatment of knee osteoarthritis, providing reference for the safe and effective treatment of knee osteoarthritis. This study provides evidence of whether aromatherapy massage is effective.Systematic review registration: INPLASY202210010URL: https://inplasy.com/inplasy-2022-1-0010/.

Association of Serum Low-Density Lipoprotein, High-Density Lipoprotein, and Total Cholesterol With Development of Knee Osteoarthritis.

Studies suggest an association between elevated total serum cholesterol, particularly low-density lipoprotein (LDL), and osteoarthritis (OA). The present study was undertaken to evaluate the association between total cholesterol, LDL, and high-density lipoprotein (HDL) and risk of knee OA. We studied participants from the Multicenter Osteoarthritis study (MOST) cohort at risk of developing knee OA. From baseline through 7 years, repeated knee radiographs and magnetic resonance images (MRIs) were obtained, and knee symptoms were queried. From baseline fasting blood samples, lipids and lipoproteins were analyzed using standard assays. After excluding participants with baseline OA, we defined 2 sets of patients: those developing radiographic OA, and those developing symptomatic OA (knee pain and radiographic OA). Controls did not develop these outcomes. Additionally, we examined worsening of cartilage loss and synovitis on MRI and of knee pain using the Western Ontario and McMaster Universities Osteoarthritis Index scale. We carried out logistic regression adjusting for age, sex, body mass index, education, baseline pain, and depressive symptoms, testing total cholesterol and lipoproteins as continuous measures, and we performed sensitivity analyses examining whether commonly used thresholds for high cholesterol, LDL, or low HDL increased risk. We studied 337 patients with incident symptomatic OA and 283 patients with incident radiographic OA. The mean age at baseline was 62 years (55% women). Neither total cholesterol, LDL, nor HDL showed a significant association with radiographic or symptomatic OA. Additionally, we found no association of these lipid measures with cartilage loss, worsening synovitis, or worsening knee pain. Our data do not support an association between total cholesterol, LDL, or HDL with OA outcomes.

Makoplasty medial unicondylar knee replacement: Correction or postoperative angle matters?

Various considerations prevail around optimal postoperative varus deformity, correction angle and physiological constitutional varus deformity. The goal of our present study was to understand correlation between these parameters and their influence over Western Ontario McMaster University Osteoarthritis Index scale (WOMAC). Consecutive robotic-arm-assisted medial onlay fixed bearing unicompartmental knee arthroplasty (UKA) in 143 knees studied. WOMAC score was recorded preoperatively and at specific intervals after surgery for consecutive 2 years. Mean preoperative and postoperative varus deformities were 10.2° and 4.8°, respectively, and mean correction angle was 5.4°. The preoperative varus and correction angles were found well correlated (r=0.815). The amount of improvement in the WOMAC total score was not influenced by the postoperative varus angle. The correction angle has a stronger correlation with preoperative varus deformity, and postoperative varus deformity does not imply favourable clinical outcomes.

Health-Related Quality of Life and Outcome after Total Knee Replacement: Results from a Cross-Sectional Survey in Jordan.

Total knee replacement (TKR) is a common procedure that is considered cost-effective with excellent long-term survivorship. This cross-sectional study, which includes 118 selected patients in Jordan from January 2020 to January 2021, aims to assess health-related quality of life (HQOL), functional status, and associated factors before and after 3 to 12 months of TKR. Furthermore, several demographical factors were included in this study to evaluate the potential association with the procedure's outcome. Western Ontario and McMaster Universities Osteoarthritis Index scale (WOMAC) and Short Form-36 (SF-36) scale were used in this study. It was found that the main change occurred 6–12 months after the procedure. Gender and age were found to be the primary predictor of quality of life among TKR patients. Patients before the TKR procedure experienced severe pain, joint stiffness, physical impairment, and psychological demand issues. After the TKR procedure, all symptoms were improved significantly. The TKR procedure can improve the quality of life for patients, which can be detected for several months after the procedure. Function and pain are the most critical indicators of improvement in quality of life. Assessing the quality of life is a key indicator for identifying patients without improvement, as well as improving the health care process and comparing other alternative interventions.

Evaluation of the efficacy of gallium-aluminum-arsenide laser acupuncture in the management of knee osteoarthritis

Background/aim Knee osteoarthritis is a common degenerative disease affecting the joint, causing progressive loss of cartilage and inflammation. Its main symptoms are pain and stiffness. Medications such as NSAIDs have little benefit and are usually accompanied by serious adverse effects. The aim of this study was to evaluate the efficiency of laser acupuncture in the management of stage 2 or 3 knee osteoarthritis. Patients and methods The study was carried out on 30 patients (24 females and six males) diagnosed as having stage 2 or 3 knee osteoarthritis. The patients were recruited from the Complementary and Alternative Medicine Clinic at the Medical Centre of Excellence, National Research Centre, Cairo, Egypt. The patients were subjected to low-power laser (gallium-aluminum-arsenide 905 nm) with touch sensor guide light, power output of 100 mill watts, beam area of 1 cm2, 1-min irradiation time, frequency 10 000 Hz, duty cycle 100%, total energy per point 6 J, energy density 6 J/cm2, and irradiance 0.1 W/cm2, for 3 days/week for a duration of 4 weeks (12 session), directed at various acupuncture points (ST 35, ST 36, Sp 9, Sp 10, GB 34, Sp 6, and liv3). Clinical and laboratory parameters were assessed before and after laser therapy. Results Pain on visual analog scale, number of tender points, tenderness score, angle of knee flexion, heel to hip distance, Western Ontario McMaster Universities Osteoarthritis Index scale score, and Lequesne Index showed significant improvement after treatment (P&lt;0.05). Timed up and go test result was decreased after laser sessions, but its improvement was insignificant statistically. Significant improvement and increase of enkephalin and immunoglobulin (IL-4) were recorded after treatment. Conclusion Laser acupuncture showed efficacy in the management of stage 2 or 3 knee osteoarthritis.

Autologous chondrocyte transplantation: a phase 1 study protocol to validate the safety and feasibility of a new advanced cell therapy product for articular cartilage repair in Brazil

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Membrane-assisted autologous chondrocyte transplantation is considered the gold standard surgical technique to treat greater than two millimetres diameter cartilage lesions in the knee in patients after conservative treatment failure. However, this technique is only available in developed countries of North America, Europe and Japan. According to Brazilian law, it is considered an advanced cell therapy product. There is currently no product of this type enabled for clinical use in Brazil. Following the request of the Brazilian regulatory agency (ANVISA), this phase 1 study was developed. The objective is to access feasibility and safety of a new membrane-assisted autologous chondrocyte product.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Three participants with a larger than two millimetres articular cartilage lesion in the distal femur or the patella, which did not improve their symptoms with conservative treatment, will be submitted to an arthroscopically assisted cartilage biopsy. After isolation and expansion in a good manufacturing practices facility, chondrocyte seeded collagen membranes will be surgically inserted in the lesion and fixed with fibrin glue. The follow-up period will last 1 year. Primary outcome will be incidence and severity of complications according to NCI-CTCAE version 4.0. Secondary outcomes will be Western-Ontario McMaster Universities Osteoarthritis Index scale, International Knee Documentation Committee subjective scale and magnetic resonance observation of cartilage repair tissue magnetic resonance scale.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study, together with previous preclinical results and international experience, will allow patients in Latin America to have access to this advanced cell therapy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Trial Registration:&lt;/strong&gt; Brazilian registry of clinical trials RBR-6fgy76 (http://www.ensaiosclinicos.gov.br/rg/RBR-6fgy76/). Ethical approval: CAAE: 73911617.2.0000.0071.&lt;/p&gt;

The complexity of molecular processes in osteoarthritis of the knee joint.

Osteoarthritis (OA) is a common medical problem leading to chronic pain and physical disability among the world’s population. Analyzing the molecular background of the degenerative arthritis creates the potential for developing novel targeted methods of treatment. Fifty samples of meniscus, anterior cruciate ligaments (ACLs) and articular surfaces were collected from patients who underwent total knee arthroplasty in 2016. Enzyme-linked immunosorbent assay was used to assess the levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF), transforming growth factor-β1 and LUMINEX for MMP-1, MMP-2, MMP-3, MMP-9 and MMP-13. The collected data were correlated with the severity of radiological OA, demographic data and clinical scales. Strong positive correlations in the concentration of metalloproteinases and proinflammatory cytokines, TNF-α (MMP-2 and MMP-13) and IL-6 (MMP-13), were identified. MMP-13 had a positive correlation with the concentration of MMP-1, MMP-2 and MMP-9. Negative correlation coefficient exists between clinical conditions measured with the Western Ontario and McMaster Universities Osteoarthritis Index scale and the level of TNF-α and MMP-1. The TNF-α concentration was lower in the cartilage of the articular surface among patients who took non-steroidal anti-inflammatory drugs periodically. The decrease in MMP-2 in the cartilage of the articular surface corresponded with the severity of radiological OA on the Kellgren–Lawrence scale. Current treatment methods for OA do not stop disease progression. Identifying signaling pathways and molecular particles engaged in OA and their correlations with the patient’s clinical condition brings new therapeutic possibilities.

Peer Support Intervention Improves Pain-Related Outcomes Among Rural Adults With Diabetes and Chronic Pain at 12-Month Follow-Up.

Adults with diabetes mellitus (DM) suffer often from chronic pain, yet evidence-based interventions for comorbid pain and DM are scarce. We tested the effect of a peer-led cognitive behavioral training (CBT) intervention on pain self-efficacy (PSE), pain intensity, and pain-related functional limitations (PRFL) in adults with DM, 1 year after trial initiation. The yearlong "Living Healthy" cluster-randomized trial included 230 residents of rural Alabama with DM, who reported pain in the past month; communities were treated as clusters. Intervention participants received a peer-delivered 8-session structured CBT intervention in the context of diabetes self-management; attention control arm participants received a peer-delivered 8-session general health education program. Outcomes included PSE (Arthritis Self-Efficacy Scale, range 10-100); pain intensity (McGill Pain Questionnaire, range 0-45); and PRFL (Western Ontario and McMaster Universities Osteoarthritis Index scale, range 0-100). We examined control-intervention differences in changes in outcome scores from baseline to 3-month and 12-month follow-up, adjusted for clustering. The 195 participants with follow-up data were aged 59 ± 10.4 years, 96% were African American, 79% were women, and 80% reported pain on the day of baseline data collection. At 3-month follow-up, PSE increased more for intervention (21-point increase) than control (5-point increase) participants (P for control-intervention (C-I) difference in change < .001); pain intensity decreased for both groups; and PRFL decreased only for intervention participants (-11 score; P for C-I difference in change < .001). Results were sustained at 12 months, and pain intensity significantly improved in only the intervention arm (P for C-I difference in change = .01). This peer-delivered CBT intervention improved pain self-efficacy, pain-related functional limitations, and pain intensity over 12 months among rural participants with DM and chronic pain.

Robot-assisted unicompartmental knee arthroplasty can reduce radiologic outliers compared to conventional techniques.

BackgroundThe aim of this study was to compare the clinical and radiologic outcomes of robot-assisted unicompartmental knee arthroplasty (UKA) to those of conventional UKA in Asian patients.MethodsFifty-five patients underwent robot-assisted UKA and 57 patients underwent conventional UKA were assessed in this study. Preoperative and postoperative range of motion (ROM), American Knee Society (AKS) score, Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC), and patellofemoral (PF) score values were compared between the two groups. The mechanical femorotibial angle (mFTA) and Kennedy zone were also measured. Coronal alignments of the femoral and tibial components and posterior slopes of the tibial component were compared. Additionally, polyethylene (PE) liner thicknesses were compared.ResultsThere was no significant difference between the two groups regarding postoperative ROM, AKS, WOMAC and PF score. Robot group showed fewer radiologic outliers in terms of mFTA and coronal alignment of tibial and femoral components (p = 0.022, 0.037, 0.003). The two groups showed significantly different PE liner thicknesses (8.4 ± 0.8 versus 8.8 ± 0.9, p = 0.035). Robot group was the only influencing factor for reducing radiologic outlier (postoperative mFTA) in multivariate model (odds ratio: 2.833, p = 0.037).ConclusionIn this study, robot-assisted UKA had many advantages over conventional UKA, such as its ability to achieve precise implant insertion and reduce radiologic outliers. Although the clinical outcomes of robot-assisted UKA over a short-term follow-up period were not significantly different compared to those of conventional UKA, longer follow-up period is needed to determine whether the improved radiologic accuracy of the components in robotic-assisted UKA will lead to better clinical outcomes and improved long-term survival.

Is Home-Based, High-Intensity Interval Training Cycling Feasible and Safe for Patients With Knee Osteoarthritis?: Study Protocol for a Randomized Pilot Study.

Background:Osteoarthritis (OA) is a degenerative joint disease affecting the knee joint of many middle-aged and older adults. As OA symptoms typically involve knee pain and stiffness, individuals with knee OA are often insufficiently physically active, have low levels of physical function, and are at increased risk of other comorbidities and reduced quality of life. While moderate-intensity continuous training (MICT) cycling is often recommended, little is known about the feasibility, safety, and benefits of high-intensity interval training (HIIT) cycling for this population, even though the feasibility, safety, and benefits of HIIT have been demonstrated in other chronic disease groups.Purpose:The primary objective of this pilot study was to examine the feasibility and safety of home-based HIIT and MICT cycling in middle-aged and older adults with knee OA. A secondary objective was to gain some insight into the relative efficacy of HIIT and MICT for improving health status (pain, stiffness, and disability), muscle function, and body composition in this population. This study protocol is being published separately to allow a detailed description of the research methods, explain the rationale for choosing the methodological details, and to stimulate consideration of the best means to simulate a research protocol that is relevant to a real-life treatment environment.Study Design:Randomized pilot study protocol.Methods:This trial sought to recruit 40 middle-aged and older adults with knee OA. Participants were randomly allocated to either continuous (MICT) or HIIT home-based cycle training programs, with both programs requiring the performance of 4 cycling sessions (approximately 25 minutes per session) each week. Participants were measured at baseline and postintervention (8 weeks). Feasibility and safety were assessed by adherence rate, dropout rate, and number of adverse events. The relative efficacy of the cycling programs was investigated by 2 knee OA health status questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index scale[WOMAC] and the Lequesne Index) as well as the timed up and go, sit to stand, preferred gait speed, and body composition.Discussion:This pilot study appears to be the first study assessing the feasibility and safety of a home-based HIIT training program for middle-aged and older adults with knee OA. As HIIT has been demonstrated to be more effective than MICT for improving aspects of health status, body composition, and/or muscular function in other chronic disease groups, the current study has the potential to improve patient outcomes and inform the design of future randomized controlled trials.

Association of Physical Activity Measured by Accelerometer, Knee Joint Abnormalities, and Cartilage T2 Measurements Obtained From 3T Magnetic Resonance Imaging: Data From the Osteoarthritis Initiative.

To study the cross-sectional association between physical activity measured with an accelerometer, structural knee abnormalities, and cartilage T2 values assessed with 3T magnetic resonance imaging (MRI). We included 274 subjects from the Osteoarthritis Initiative cohort without definite radiographic osteoarthritis (Kellgren/Lawrence grades 0 and 1) and with at most mild pain, stiffness, and functional limitation in the study knee (Western Ontario and McMaster Universities Osteoarthritis Index scale 0-1), which had not limited their activity due to knee pain. Physical activity was measured over 7 days with an ActiGraph GT1M accelerometer. Subjects were categorized by quartile of physical activity based on the average daily minutes of moderate to vigorous physical activity (mv-PA). MRI images of the right knee (at 48-month visit) were assessed for structural abnormalities using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) and for T2 relaxation times derived from segmented cartilage of 4 femorotibial regions and the patella. WORMS grades and T2 measurements were compared between activity quartiles using a linear regression model. Covariates included age, sex, body mass index, knee injury, family history of knee replacement, knee symptoms, hip and ankle pain, and daily wear time of the accelerometer. Higher mv-PA was associated with increased severity (P = 0.0087) and number of lesions of the medial meniscus (P = 0.0089) and with severity of bone marrow edema lesions (P = 0.0053). No association between cartilage lesions and mv-PA was found. T2 values of cartilage (loss, damage, and abnormalities) tended to be greater in the higher quartiles of mv-PA, but the differences were nonsignificant. In knees without radiographic osteoarthritis in subjects with no or mild knee pain, higher physical activity levels were associated with increases in meniscal and bone marrow edema pattern lesions.

Effect of low-level laser therapy in patients with chronic knee osteoarthritis: a single-blinded randomized clinical study

The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on pain relief and functional performance in patients with chronic knee osteoarthritis (OA). Forty patients with knee OA were randomly assigned into active laser group (n = 20) and placebo laser group (n = 20). The LLLT device used was a Ga-As diode laser with a power output of 50mW, a wavelength of 850nm, and a diameter beam of 1mm. Eight points were irradiated and received dosage of 6J/point for 60s, with a total dosage of 48J/cm(2) in each session. The placebo group was identical but treated without emission of energy. LLLT was applied two times per week over the period of 4weeks. Outcome measurements included pain intensity at rest and at movement on visual analog scale, knee function using Western Ontario McMaster Universities Osteoarthritis Index scale, and ambulation duration. These measurements were collected at baseline and post-intervention. The results showed significant improvements in all assessment parameters in both groups compared to baseline. Active laser group showed significant differences in pain intensity at rest and movement, knee function, and ambulation duration when compared with the placebo group. Therefore, LLLT seemed to be an effective modality for short-term pain relief and function improvement in patients with chronic knee OA.

Interpretations of the Clinical Outcomes of the Nonresponders to Mail Surveys in Patients After Total Knee Arthroplasty

This study examined whether or not nonresponders to mail survey have poorer clinical outcomes than responders. A postal questionnaire, which was designed to evaluate the functional disability and patient's satisfaction, was mailed to 387 patients whose 1-year clinical outcomes were available. Of the 270 patients (69.8%) who responded, 247 (91.4%) reported that they were satisfied with their replaced knees. The knees of the nonresponders showed significantly poorer results in terms of the function-related scales (American Knee Society score function, Western Ontario McMaster University Osteoarthritis Index scale function, Short-Form 36 physical and functional scores) than the knees of the responders, whereas there were no significant differences in the pain-related scales. The clinical results of the nonresponders were poorer in most of the clinical outcome scales than those of the satisfied subgroup of responders but better than those of the dissatisfied subgroup. The results of the pain-related scales were similar to the satisfied subgroup but the function-related scales were similar to the dissatisfied subgroup.

Causes and Predictors of Patient's Dissatisfaction After Uncomplicated Total Knee Arthroplasty

We aimed to identify the causes and predictors of patient's dissatisfaction after total knee arthroplasty (TKA). Patient's satisfaction was evaluated in 438 TKAs. Causes of patient dissatisfaction were identified using patient interview, physical examinations, laboratory and radiographic tests, and relevant medical consultations. Investigation of 33 dissatisfied knees identified knee-related symptoms in 16 knees (48.5%) and the symptoms unrelated to the replaced knee in 17 knees (51.5%). Multivariate logistic regression analysis revealed that worse preoperative Western Ontario McMaster University Osteoarthritis Index scale pain score and postoperative decrease in range of motion were significantly associated with postoperative dissatisfaction (odds ratio, 7.6 and 2.1, respectively). This study demonstrates that residual symptoms or dysfunctions not directly associated with the replaced knee could be a frequent cause of postoperative dissatisfaction after TKA in osteoarthritic patients.