Postoperative Oxford Knee Score Research Articles

A Matched Comparison of Implant and Functional Outcomes of Cemented and Cementless Unicompartmental Knee Replacements: A Study from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man and the Hospital Episode Statistics Patient Reported Outcome Measures Database.

Unicompartmental knee replacement (UKR) is an effective treatment for end-stage medial compartment osteoarthritis, but there can be problems with fixation. The cementless UKR was introduced to address this issue. It is unknown how its functional outcomes compare with those of the cemented version on a national scale. We performed a matched comparison of the clinical and functional outcomes of cementless and cemented UKRs. Using the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR), 14,764 Oxford UKRs with linked data regarding patient-reported outcomes were identified. A total of 6,906 UKRs (3,453 cemented and 3,453 cementless) were propensity score matched on the basis of patient, surgical, and implant factors. The 10-year cumulative implant survival rate was 93.0% (95% confidence interval [CI], 90.0% to 95.1%) for cementless UKRs and 91.3% (95% CI, 89.0% to 93.0%) for cemented UKRs. The cementless UKR group had a significantly lower revision risk (hazard ratio [HR], 0.74; p = 0.02). Subgroup analyses showed a stronger effect size (HR, 0.66) among UKRs performed by high-caseload surgeons (i.e., surgeons performing ≥30 UKRs/year). In the overall cohort, the postoperative Oxford Knee Score (OKS) in the cementless group (mean and standard deviation, 39.1 ± 8.7) was significantly higher (p = 0.001) than that in the cemented group (38.5 ± 8.6). The cementless group gained a mean of 17.6 ± 9.3 points in the OKS postoperatively and the cemented group gained 16.5 ± 9.6 points, with a difference of 1.1 points between the groups (p < 0.001). The difference in OKS points gained postoperatively was highest among UKRs performed by high-caseload surgeons, with the cementless group gaining 1.8 points more (p < 0.001) than the cemented group. The cementless UKR demonstrated better 10-year implant survival and postoperative functional outcomes than the cemented UKR. The difference was largest among UKRs performed by high-caseload surgeons, with the cementless fixation group having an HR for revision of 0.66 and an approximately 2-point greater improvement in the OKS compared with the cemented fixation group. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The influence of implant factors on patient outcomes in primary total knee arthroplasty

BackgroundThe influence of implant factors on patient-reported outcome measures (PROMS) after total knee arthroplasty (TKA) has previously been studied but findings are often inconsistent, restricted in scope and biased by confounding factors. This study aims to determine the association between implant-related factors and early post-operative PROMs after TKA. MethodsUsing data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) PROMs program, the study included 9487 primary TKA procedures performed in 43 hospitals from July 31, 2018 to December 31, 2020. Data included baseline demographic data, surgical details and PROMs collected pre- and 6 months post-operatively. Seven prosthesis characteristics were incorporated in the multivariable model, with proportional odds ordinal regression analysis used to assess their effects on post-operative Oxford knee score (OKS) and joint pain. Adjustments were made for pre-operative OKS and joint pain, as well as potential patient confounders. ResultsAt six months, fixed bearing implants showed higher odds of better OKS compared to mobile bearing implants (odds ratio [OR] = 1.20, 95 % confidence interval [CI] 1.06–1.37. p < 0.004). Similar findings were found with the use of image derived instrumentation (IDI) (OR = 1.27, 95 % CI 1.11–1.46, p < 0.001), robotic assisted vs. non-navigated knees (OR = 1.21, 95 % CI 1.06–1.38, p < 0.005) and no patella resurfacing (OR = 1.10, 95 % CI 1.01–1.20, p < 0.032). For lower pain scores at six months, the use of highly crosslinked polyethylene (OR = 1.12, 95 % CI 1.02–1.22, p < 0.015), cemented femoral components (OR = 1.11, 95 % CI 1.01–1.22, p < 0.024), IDI (OR = 1.20, 95 % CI 1.05–1.37, p < 0.009) or no patella resurfacing (OR = 1.10, 95 % CI 1.01–1.20, p < 0.034) were associated. ConclusionUtilizing a fixed bearing or robotic assistance correlated with improved OKS scores, whereas highly crosslinked polyethylene or cemented femoral components were associated with improved pain scores. At six months, the use of IDI compared to non-navigated TKA, and patellar resurfacing showed both improved OKS and pain scores.

Are relative contraindications for unicompartmental knee replacements in medial compartment osteoarthritis really contraindications?

BackgroundMedial unicompartment knee replacement (UKR) is performed for isolated medial compartment osteoarthritis. Understanding the factors influencing functional outcomes helps patient selection and outcomes. We will review the association between pre-operative BMI and patellofemoral articular wear on post operative Oxford Knee Scores at >2 and > 5 years. MethodsA retrospective review of a prospectively collected database was performed. Inclusion criteria were medial UKR for medial compartment OA. The exclusion criteria were age <16, revision procedures and lateral UKR's. Data was collected between 26/6/2014 and 25/8/2022. Statistical analysis was performed using SPSS. Significance was given to variables that reached p < 0.05. Results159 UKR procedures were identified in 155 patients. 116 procedures carried out on 111 patients had follow up at > 2 years. At 5 years there were 14 patients had OKS recorded. There was no statistical difference in the ICRS grade I&II vs III&IV groups for >2 year or >5 year OKS with p = 0.408 and p = 0.876. For BMI there was a moderately negative correlation on spearman's rank p(df) = -0.339 (CI 95 % −0.538, −0.104) at >2 years, which was statistically significant with p = 0.004. >5 year data didn't reach significance with p = 0.828. ConclusionBMI maybe an important patient factor in predicting post operative OKS at 2–5 years. This is beneficial to surgeons for patient selection in medial UKR. Patellofemoral wear doesn't appear to impact on post operative functional outcomes. This supports the theory that patient who suffer from patellofemoral wear, as well as medial compartment wear can benefit from UKR, expanding the current indications.

Anatomical site of radiographic degeneration is an independent variable influencing outcome of total knee arthroplasty

ObjectivesWe aimed to determine whether the site of anatomical degenerative change could be identified as an independent risk factor influencing clinical outcome of total knee arthroplasty (TKA) 12 months postoperatively. MethodsWe compared preoperative, postoperative and the change observed in Oxford Knee Score (OKS) amongst TKA patients categorised as primarily medial, lateral or patellofemoral osteoarthritis (PFJOA). Multivariable regression analysis was conducted on 434 consecutive knees in 333 patients, adjusting for sex, age and body mass index (BMI). ResultsAdjusted estimates showed that preoperatively, patients with medial and lateral osteoarthritis (OA) had a lower mean OKS of 2.1 (p ​= ​0.049) and 2.3 (p ​= ​0.056) points respectively, while those with PFJOA had mean scores 2.7 points higher (p ​= ​0.062). There was no statistically significant difference between compartments in absolute postoperative OKS. The greatest improvement of 30.1 points (95% confidence interval (CI) 16.9–36.0, p ​= ​0.012) in OKS was observed for those with lateral OA, followed by 28.9 points (95% CI 16.7–35.3, p ​= ​0.049) for those with medial OA. The improvement observed postoperatively in patients with PFJOA was less than that observed for the average of the cohort at 24.5 (95% CI 11.5–29.7, p ​= ​0.088). ConclusionsThe site of compartmental involvement in knee OA is an independent factor influencing clinical outcome of TKA. With arthroplasty registry adoption of patient-reported outcome measures (PROMs), this study supports precise anatomical categorisation of knee OA in outcome studies. Level of EvidenceLevel III, Retrospective consecutive clinical study.

Medium-term outcome of medial patellofemoral ligament reconstruction using synthetic graft

BackgroundRecurrent patella instability is a common and debilitating condition which affects mainly adolescents and young adults. Medial patellofemoral ligament (MPFL) reconstruction is the most popular surgical treatment for recurrent patella instability. The most common graft choice in the literature is ipsilateral hamstring tendon (gracilis or semitendinosis) but the complication rate remains high (11–26%). Conversely, there are very few papers on the use of modern, synthetic grafts. MethodsA total of 85 patients who underwent MPFL reconstruction using a modern, synthetic graft (Xiros, UK) from 2014 to 2022 were retrospectively reviewed. Exclusion criteria were patella alta, malalignment, trochlea dysplasia and significant pain between episodes of instability. The author has developed an operative technique which is anatomic, minimally invasive and reproducible. Pre- and post-operative Kujala and Oxford knee scores were collected and analysed. ResultsThe male to female ratio was 27:58, the average age was 28 years, and the follow up range was 1–9 years (mean follow up 4.84 years). We found a statistically significant improvement in mean Kujala and Oxford knee scores (P < 0.001) postoperatively. No major complications such as knee stiffness, soft tissue reaction, re-dislocation, patella fracture were identified in the series. There were nine minor complications (10.6%): five cases of medial knee pain, two cases of residual instability and two of superficial infection. ConclusionThis study demonstrates that modern, synthetic graft is a viable option for MPFL reconstruction. The technique described, achieves good clinical outcomes with low complication rates when compared with the published literature.

Prognostic factors of knee pain and function 12 months after total knee arthroplasty: A prospective cohort study of 798 patients

BackgroundApproximately 20% of patients undergoing total knee arthroplasty (TKA) do not experience long-term improvements. Our aim was to identify prognostic factors of knee pain and function 12 months after TKA. MethodsIn a prospective cohort study, 1026 patients underwent primary TKA between 2018 and 2020. Main outcome was measured by the Oxford Knee Score (OKS) categorized in five categories (0–9, 10–19, 20–29, 30–39 and 40–48). Potential prognostic factors obtained at baseline included sex, age, baseline OKS, pain catastrophizing scale, EuroQol 5 dimensions, previous surgery, BMI, ASA classification, opioid consumption, living and employment conditions as well as educational level. Ordinal logistic regression analysis was used to identify prognostic factors of OKS. ResultsA total of 915 patients completed follow up (89%), and patients with complete data were included (n = 798). Patients with a baseline OKS between 10–19 and 20–29 had 2.5 (CI 1.6;4.0) and 1.6 (CI 1.1;2.4) higher odds, respectively, of no improvement or deterioration to a lower post-operative OKS category, compared with patients with a baseline score between 30 and 39. Female patients had 1.5 (CI 1.1;2.0) and patients receiving social benefits compared with retired patients had 2.0 (CI 1.1;3.5) higher odds of no improvement or deterioration to a lower OKS category. ConclusionBaseline level of pain and function, sex and employment status were significant prognostic factors of OKS 12 months after TKA. Overall, the regression analysis only explained 4% of the outcome, indicating that it is difficult to predict 12-month TKA outcome prior to surgery.

The impact of preoperative MRI-detected lateral meniscal intra-substance signal abnormalities on mid-term functional outcomes following mobile-bearing unicompartmental knee arthroplasty.

There is a dilemma as to whether the presence of degenerative changes of lateral meniscus is a contraindication to medial unicompartmental knee arthroplasty (UKA). Therefore, the purpose of this study is to assess the influence of preoperative MRI-detected lateral meniscal intra-substance signal abnormalities on mid-term functional outcomes following mobile-bearing UKA. We performed a retrospective review of the record on a consecutive series of patients who have undergone mobile-bearing medial UKA from September 2020 to June 2023. The mean duration of follow-up was 2.34 years. All records were collected from case system. MRI assessment of lateral meniscus was performed with the use of the Stoller's classification system. Patients were categorized into two groups (grade 0 and ≥ grade 1). Patient-reported outcomes were assessed with the use of the American Knee Society functional Score (AKSS-F), American Knee Society Objective Score (AKSS-O), and Oxford Knee Score (OKS) preoperatively and at latest follow-up. Furthermore, range of motion (ROM) and hip-knee-ankle angle (HKA) were measured in preoperative and postoperative periods. A total of 92 patients (101 knees) were included in our study. No differences in AKSS-F, AKSS-O, OKS, HKA, or ROM were found between those who showed normal or abnormal signal change of lateral meniscus preoperatively (P < 0.05). Furthermore, there were also no significant differences between two groups concerning AKSS-F, AKSS-O, OKS, HKA, or ROM at latest postoperative follow-up (P < 0.05). Age and duration of disease were independent predictors of low postoperative AKSS-F and AKSS-O (P < 0.05). Nevertheless, ROM was an independent predictor of high postoperative AKKS-O (P < 0.05). Age and female were independent predictors of high postoperative OKS (P < 0.05). The presence of preoperative MRI-detected lateral meniscal degenerative changes did not affect mid-term functional outcomes in patients who underwent mobile-bearing medial UKA. On the basis of the results of the current study, we believe that the presence of degenerative changes of lateral meniscus is acceptable in mobile-bearing medial UKA.

Do the Revision Rates of Arthroplasty Surgeons Correlate With Postoperative Patient-reported Outcome Measure Scores? A Study From the Australian Orthopaedic Association National Joint Replacement Registry.

Patient-reported outcome measures (PROMs) are a pragmatic and efficient means to evaluate the functional quality of arthroplasty beyond revision rates, which are used by most joint replacement registries to judge success. The relationship between these two measures of quality-revision rates and PROMs-is unknown, and not every procedure with a poor functional result is revised. It is logical-although still untested-that higher cumulative revision rates correlate inversely with PROMs for individual surgeons; more revisions are associated with lower PROM scores. We used data from a large national joint replacement registry to ask: (1) Does a surgeon's early THA cumulative percent revision (CPR) rate and (2) early TKA CPR rate correlate with the postoperative PROMs of patients undergoing primary THA and TKA, respectively, who have not undergone revision? Elective primary THA and TKA procedures in patients with a primary diagnosis of osteoarthritis that were performed between August 2018 and December 2020 and registered in the Australian Orthopaedic Association National Joint Replacement Registry PROMs program were eligible. THAs and TKAs were eligible for inclusion in the primary analysis if 6-month postoperative PROMs were available, the operating surgeon was clearly identified, and the surgeon had performed at least 50 primary THAs or TKAs. Based on the inclusion criteria, 17,668 THAs were performed at eligible sites. We excluded 8878 procedures that were not matched to the PROMs program, leaving 8790 procedures. A further 790 were excluded because they were performed by unknown or ineligible surgeons or were revised, leaving 8000 procedures performed by 235 eligible surgeons, including 4256 (53%; 3744 cases of missing data) patients who had postoperative Oxford Hip Scores and 4242 (53%; 3758 cases of missing data) patients who had a postoperative EQ-VAS score recorded. Complete covariate data were available for 3939 procedures for the Oxford Hip Score and for 3941 procedures for the EQ-VAS. A total of 26,624 TKAs were performed at eligible sites. We excluded 12,685 procedures that were not matched to the PROMs program, leaving 13,939 procedures. A further 920 were excluded because they were performed by unknown or ineligible surgeons, or because they were revisions, leaving 13,019 procedures performed by 276 eligible surgeons, including 6730 (52%; 6289 cases of missing data) patients who had had postoperative Oxford Knee Scores and 6728 (52%; 6291 cases of missing data) patients who had a postoperative EQ-VAS score recorded. Complete covariate data were available for 6228 procedures for the Oxford Knee Score and for 6241 procedures for the EQ-VAS. The Spearman correlation between the operating surgeon's 2-year CPR and 6-month postoperative EQ-VAS Health and Oxford Hip or Oxford Knee Score was evaluated for THA and TKA procedures where a revision had not been performed. Associations between postoperative Oxford and EQ-VAS scores and a surgeon's 2-year CPR were estimated based on multivariate Tobit regressions and a cumulative link model with a probit link, adjusting for patient age, gender, ASA score, BMI category, preoperative PROMs, as well as surgical approach for THA. Missing data were accounted for using multiple imputation, with models assuming they were missing at random and a worst-case scenario. Of the eligible THA procedures, postoperative Oxford Hip Score and surgeon 2-year CPR were correlated so weakly as to be clinically irrelevant (Spearman correlation ρ = -0.09; p < 0.001), and the correlation with postoperative EQ-VAS was close to zero (ρ = -0.02; p = 0.25). Of the eligible TKA procedures, postoperative Oxford Knee Score and EQ-VAS and surgeon 2-year CPR were correlated so weakly as to be clinically irrelevant (ρ = -0.04; p = 0.004 and ρ = 0.03; p = 0.006, respectively). All models accounting for missing data found the same result. A surgeon's 2-year CPR did not exhibit a clinically relevant correlation with PROMs after THA or TKA, and all surgeons had similar postoperative Oxford scores. PROMs, revision rates, or both may be inaccurate or imperfect indicators of successful arthroplasty. Missing data may limit the findings of this study, although the results were consistent under a variety of different missing data scenarios. Innumerable factors contribute to arthroplasty results, including patient-related variables, differences in implant design, and the technical quality of the procedure. PROMs and revision rates may be analyzing two different facets of function after arthroplasty. Although surgeon variables are associated with revision rates, patient factors may exert a stronger influence on functional outcomes. Future research should identify variables that correlate with functional outcome. Additionally, given the gross level of function that Oxford scores record, outcome measures that can identify clinically meaningful functional differences are required. The use of Oxford scores in national arthroplasty registries may rightfully be questioned. Level III, therapeutic study.

Clinical Outcomes of Unicompartmental Knee Arthroplasty in Patients with Full-versus Partial-Thickness Cartilage Loss: A Systematic Review and Meta-Analysis.

The objective of the study was to compare postoperative patient-reported outcomes and reoperation rates following unicompartmental knee arthroplasty (UKA) between patients with full-thickness cartilage loss (FTCL) and partial-thickness cartilage loss (PTCL). Multiple databases, including PubMed, Embase, Cochrane Library, and CNKI, were searched until October 2019 for studies comparing the Oxford Knee Score (OKS), American Knee Society (AKS) score, and reoperation rates between patients with FTCL and PTCL following UKA. Data analysis was performed using Review Manager software. A total of 613 UKA cases from 5 retrospective cohort studies were included. The mean difference in postoperative OKSs was significantly higher by 2.92 in FTCL group than in PTCL group (95% confidence interval [CI] = -5.29 to -0.55; P = 0.02). Improvement in OKS was significantly higher by 2.69 in FTCL group than in PTCL group (95% CI = -4.79 to -0.60; P = 0.01). However, the differences in OKSs were not clinically significant. The mean difference in AKS knee scores was similar between the 2 groups (95% CI = -9.14 to -3.34; P = 0.36), whereas the pooled mean difference in AKS function scores was higher by 5.63 in FTCL group than in PTCL group (95% CI = -9.27 to -1.98; P = 0.002), which was clinically relevant. The reoperation rates were statistically higher in PTCL group than in FTCL group (odds ratio = 2.24; 95% CI = 1.15 to 4.38; P = 0.02). Patients with FTCL achieved superior postoperative patient-reported outcomes and lower reoperation rates following UKA compared with those with PTCL. Thus, we believe this procedure should only be applied to end-stage medial osteoarthritis of the knee joint.

Outcomes and motives for not proceeding with the second stage bilateral knee replacement: a comparison of cancelled and completed bilateral total knee arthroplasty.

Staged bilateral total knee arthroplasty (TKA) is a common treatment option for patients with bilateral symptomatic knee osteoarthritis, yet some patients do not proceed with their second procedure. Our study aimed to identify the rate and reasons why patients did not proceed with their second procedure and compare their functional outcomes, satisfaction and complication rates with those of patients who had completed a staged bilateral TKA. We determined the proportion of patients who underwent TKA but did not proceed with planned surgery for the second knee within 2 years, and compared their satisfaction with surgery, improvement in the Oxford Knee Score (OKS) and complications between groups. Our study included 268 patients: 220 patients who underwent staged bilateral TKA and 48 patients who cancelled their second procedure. The most common reason for not proceeding with the second procedure was a slow recovery after the first TKA (43.2%), followed by functional improvement in symptoms in the unoperated knee negating the need for surgery (27.3%), poor experience with the first surgery (22.7%), treatment of other comorbidities necessitating cancellation of their second procedure (4.6%) and employment reasons (2.3%). Patients who cancelled their second procedure were noted to have a worse postoperative OKS improvement (p < 0.001) and lower satisfaction rate (p < 0.001), than patients who underwent staged bilateral TKA. About one-fifth of patients scheduled for staged bilateral TKA declined to proceed with the second knee surgery within 2 years showing a substantially decreased functional outcome and satisfaction rate. However, more than one-quarter (27.3%) of patients noted improvements in their contralateral (unoperated) knee, such that a second surgery was no longer felt to be necessary.

Enhanced recovery after surgery (ERAS) protocol in geriatric patients underwent unicompartmental knee arthroplasty: A retrospective cohort study.

The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients' perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group (P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients (P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.

THE USE OF MRI IN PREOPERATIVE PLANNING FOR MEDIAL UNICOMPARTMENTAL KNEE ARTHROPLASTY

Contemporary indications for unicompartmental knee replacement (UKR) include bone on bone radiographic changes in the medial compartment with relatively preserved lateral and patellofemoral compartments. The role of MRI in identifying candidates for UKR is commonplace. The aim of this study was to assess the relationship between radiographic and MRI pre-operative grade and outcome following UKR.A retrospective analysis of medial UKR patients from 2017 to 2021. Inclusion criteria were medial UKR for osteoarthritis with pre-operative and post-operative Oxford Knee Scores (OKS), pre-operative radiographs and MRI.89 patients were included. Whilst all patients had grade 4 ICRS scores on MRI, 36/89 patients had grade 3 KL radiographic scores in the medial compartment, 50/89 had grade 4 KL scores on the medial compartment. Grade 3 KL with grade 4 IRCS medial compartment patients had a mean OKS change of 17.22 (Sd 9.190) meanwhile Grade 4 KL had a mean change of 17.54 (SD 9.001), with no statistical difference in the OKS change score following UKR between these two groups (p=0.873). Medial bone oedema was present in all but one patient. Whilst lateral compartment MRI ICRS scores ranged from 1 to 4 there was no association with MRI score of the lateral compartment and subsequent change in oxford score (P value 0.458). Patellofemoral Compartment (PFC) MRI ICRS ranged from 0 to 4. There was no association between PFC ICRS score and subsequent change in oxford knee score (P value .276)Radiographs may under report severity of some medial sided knee osteoarthritis. We conclude that in patients with grade 3 KL score that would normally not be considered for UKR, pre-operative MRI might identify grade 4 ICRS scores and this subset of patients have equivalent outcomes to patients with radiographic Grade 4 KL medial compartment osteoarthritis.

Patella resurfacing is not associated with a difference in the Oxford knee score after total knee arthroplasty but stair descent is enhanced.

The primary aim was to assess the Oxford knee scores (OKS) on patients who underwent a total knee arthroplasty (TKA) with patellar resurfacing compared to those who did not. Secondary aims were to identify: (1) factors associated with resurfacing, (2) the effect of resurfacing on specific components of the OKS related to patellofemoral function, (3) the influence on patient satisfaction, and (4) whether a subgroup of patients had an improved outcome when resurfacing was undertaken. A retrospective cohort study was undertaken using outcome data from the arthroplasty database held at the study centre. Patient demographics and OKS were collected preoperatively and at 1 and 2years postoperatively. Patient satisfaction was assessed at 1 and 2years postoperatively. Three thousand one hundred and twenty-two patients met the inclusion criteria of which 46.5% (n = 1453) underwent resurfacing. There were no differences in the OKS change at 1 or 2years between those undergoing and not undergoing resurfacing (difference 0.2, p ≥ 0.469). Patients undergoing resurfacing were more likely to be female (odds ratio (OR) 1.53, 95% CI 1.30-1.79, p < 0.001), undergo a posterior stabilised knee (OR 6.87, 95% CI 5.71-8.27, p < 0.001) or had a worse response to question 5-standing from a chair, (p = 0.011) or 12-stair descent, (p = 0.017) of the OKS preoperatively. There was no difference in postoperative patient satisfaction (p ≥ 0.180). There was a significantly greater improvement in question 12 of the OKS at 1year (p = 0.019) in the resurfaced group. There were no patient-related factors or symptoms that were associated with a clinically significant (≥ 5 points) greater postoperative OKS. Patella resurfacing was not associated with a clinically important improvement in OKS. No specific indications for patella resurfacing were identified that offered an improved outcome, but when it was undertaken there was a greater improvement in the ability to descend stairs. Level of evidence Retrospective diagnostic study, Level III.

Short- to Mid-Term Outcomes in Arthroscopic Debridement of the Knee: A Prospective Case Series.

Introduction Osteoarthritis of the knee is a common debilitating disease in the elderly population. There are many treatment options available including physiotherapy, analgesics, steroid injections, arthroscopic debridement, high tibial osteotomy (HTO) and arthroplasty. Arthroscopic debridement is beneficial when patients are chosen with certain characteristics. This is a prospective case series where we have correlated the patient and disease characteristics, with the pre- and post-operative Oxford Knee Scores (OKS). Methods This study was done in a single centre with appropriate ethical committee approval and consent. Forty-nine patients were enrolled in the study. The scores were recorded pre-operatively and at 12 months after the interventions. Analysis was done for correlation of the outcome with patient characteristics, radiological and arthroscopic grading. Results Patients below the age of 56 years, with partial thickness chondral lesions, grade I-III Kellgren-Lawrence (KL) radiological grading and grade I-II Outerbridge arthroscopic grading showed significant improvement at 12 months. Conclusion Arthroscopic debridement is effective in younger patients with mild to moderate arthroscopic and radiologically graded osteoarthritis of the knee joint.

Five-year results after total knee arthroplasty in lymphoedema and lipoedema: encouraging functional and clinical outcomes and low rates of infection

BackgroundThe aim of this study was to define outcomes after total knee arthroplasty (TKA) in lymphoedema and lipoedema patients managed by a multidisciplinary team and daily compression bandaging.MethodsA retrospective study was performed in a single centre. Between 2007 and 2018, 36 TKA procedures were performed on 28 consecutive patients with a diagnosis of lymphoedema and lipoedema. Oxford Knee Scores (OKS), EuroQol-5D (EQ-5D) scores, satisfaction scores, radiographs, and complications were obtained at the final follow-up. Patients were admitted to the hospital up to two weeks prior to surgery and remained on the ward for daily compression bandaging by the specialist lymphoedema team.ResultsOver the study period, 36 TKAs were performed on 28 patients (5 males, 23 females) with a mean age of 71 years (range 54–90). Of these, 30 TKAs were in patients with lymphoedema, five with lipoedema, and one with a dual diagnosis. Overall, 28 TKAs (21 patients) were available at the final follow-up with a mean follow-up time of 61 months (range 9–138). The mean BMI was 38.5 kg/m2. The mean pre-operative and post-operative Oxford Knee Score increased from 18 (range 2–38) to 29 (range 10–54); p < 0.001. EQ-5D score increased from 0.48 (range 0.15–0.80) to 0.74 (0.34–1.00) (p < 0.001). Mean post-operative satisfaction was 7.6/10 (range 2–10), with 89.3% TKAs satisfied. Complications were one (4%, 1/28) deep vein thrombosis, one superficial wound infection, one prosthetic joint infection, one stiff knee requiring manipulation, and one intra-operative femoral fracture.ConclusionsLymphoedema and lipoedema should not be seen as barriers to TKA if adopting a multidisciplinary approach.

The Desired Oxford Knee Score Obtained Before Total Knee Arthroplasty is Predictive of the Postoperative Oxford Knee Score: A Prospective Study

BackgroundThe relationship between patient expectations and patient-reported outcome measures (PROMs) after total knee arthroplasty (TKA) is not well understood. The purpose of the study was to test the influence of desired knee function on postoperative perceived knee function 1 year after TKA. MethodsA total of 102 patients undergoing primary TKA were available for data analyses. Preoperatively, patients completed the Oxford Knee Score (OKS) twice, one representing preoperative function (preoperative OKS); the second representing desired function after TKA (desired OKS). Western Ontario and McMaster Universities Arthritis Index (WOMAC), University of California, Los Angeles (UCLA) Activity score, Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES), Patient Health Questionnaire-9, and EuroQol-visual analogue scales were obtained preoperatively. One year after surgery, all surveys besides the UCLA activity score and HSS-KRES were repeated. The associations between postoperative OKS and WOMAC versus desired OKS and HSS-KRES were assessed using multivariable linear regression models, wherein linear regression coefficients represent the additive effect on the mean postoperative PROM. ResultsThe desired OKS was independently associated with the postoperative OKS (linear regression coefficient = 0.43; P = .011), that is, each point increase in desired OKS yielded a 0.43 increase in postoperative OKS. The preoperative OKS showed no association with postoperative PROMs. Desired OKS was correlated with postoperative WOMAC (coefficient = −0.67; P = .014). The HSS-KRES was not associated with the postoperative OKS (coefficient = −0.005; P = .965) or WOMAC (coefficient = 0.18; P = .288). ConclusionIn TKA patients, higher preoperative desired function predict greater postoperative PROMs. Effects of preoperative expectations on outcomes are independent of patient demographics or preoperative function.

The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty

BackgroundThe health-related quality of life of patients awaiting a total knee arthroplasty (TKA) deteriorates with increasing time to surgery and identification of those with the worst quality of life may help to prioritize patients. The aims were to identify and validate independent variable(s) associated with a health state worse than death (WTD) in patients awaiting a TKA and whether these variables influenced patients-reported outcome measures.MethodsA retrospective cohort of 5857 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, body mass index (BMI), index of multiple deprivation, Oxford Knee Score (OKS), EuroQoL five dimension (EQ-5D) 3 level, and visual analogue scale (EQ-VAS) were collected preoperatively and one year postoperatively. An EQ-5D utility of less than zero was defined as WTD. A randomly selected subset of patients (n = 3076) was used to validate the variable that was most predictive of a state WTD and to assess the influence on patient-reported outcomes.ResultsThere were 771 (13.2%) patients with a health state WTD. Increasing social deprivation (P = 0.050), worse preoperative OKS (P < 0.001), or EQ-VAS (P < 0.001) were independently associated with a health state WTD. The OKS was the most reliable predictor (area under curve 88.9%, 95% CI 87.8 to 90.1, P < 0.001) of a health state WTD. A threshold value of 16 or less, 80% sensitive and specific, was validated and confirmed to have a negative predictive value of 97.5%. Patients with an OKS of 16 or less had a significantly greater improvement in their OKS (difference 6.9, P < 0.001) and EQ-5D score (difference 0.257, P < 0.001). When adjusting for confounding factors, a health status WTD was not associated with worse postoperative OKS (difference –0.6, 95% CI –1.4 to 0.3, P = 0.177), EQ-5D (difference –0.016, 95% CI –0.036 to 0.003, P = 0.097) or patient satisfaction (difference –1.8, 95% CI –4.3 to 0.7, P = 0.162).ConclusionA threshold score 16 or less in OKS was a reliable predictor of a health status WTD and was associated with a greater improvement in knee-specific and health-related quality of life following TKA.

Preoperative Anemia Is Associated With Worse Joint-Specific Postoperative Outcomes, but Is Not Associated With Health-Related Quality of Life or Patient Satisfaction After Total Knee Arthroplasty

BackgroundThe primary aim assessed whether preoperative anemia was associated with a worse knee-specific functional outcome after total knee arthroplasty (TKA). The secondary aims assessed the association of preoperative anemia with generic health and patient satisfaction. MethodsA retrospective cohort study was undertaken to compare patients who did and did not have anemia (Hb <13.0 g/dL for men and Hb <11.5 g/dL for women). During a 1-year period, 497 patients underwent a total knee arthroplasty with complete preoperative and postoperative data, including 215 (43.3%) men and 282 (56.7%) women, who had a mean age of 70 years (range 45-93). Patient demographics, comorbidities, preoperative and postoperative (1 year) Oxford Knee Score (OKS), EuroQol 5 dimension (EQ-5D), postoperative Forgotten Joint Score (FJS), and patient satisfaction were collected. Regression analyses were used to adjust for confounding factors between the groups. ResultsThe 56 (11.3%) patients who had anemia were older (4.6 years, P < .001) and more likely to have chronic obstructive pulmonary disease (P = .004), connective tissue (P = .047), or kidney disease (P = .011) compared to those who did not have anemia. There were no differences in the preoperative OKS (P = .752) or EQ-5D (P = .762) scores between the groups. When adjusting for confounding differences, there was a significantly lower postoperative OKS (−3.0 points, P = .035) and FJS (−11.6 points, P = .011) associated with the anemia group. There were no significant differences in the EQ-5D (P = .118) or patient satisfaction between groups (odds ratio 0.84, P = .976). ConclusionPreoperative anemia is associated with a lower postoperative joint-specific functional outcome. It is not clear if these differences are clinically meaningful. No difference in patient satisfaction was observed. Level of EvidenceLevel III, diagnostic study.

Midterm Outcome of Open Wedge High Tibial Osteotomy without Bone Graft with Locking Plate Fixation

Purpose: The purpose of this study was to assess the midterm outcomes of open-wedge high tibial osteotomy without bone graft (OWHTO) in patients with advanced medial compartment arthritis. Methods: From January 2014 to December 2020, all patients treated with OWHTO had medial compartmental arthritis. Twenty patients underwent OWHTO. Clinically, we evaluated the Oxford Knee Score (OKS), Knee Society Score (KSS), and range of motion (ROM) at the five years follow-up. Results: The mean age of the patients was 52.65±4.88 years. All clinical outcomes gradually improved from the postoperative period to the final follow-up period. The mean follow-up duration was 5.05±0.43 years. Pre-operative OKS was 20.85±3.47; Post-operative OKS was 36.70±2.16; P = 0.034. Pre-operative KSS was 35.8±20, Post-operative KSS was 53.2±20.2, and P = 0.02. Pre-operative ROM was 100.59±11.22; Post-operative ROM was 120.57±11.06; P = 0.044. Conclusions: OWHTO has good clinical outcomes. Thus, the results of this study suggest that OWHTO may be a good alternative treatment for medial unicompartmental arthritis.

Clinical Outcomes Following Total Knee Replacement

Introduction: Total knee replacement (TKR) is commonly carried out in patients with advanced osteoarthritis to reduce pain and increase. The study aimed to investigate functional outcomes after Total Knee Replacement (TKR) among orthopedic patients at Babcock University Teaching Hospital, Ogun, South West, Nigeria. Methods: Registry data of patients who underwent TKR between January 1st, 2021 to December 30th, 2021 were collected and retrospectively reviewed. Sociodemographic and anthropometric data together with the Oxford Knee Score (OKS) were collated both preoperatively and postoperatively (12 weeks after surgery). Results: There was significant increase in the OKS postoperatively, which was statistically significant. There was significant difference between pre-operative OKS and post-operative OKS (p=0.0049). Conclusion: Overall, there was clinically significant change in the OKS after surgery. This implies greater reduction in pain and increase functional outcomes.