Postoperative WOMAC Scores Research Articles

Does Patellectomy Jeopardize Function After TKA?

The patella provides important mechanical leverage to the knee extensor mechanism. Patellectomy does not exclude the development of tibiofemoral arthrosis. We asked whether (1) TKA provides improvements in clinical outcome scores in patellectomized knees and (2) the scores of TKA in patellectomized knees are comparable to those in knees with intact patellae. We evaluated 50 patients (52 primary TKAs) with patellectomized knees and a control group of 52 patients (52 primary TKAs) with intact patellae matched for age, sex, implant, and surgical year between 1984 and 2009. We compared the preoperative and latest postoperative SF-12, WOMAC, and Knee Society score (KSS). Minimum followup was 24months (mean, 69months; range, 24-204months). The mean WOMAC score in the control group improved from 41.8 (range, 7.5-72.4) preoperatively to 69.1 (range, 17.0-100.0) postoperatively, while that in the patellectomized group improved from 35.8 (range, 5.2-62.2) to 61.3 (range, 17.5-96.2). The mean KSS improved from 80.4 (range, 4.0-143.0) preoperatively to 161.4 (range, 69.0-200.0) postoperatively in the control group and from 76.9 (range, 5-134) to 136.8 (range, 7-199) in the patellectomized group. Mean postoperative WOMAC scores were comparable between the two groups, while the mean KSS was lower in the patellectomized group. The mean SF-12 scores were not different after TKA or between groups. Despite the mechanical disadvantage to the knee extensor mechanism rendered by a previous patellectomy, TKA for tibiofemoral arthrosis in these patients relieved pain and restored function, but function was on average lower than that in patients with intact patellae. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

“Total Knee Arthroplasty in the Context of Severe and Morbid Obesity in Adults”

Medical treatment for knee osteoarthritis proves insufficient in a considerable number of patients, who thus require surgical intervention, with arthroplasty being one of the most common procedures. The rate of knee replacement is consequently higher in the obese population. Obese patients who undergo knee arthroplasty face a larger number of associated comorbidities than do non-obese individuals, and this greater comorbidity can lead to more postoperative complications and worse outcomes. Given that obesity defined according to BMI would cover a large proportion of the population (a quarter of adults have a BMI > 30 kg/m 2 in some western societies) attention has focused on which sub- groups might present the greatest problems. It appears that morbidly obese patients (BMI > 40 kg/m 2 ) are most at risk of complications. Some authors suggest the need to study more precise methods for component alignment in these patients. The use of an intramedullary guide made surgical intervention easier and was associated with a significantly shorter tourniquet time. Although the studies refer greater surgical difficulties on the basis of their BMI, the difficulty of surgery will ultimately depend on the morphology of the knee. The factors associated with a worse postoperative WOMAC score in severely and morbidly obese patients were the number of comorbidities, infrapatellar anthropometric index below percentile 75, greater intraoperative difficulty and the number of postoperative complications. When starting from a comparable preoperative status, severely and morbidly obese patients show a similar improvement than other patients.

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Several studies have shown mechanical alignment influences the outcome of TKA. Robotic systems have been developed to improve the precision and accuracy of achieving component position and mechanical alignment. We determined whether robotic-assisted implantation for TKA (1) improved clinical outcome; (2) improved mechanical axis alignment and implant inclination in the coronal and sagittal planes; (3) improved the balance (flexion and extension gaps); and (4) reduced complications, postoperative drainage, and operative time when compared to conventionally implanted TKA over an intermediate-term (minimum 3-year) followup period. We prospectively randomized 100 patients who underwent unilateral TKA into one of two groups: 50 using a robotic-assisted procedure and 50 using conventional manual techniques. Outcome variables considered were postoperative ROM, WOMAC scores, Hospital for Special Surgery (HSS) knee scores, mechanical axis alignment, flexion/extension gap balance, complications, postoperative drainage, and operative time. Minimum followup was 41 months (mean, 65 months; range, 41-81 months). There were no differences in postoperative ROM, WOMAC scores, and HSS knee scores. The robotic-assisted group resulted in no mechanical axis outliers (> ± 3° from neutral) compared to 24% in the conventional group. There were fewer robotic-assisted knees where the flexion gap exceeded the extension gap by 2 mm. The robotic-assisted procedures took an average of 25 minutes longer than the conventional procedures but had less postoperative blood drainage. There were no differences in complications between groups. Robotic-assisted TKA appears to reduce the number of mechanical axis alignment outliers and improve the ability to achieve flexion-extension gap balance, without any differences in clinical scores or complications when compared to conventional manual techniques.

Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study

The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects. Hydroxyapatite calcium carbonate synthetic bone graft was utilised in 14 patients (six males and eight females). Allograft/autograft were utilised in the remaining 10 patients (six males and four females). All the 24 patients had clinical, radiological and subjective functional score assessments. There was no significant statistical difference between the groups for post-operative articular reduction, long-term subsidence, and WOMAC scores. The degree of subsidence was not related to age or fracture severity. Maintenance of knee flexion was found to be better in the allograft/autograft group (p = 0.048) when compared between the groups. Multivariate analysis compared graft type, fracture severity, post-operative reduction, subsidence rate, range of movement and WOMAC score. The only finding was a statistical significant association with the graft type related to the 6-month range of movement figures. Use of autologous or allogenic bone graft allows better recovery of long-term flexion, possibly due to reduced inflammatory response compared with synthetic bone composites. However, all other parameters, such as maintenance of joint reduction and subjective outcome measures were comparable with the use of hydroxyapatite calcium carbonate bone graft. This study shows that synthetic bone graft may be a suitable alternative in fixation of unstable tibia plateau fractures, avoiding risk of disease transmission with allograft and donor site morbidity associated with autograft.

Comparative Study of Clinical and Radiological Outcomes of Unconstrained Bicondylar Total Knee Endoprostheses with Anti-allergic Coating

Background:Hypersensitivity reactions to implant materials have become more important in total knee replacement (TKR). The purpose of this retrospective comparative study was to evaluate the clinical and radiological outcomes of unconstrained bicondylar total knee prostheses with and without anti-allergic titanium(niobium)nitrite (Ti(Nb)N) coating.Methods:Twenty-four patients (25 TKRs) underwent a preoperative clinical evaluation and then a postoperative evaluation after 26.2 months in the allergy group treated with coated implants (n=13 implants) and after 24.5 months in the control group treated with uncoated implants but identical geometry (n=12) using HSS, WOMAC and SF-36 scores. Radiological evaluations were performed using standard anterior-posterior (a.p.) and lateral X-rays.Results:During follow-up two patients of the allergy group had to undergo revision surgery due to non-implant-related reasons. A comparative analysis of both study groups showed a significant difference in the HSS scores at both evaluation time points (MW test p≤0.050); these findings are remarkable since the control group had a significantly lower score preoperatively (54.0 vs 65.0 points) and a significantly higher score (82.5 vs 75.0 points) postoperatively. The preoperative and postoperative WOMAC and SF-36 scores were comparable in both groups (MW test p≥0.052), although the postoperative increase in the score for the allergy group was lower. The radiological results were comparable in both groups and were unlikely to influence the results.Conclusions:This clinical study demonstrates the restricted outcome in postoperative function and quality of life in the allergy group compared to the control group.

Stable Fixation of Short-stem Femoral Implants in Patients 70 Years and Older

Limitations of conventional uncemented femoral stems persist, including proximal-distal mismatch, nonideal load transfer, loss of bone, and difficulties with minimally invasive surgery. Metaphyseal-engaging short-stem implants have been designed to address these issues in THA. While these devices have been studied in younger patients, it is unclear whether they offer advantages in older patients. We asked whether the stability and bony ingrowth of an off-the-shelf short stem in patients 70 years and older were similar to those achieved in patients younger than 70 years at 2-year followup. Furthermore, we asked whether pain and function scores were affected by age, bone quality, or varus alignment. We retrospectively reviewed 60 patients (65 hips) 70 years and older (mean, 75 years; range, 70-86 years) treated with an uncemented short stem (range, 90-105 mm). We compared radiographic alignment, stability, and bony ingrowth, as well as Harris hip scores and WOMAC pain scores, to a cohort of 89 patients (91 hips) younger than 70 years. Minimum followup was 24 months (mean, 35 months; range, 24-60 months). Radiographs showed proximal bony ingrowth and stable fixation of all implants. Average Harris hip score at last followup was 88 (range, 70-100) for the 70 years and older cohort and 93 (range, 70-100) for younger than 70 years cohort; no patients reported thigh pain. Postoperative WOMAC scores averaged 6 (range, 0-43) and 5 (range, 0-25), respectively. Short-stem implants provide solid, dependable fixation in osteoporotic bone at minimum 2-year followup, while meeting some of the limitations in conventional primary THA. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Preliminary Clinical and Radiographic Results of Large Ceramic Heads on Highly Cross-Linked Polyethylene

Data are limited regarding large ceramic femoral heads with highly cross-linked polyethylene. We hypothesized that large ceramic head articulation with highly cross-linked polyethylene is safe with a low wear rate, comparable to metal-on-highly cross-linked polyethylene.The study group comprised 63 patients (72 hips) who had undergone total hip replacement (THR) with ceramic-on-highly cross-linked polyethylene between April 2006 and March 2007 with a minimum 2-year follow-up. Postoperative Western Ontario and Mc-Master Universities Arthritis Index (WOMAC) and Hospital for Special Surgery (HSS) scores were used for clinical assessment. Six-week and 2-year radiographs were analyzed by 2 independent observers using Roman 1.70 software. Twenty-six patients (29 hips) had 32-mm and 37 patients (43 hips) had 36-mm Biolox delta ceramic femoral heads (Ceramtec, Plochingen, Germany). Mean patient age was 60.9 ± 8.9 years, and mean follow-up was 2.9 ± 0.5 years. Mean postoperative WOMAC and HSS hip scores were 30.4 and 36.6, respectively. Mean wear at 1 and 2 years postoperatively was 0.06 ± 0.28 and 0.006 ± 0.12 mm/yr for all hips, respectively. Mean wear at 1 and 2 years postoperatively for the 32-mm femoral head was 0.063 ± 0.278 and 0.007 ± 0.126 mm/yr, respectively, and for the 36-mm femoral head was 0.057 ± 0.292 and 0.006 ± 0.118 mm/yr, respectively. No patient had any clinical complications, such as reoperation, infection, fractures, or radiographic evidence of osteolysis or loosening. The early results of THR with large ceramic heads demonstrate high safety and efficacy. Our data with 2-year follow-up show low wear rates, similar to published data for metal-on-highly cross-linked polyethylene.

Periacetabular Osteotomy After Failed Hip Arthroscopy for Labral Tears in Patients with Acetabular Dysplasia

Chronic mechanical overload of the acetabular rim may lead to acetabular labral disease in patients with hip dysplasia. Although arthroscopic debridement of the labrum may provide symptomatic relief, the underlying mechanical abnormality remains. There is little information regarding how the results of periacetabular osteotomy are affected by a prior primary treatment for labral disease in the presence of acetabular dysplasia. In a retrospective matched-cohort study, seventeen patients who had arthroscopic labral debridement prior to periacetabular osteotomy (the arthroscopy group) were compared with a control group of thirty-four patients who did not undergo arthroscopic labral debridement prior to periacetabular osteotomy (the non-arthroscopy group). Two control patients were randomly matched to each experimental patient from a pool of controls. Functional outcomes were assessed with use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Failure of periacetabular osteotomy was defined as conversion to a total hip replacement. Changes in the preoperative and postoperative WOMAC scores of arthroscopy and non-arthroscopy patients were comparable, and the differences between the two treatment groups were not significant. We were unable to show a significant difference between the seventeen arthroscopy and thirty-four non-arthroscopy patients with regard to the risk of having to undergo a total hip replacement. When arthroscopic labral debridement fails to improve symptoms in patients with labral disease secondary to acetabular dysplasia, periacetabular osteotomy may still be considered as a joint-preserving procedure that can achieve good functional results.

Comparison of a Standard and a Gender-Specific Posterior Cruciate-Substituting High-Flexion Knee Prosthesis

Recently, much debate has focused on the effect of gender-specific total knee arthroplasty. The purpose of the present study was to compare clinical and radiographic results as well as femoral component fit in patients receiving either a standard posterior cruciate-substituting LPS-Flex or gender-specific posterior cruciate-substituting LPS-Flex total knee prosthesis. Sequential simultaneous bilateral total knee arthroplasty was performed for eighty-five patients (170 knees). Eighty-five women (mean age, 69.7 years) received a standard LPS-Flex prosthesis in one knee and a gender-specific LPS-Flex prosthesis in the contralateral knee. The mean duration of follow-up was 2.13 years. At each follow-up, the Knee Society score, the Hospital for Special Surgery knee score, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, and radiographs were evaluated. The aspect ratio of the distal part of the femur was compared with those of the standard LPS-Flex prosthesis and the gender-specific LPS-Flex prosthesis. The mean postoperative Knee Society scores (95.5 points in the standard implant group, compared with 96.5 points in the gender-specific implant group) and Hospital for Special Surgery knee scores (90.7 points in the standard implant group, compared with 91.2 points in the gender-specific implant group) were similar in both groups. The mean postoperative WOMAC score was 36.6 points. Postoperatively, the mean ranges of knee motion in the supine position (125 degrees in the standard implant group, compared with 126 degrees in the gender-specific implant group), patient satisfaction (8.3 points in the standard implant group, compared with 8.1 points in the gender-specific implant group), and radiographic results were similar in both groups. The femoral component in the standard implant group fit significantly better than that in the gender-specific implant group (p < 0.0001). The present study did not show any clinical benefits of a gender-specific LPS-Flex total knee prosthesis at the time of short-term follow-up. Longer follow-up is needed to determine whether there will be an advantage in terms of longer-term function. Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Which is more important after total knee arthroplasty: Local inflammatory response or systemic inflammatory response?

We aimed to determine the relationship between functional recovery after knee arthroplasty and systemic and local inflammatory responses. A prospective, clinical study of thirty patients who had osteoarthritis was conducted. After the total knee arthroplasty (TKA), intraarticular IL-6 levels, serum IL-6 levels and serum CRP levels were measured. The primary outcome measures for functional recovery after TKA were the the Knee Society Score (KSS) and Western Ontario and McMaster Universities Index (WOMAC). All patients were examined preoperatively and at 4, 8 and 24 weeks postoperatively. The mean postoperative intraarticular IL-6 level was 218355.1 pg/ml, the mean postoperative serum CRP level was 109.9 mg/L and the mean postoperative serum IL-6 level was 219.0 pg/ml. Preoperative and 4-, 8- and 24-week postoperative KSS and WOMAC scores were evaluated. Significant correlations were found between intraarticular IL-6 concentrations and KSS and WOMAC scores at the first month according to the Pearson correlation test, but no correlations were found between serum IL-6 and CRP levels and KSS and WOMAC scores. The local inflammatory response is more important than the systemic response for early postoperative functional recovery. After TKA, control of local inflammation is much more important than control of systemic inflammation.

A prospective study of hip revision surgery using the Exeter long-stem prosthesis: function, subsidence, and complications for 57 patients

BackgroundThe long-stem Exeter femoral component is commonly used in revision hip surgery. Subsidence of the femoral stem in primary hip arthroplasty has been studied extensively, but much less is known about its significance in revision surgery. This prospective study examined the relationship between radiological subsidence, Western Ontario and McMaster (WOMAC) osteoarthritis index pain score, patient satisfaction and complication rates for the long-stem Exeter hip prosthesis.Materials and methodsData was prospectively collected for a single-surgeon series of 96 patients undergoing revision surgery with a mean follow-up period of 36 months. Pre- and post-operative clinical evaluation was carried out using the validated WOMAC osteoarthritis index. Radiographic evaluation was carried out on magnification-adjusted digital radiographic images.ResultsData from 57 patients were analysed. The mean rate of subsidence recorded was 0.43 mm/year, with a mean total subsidence of 0.79 mm [95% confidence interval (CI) 0.57–1.01] at 36.3 months. There was no correlation between subsidence and post-operative WOMAC score, complication rate or patient satisfaction. There was a statistically significant reduction between pre-operative and post-operative WOMAC scores, with means of 33.5 and 10.7, respectively (P < 0.001), and high patient satisfaction.ConclusionOur subsidence rates for long-stem revision femoral components are lower than the published data but demonstrate the same plateau. Radiographic subsidence does not appear to relate to functional outcome or complication rates in our data.

Range of Motion of Standard and High-Flexion Posterior Cruciate-Retaining Total Knee Prostheses*

The main goals of total knee arthroplasty are pain relief and improvement in function and the range of motion. The purpose of this study was to compare the ranges of motion of the knees of patients treated with a standard posterior cruciate-retaining total knee prosthesis in one knee and a high-flexion posterior cruciate-retaining total knee prosthesis in the other. Fifty-four patients (mean age, 69.7 years) received a standard posterior cruciate-retaining total knee prosthesis in one knee and a high-flexion posterior cruciate-retaining total knee prosthesis in the contralateral knee. Five patients were men, and forty-nine were women. At a mean of three years postoperatively, the patients were assessed clinically and radiographically with the knee-rating systems of the Knee Society and the Hospital for Special Surgery and with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The mean postoperative Knee Society and Hospital for Special Surgery knee scores were 93.7 and 89 points, respectively, for the knees with a standard posterior cruciate-retaining prosthesis, and they were 93.9 and 90 points, respectively, for the knees with a high-flexion posterior cruciate-retaining prosthesis. The mean postoperative WOMAC score was 22 points. Postoperatively, the mean ranges of motion without and with weight-bearing were 131 degrees (range, 90 degrees to 150 degrees) and 115 degrees (range, 75 degrees to 145 degrees), respectively, in the knees with a standard prosthesis and 133 degrees (range, 90 degrees to 150 degrees) and 118 degrees (range, 75 degrees to 145 degrees), respectively, in those with a high-flexion prosthesis. Patient satisfaction and radiographic results were similar in the two groups. No knee had aseptic loosening, revision, or osteolysis. After a minimum duration of follow-up of three years, we found no significant differences between the two groups with regard to the range of knee motion or the clinical or radiographic parameters.

Donor-Site Morbidity After Osteochondral Autologous Transplantation for Lesions of the Talus

Autologous osteochondral transplantation is accepted as one of the major treatment options for cartilage defects of the talus. One disadvantage of this technique is the need to harvest a donor graft from a normal knee. The potentially detrimental effect of graft harvest on knee function remains unclear. Two hundred patients who had transplantation of an autologous osteochondral graft obtained from an asymptomatic knee for the treatment of an osteochondral defect of the talus were evaluated. Of the 200 patients, 112 were followed for a minimum of two years (mean duration of follow-up, fifty-five months). The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and the Lysholm score were used to assess functional outcome. Variables that were examined included the number of grafts, total size of the harvested cylinders, patient age, body mass index, and overall satisfaction of the patient with the result of the procedure at the knee. A multiple linear regression analysis was utilized to determine the influence of each parameter on the WOMAC and Lysholm scores. In addition, the Lysholm scores for the entire patient group were reviewed to determine how long after the index surgery clinical improvement ceased. The mean postoperative WOMAC score (and standard deviation) for the 112 patients who had been followed for a minimum of two years was 5.5% +/- 0.1%, and the mean postoperative Lysholm score was 89 +/- 17 points. The number of grafts, the size of the transplanted cylinders, and patient age did not influence either the Lysholm or the WOMAC score. A higher body mass index and lower general satisfaction ratings did negatively influence the Lysholm and WOMAC scores. Gradual clinical improvement, as measured with the Lysholm score for all 200 study subjects, continued throughout the postoperative period. Donor-site morbidity of a knee from which a graft has been harvested can potentially lead to functional impairment. In our study, the functional outcome of the knee was not affected by the number of donor grafts, the size of the donor grafts, or the age of the patient. Surgeons performing osteochondral transplantations and harvesting autografts from the knee should be aware of the potentially negative effect of a higher body mass index on clinical outcomes after surgery.

Surgical Dislocation in the Management of Pediatric and Adolescent Hip Deformity

The surgical dislocation approach is useful in assessing and treating proximal femoral hip deformities commonly due to pediatric conditions. We sought to demonstrate the efficacy and problems associated with this technique. Diagnoses included slipped capital femoral epiphysis, Perthes disease, developmental dysplasia of the hip, osteonecrosis, and exostoses. Through this approach, femoral head-neck osteoplasty (22), intertrochanteric osteotomy (eight), femoral head-neck osteoplasty plus intertrochanteric osteotomy (15), femoral neck osteotomy (five), open reduction and internal fixation of an acute slipped capital femoral epiphysis with callus resection (five), open reduction and internal fixation of an acetabular fracture (one), trapdoor procedure (one), and acetabular rim osteoplasty (one) were performed. The average patient age was 16 years. The minimum followup was 12 months (average, 41.6 months; range, 12-73 months). Patients with Perthes disease and SCFE had preoperative and postoperative WOMAC scores of 9.6 and 5.1, and 7.9 and 3.5 respectively. In patients with unstable SCFEs, the average postoperative WOMAC score was 1.2. Seven patients underwent THAs and two patients underwent hip fusion. Complications in the 58 procedures included four cases of osteonecrosis: three after femoral neck osteotomy and one after intertrochanteric osteotomy. The surgical dislocation technique can be utilized to effectively treat these deformities and improve short-term symptoms. Although the technique is demanding, we believe surgical dislocation offers sufficient advantages in assessing and treating these complex deformities that it justifies judicious application.

Relationship between self-reported and performance-based tests in a hip and knee joint replacement population

Our objectives were: (1) to assess the relationship between self-reported measures (Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Study Short Form-36 (SF-36)) and a performance-based timed-up-and-go (TUG) test in a hip and knee joint replacement population and (2) to determine the predictors of postoperative functional status as measured by the 12-week WOMAC and TUG scores. We surveyed 200 patients undergoing primary hip or knee replacement surgery for demographic data and outcome scores at baseline and 12-week follow-up. There was a weak correlation between preoperative TUG scores and preoperative SF-36 physical function scores (r = -0.28, p < 0.0001), SF-36 role-physical scores (r = -0.21, p = 0.0022) and WOMAC (r = 0.29, p < 0.0001) scores. The relationship was stronger between the postoperative TUG scores and WOMAC scores (r = 0.43, p < 0.0001), SF-36 physical function scores (r = -0.39, p < 0.0001) and SF-36 role-physical (r = -0.33, p < 0.0001) scores. Significant predictors for the TUG test at 12-week follow-up were age (p = 0.004) and preoperative TUG scores (p < 0.0001). Given low-to-moderate relationship between self-reported and performance-based tools, both tests are needed to assess the true level of patient disability.

Measuring Tools for Functional Outcomes in Total Knee Arthroplasty

Total knee arthroplasty has come under increasing scrutiny attributable to the fact that it is a high-volume, high-cost medical intervention in an era of increasingly scarce medical resources. Health-related quality-of-life outcomes have been developed such that healthcare providers might determine how good an intervention is and whether it is cost-effective. Total knee arthroplasty has been subjected to disease-specific, patient-specific, global health, functional capacity, and cost-to-utility outcome measures. Patient satisfaction is high (90%) after total knee arthroplasty and 93% of patients would have this operative procedure again. Large improvements in preoperative to postoperative WOMAC scores occurred (over 39 of 100 points in 82% of patients). Cost-to-quality outcomes demonstrated total knee arthroplasties are extremely cost-effective. This analysis documents total knee arthroplasty is a highly efficacious procedure that competes favorably with all medical and surgical interventions.

Does TKA Improve Functional Outcome and Range of Motion in Patients with Stiff Knees?

The main goals of TKA are pain relief and improvement of function and range of motion (ROM). To ascertain whether TKA in patients with stiff knees would relieve pain and improve functional outcome and ROM, we asked four questions: whether (1) Knee Society and WOMAC scores would improve after TKA; (2) poor preoperative ROM would improve after TKA; (3) the revision rate of TKA in stiff knees would be high; and (4) complication rates would be high in these patients after TKA. We retrospectively reviewed 74 patients (86 knees) with stiff knees (mean age, 56.8 years) who underwent TKAs with a condylar constrained or a posterior stabilized prosthesis. The minimum followup was 5 years (mean, 9.1 years; range, 5-12 years). The mean preoperative Hospital for Special Surgery knee score and Knee Society knee and functional scores were 42, 11, and 42 points, respectively, and postoperatively they were 84, 90, and 84 points, respectively. Preoperative and postoperative total WOMAC scores were 73 and 34 points, respectively. One knee (1.2%) had aseptic loosening of the tibial component and 12 knees (14%) had complications. Despite a relatively high rate of complications, most patients had substantial improvement in function. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Prospective Randomized Study of Two Different Techniques for Endoscopic Iliopsoas Release in the Treatment of Internal Snapping Hip Syndrome (SS-06)

We compare 2 randomized groups of patients that were prospectively followed, treated for internal snapping hip symptoms using two different endoscopic techniques. Sort term results are presented. To evaluate short term results of two different techniques of endoscopic iliopsoas tendon release for the treatment of internal snapping hip syndrome. Between January 2005 and January 2007 a consecutive series of patients with the diagnosis of internal snapping hip syndrome was treated with endoscopic release of the iliopsoas tendon. The patients were randomized in two different groups. Patients in group one were treated with endoscopic iliopsoas tendon release at the lesser trochanter and patients in group two were treated with endoscopic transscapsular psoas release from the peripheral compartment. Hip arthroscopy of both the central and peripheral compartment was performed in both groups using the lateral approach. Associated injuries were identified and treated arthroscopically. Postoperative physical therapy was the same for both series and every patient received 400mg of celecoxib daily for 21 days after surgery. Preoperative and postoperative WOMAC scores and imaging studies were evaluated. Nineteen patients were included in the study, 10 in group 1, 5 male and 5 female with an average age of 29.5 years and 9 in group 2, 8 female and 1 male with an average age of 32.6 years. No statistical difference was found in group composition. Associated injuries were found and treated in 8 patients in group 1 and 7 patients in group 2. No statistical difference was found between groups in preoperative WOMAC scores, every patient en both groups presented an increment in the WOMAC score. Increments in WOMAC scores were statistically significant in both groups, no difference was found in postoperative WOMAC results between groups. No complications were seen. Different techniques for endoscopic release of the iliopsoas tendon have been recently described in the literature, we compared both techniques in prospectively in 2 series of patients that were randomized and found no difference in short-term results or complication incidence.

Validation Study of a Finnish Version of the Western Ontario and McMasters University Osteoarthritis Index

The aim of the study was to validate a Finnish version of the internationally used Western Ontario and McMasters University osteoarthritis index (WOMAC) questionnaire, by testing its reliability, validity and responsiveness. The subjects of the study were patients scheduled for elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). The patients completed the WOMAC questionnaire twice prior to surgery and once postoperatively to enable reliability, construct validity and responsiveness analysis. Test-retest reliability could be calculated for 67 patients (37 TKA and 30 THA). The intraclass correlation coefficients (ICC a) exceeded 0.9 with the exception of the stiffness subscale which averaged 0.8. Correlation of the preoperative WOMAC total score with the Harris Hip Score (HHS) in 30 patients and American Knee Society Score (AKSS) in 37 patients were mediocre ranging from 0.48 to 0.53. To test responsiveness, the first preoperative and the postoperative WOMAC scores of 74 subjects were compared (41 TKA and 33 THA). Standard response means (SRM) and effect sizes (ES) exceeded the recommended score of 0.8, ranging from 1.15 to 2.35. In conclusion the Finnish translation of the WOMAC questionnaire performs as the original, is valid and can be used in future studies of osteoarthritis.

Validation study of a Finnish version of the Western Ontario and McMasters University osteoarthritis index

The aim of the study was to validate a Finnish version of the internationally used Western Ontario and McMasters University osteoarthritis index (WOMAC) questionnaire, by testing its reliability, validity and responsiveness. The subjects of the study were patients scheduled for elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). The patients completed the WOMAC questionnaire twice prior to surgery and once postoperatively to enable reliability, construct validity and responsiveness analysis. Test-retest reliability could be calculated for 67 patients (37 TKA and 30 THA). The intraclass correlation coefficients (ICC a) exceeded 0.9 with the exception of the stiffness subscale which averaged 0.8. Correlation of the preoperative WOMAC total score with the Harris Hip Score (HHS) in 30 patients and American Knee Society Score (AKSS) in 37 patients were mediocre ranging from 0.48 to 0.53. To test responsiveness, the first preoperative and the postoperative WOMAC scores of 74 subjects were compared (41 TKA and 33 THA). Standard response means (SRM) and effect sizes (ES) exceeded the recommended score of 0.8, ranging from 1.15 to 2.35. In conclusion the Finnish translation of the WOMAC questionnaire performs as the original, is valid and can be used in future studies of osteoarthritis.