Background and purposeLong-term follow-up studies after total knee replacement (TKR) using an LCS rotating platform have shown survival rates of up to 97%. Few studies have evaluated short-term functional outcome and its improvement over time. We determined the time course of functional outcome as evaluated by the knee injury and osteoarthritis outcome score (KOOS) over the first 4 years after TKR using the LCS mobile bearing.Patients and methods50 unselected patients (mean age 70 (40–85) years, 33 women) with osteoarthritis in one knee underwent TKR with an LCS mobile bearing. Data were collected by an independent investigator preoperatively and at 6 weeks, 3 months, 6 months, 1 year, 2 years and 4 years postoperatively. KOOS, a self-assessment function score validated for this purpose, and range of motion (ROM) were determined at all follow-ups.ResultsThe mean KOOS pain score increased from 43 before surgery to 66 at 6 weeks and 88 at 2 years. It was 84 at 4 years. The mean KOOS activities of daily living score (ADL) increased from 49 before surgery to 73 at 6 weeks, then gradually to 90 at 2 years. It decreased to 79 at 4 years. Mean passive ROM was 112° before surgery, 78° at departure from hospital, and then gradually increased to 116° at 2 years and 113° at 4 years.InterpretationRecovery after TKR is time-dependent. Most of the expected improvement in pain and function is achieved at 6 months postoperatively, but some further improvement can be expected up to 2 years postoperatively. ROM will also gradually improve up to 2 years after TKR, and reach the same level as before surgery.

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In order to satisfy the need of a tool for assessing the treatment of patients with degenerative lumbar spinal stenosis, an evaluation was made of the reliability, construct validity, and responsiveness of the Norwegian version of Spinal Stenosis Measure (SSM, original by Stucki)). This study was a part of a prospective, cohort study. About 75 patients referred for surgery for spinal stenosis participated in the study. A subsample of 30 patients answered the questionnaire twice, test and retest, with at least one week in between. The SSM was translated according to the Guillemin criteria. Reliability was assessed by Bland and Altman's repeatability, intraclass correlation coefficient (ICC) and the coefficient of variance (CV). Internal consistency was assessed by Cronbach's alpha. Construct validity was analysed by correlation analyses. Responsiveness was calculated by the effect size. The reliability between test and retest scores was good for all three subscales of SSM as the ICC-values were above 0.9 and the CVs were below 15%. Cronbach's alpha was above 0.8. The correlation analyses showed high correlation between scales that assessed the same construct, and low to moderate correlation between scales that assessed different constructs. Large effect sizes were found in all the SSM subscales with effect sizes C1.2.The Norwegian SSM version has added a highly useful tool for assessing the disease specific status and outcome after treatment in patients who suffer from degenerative lumbar spinal stenosis.Keywords Lumbar spinal stenosis Á Norwegian version of the spinal stenosis measure Á Reliability Á Validity Á Responsiveness

BackgroundDegenerative lumbar spinal stenosis (LSS) is a prevalent condition in adults over the age of 55 years. The condition is associated with activity limitations that are related to increased pain when engaging in weight-bearing activities, such as walking and standing, and release of pain while sitting down or bending forward. The limitation on ambulation is also associated with impaired balance although the types of balance problems are sparsely described in this patient group. The purpose of this study was to assess dynamic balance in persons with LSS by the Mini-BESTest and explore the associations with self-reported balance and functional disability.MethodsSixty two participants were included in this cross-sectional study. The main outcome measure was the Mini-BESTest, providing a total score and sub-scores for 4 balance control systems (Anticipatory Adjustment, Reactive Response, Sensory Orientation, Stability of Gait). The Swiss Spinal Stenosis Questionnaire provided sub-scores for self-reported balance problems and walking function (FUNC).ResultsThe participants showed large inter-individual variation in all measures of balance. The Mini-BESTest score ranged from very good to poor and the mean value was 22.8 (SD 3.5). Nineteen participants (31%) reported having frequent balance problems. Logistic regression analyses showed that both the total Mini-BESTest score (OR (95% CI) 1.6 (1.2, 2.0)(P = .001) and 3 of the 4 balance control systems (Anticipatory Adjustment, Sensory Orientation, Stability in Gait) were significantly associated with self-reported balance problems (.001 ≤ P ≤ .01). The strongest association was seen between Sensory Orientation and balance problems, implying that it is 4.4 times more likely that persons would have no or occasional balance problems with each unit of increase in Sensory Orientation. The total score for the Mini-BESTest was significantly associated with FUNC (P = .042).ConclusionsThe dynamic balance of persons with LSS showed a large heterogeneity with a large fraction of the participants displaying no balance impairments. The test results were associated with the participants’ self-reported balance problems and walking function. The Mini-BESTest thus appears to provide additional information to self-reported disability, and by identifying different kind of balance control impairments, the Mini-BESTest could be useful for physiotherapists working with person-centered rehabilitation in persons with LSS.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2111-x) contains supplementary material, which is available to authorized users.

Degenerative lumbar spinal stenosis is a common condition and the most usual indication for spinal surgery in adult patients. The main objective of this study was to investigate clinical outcomes, health-related quality of life (HRQoL) and satisfaction among patients with a diagnosed lumbar spinal stenosis who were surgically treated, and whether these outcomes differed according to gender and age. Surgery was performed on 100 patients with clinical and radiological defined lumbar spinal stenosis. All patients completed questionnaires twice before surgery and at 6 weeks, 12 weeks, and 1 year postoperatively. Main outcomes were symptoms, physical function and patient satisfaction assessed by the Swiss Spinal Stenosis Questionnaire and HRQoL by the Short Form 36 health survey (SF36). There were large improvements in all clinical outcomes and in the physical subscales of the SF36. A marked reduction of average 32.3% was seen in symptoms already at 6 weeks follow-up. Physical function had improved with an average of 29.8% at 1-year follow-up. There was no statistical significant effect of age and gender on symptoms and physical function. Patients more than 65 years were significantly less satisfied at the 1-year follow-up as compared to the younger patients (p=0.012). This study showed that the majority of patients improved significantly in symptoms, physical function and physical HRQoL after surgery for degenerative lumbar spinal stenosis, regardless of age and gender. Age showed to be closely connected to satisfaction.

The present study indicates that both self-reported symptoms and walking limitation are associated with leg strength, while only symptoms are associated with balance. The results suggest that a combination of simple performance tests will add information needed to map the patients disability and guide interventions. Implications for Rehabilitation One-leg-standing, 30-s sit-to-stand and stair climb test are easy to use and applicable for examining physical function in patients with lumbar spinal stenosis (LSS). Simple performance tests add information needed to map the patients' disability and guide interventions. Leg strength is a key factor for both symptoms and walking ability. Also, balance is of importance for the symptoms in LSS patients.

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