Development and Validation of Crosswalks Between the Western Ontario &amp; McMaster Universities Osteoarthritis Index and Hip Disability and Osteoarthritis Outcome Score Joint Replacement/Knee Injury and Osteoarthritis Outcome Score Joint Replacement

Fleisher, Ilan; Thompson, Madison C.; Mensah, Curtis; Joseph, Amethia; McLawhorn, Alexander S.; Padgett, Douglas E.; Lyman, Stephen

doi:10.1016/j.arth.2021.11.009

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), Kujala, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores [17, 20] at the latest follow‐up (range 2.0–9.8 years) were collected. To increase power, WOMAC scores were converted to KOOS, JR, using validated crosswalks [10]. Additional outcomes included satisfaction with the overall function of the operative knee (i.e., “very satisfied”, “satisfied”, “neutral”, “dissatisfied”, or “very dissatisfied”), and whether or not patients would opt to undergo the surgery again.…”

Section: Methodsmentioning

confidence: 99%

Restoration or relative overcorrection of pre-arthritic coronal alignment leads to improved results following medial unicompartmental knee arthroplasty

Bayoumi

Burger

Ruderman

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeA pre‐arthritic alignment strategy for medial unicompartmental knee arthroplasty (UKA) aims to restore a patient’s native lower limb alignment which may translate into improved outcomes. This study aimed to assess whether patients with pre‐arthritically aligned knees versus patients with non‐pre‐arthritically aligned knees demonstrated improved mid‐term outcomes and survivorship following medial UKA. The hypothesis was that pre‐arthritic alignment in medial UKA would lead to better postoperative outcomes. MethodsA retrospective study of 537 robotic‐assisted fixed‐bearing medial UKA was conducted. During this procedure, the surgical goal was to restore pre‐arthritic alignment guided by re‐tensioning of the medial collateral ligament (MCL). For study purposes, coronal alignment was retrospectively evaluated using the mechanical hip‐knee‐ankle angle (mHKA). Pre‐arthritic alignment was estimated through the arithmetic hip‐knee‐ankle (aHKA) algorithm. Knees were grouped according to the difference between postoperative mHKA and estimated pre‐arthritic alignment (i.e., mHKA ‐ aHKA) as Group 1 (pre‐arthritically aligned: mHKA restored within 2.0° of the aHKA), Group 2 (mHKA > 2.0° overcorrected relative to the aHKA), or Group 3 (mHKA > 2.0° undercorrected relative to the aHKA). Outcomes included the Knee Injury and Osteoarthritic Outcome Score for Joint Replacement (KOOS, JR), Kujala, proportions of knees achieving the patient acceptable symptom state (PASS) for these scores, and survivorship. PASS thresholds for KOOS, JR and Kujala were determined using a receiver operating characteristic curve method. ResultsA total of 369 knees were categorized as Group 1, 107 as Group 2, and 61 as Group 3. At 4.4 ± 1.6 years follow‐up, mean KOOS, JR was comparable among groups, while Kujala was significantly worse in Group 3. The proportion of knees achieving the PASS for Kujala (76.5 points) was lower in Group 3 (n = 32; 59%) compared to Group 1 (n = 260; 74%) (p = 0.02). 5‐year survivorship was higher in Group 1 and Group 2 (99% and 100%, respectively) compared to Group 3 (91%) (p = 0.04). ConclusionPre‐arthritically aligned knees and knees with relative overcorrection from their pre‐arthritic alignment following medial UKA demonstrated improved mid‐term outcomes and survivorship compared to knees with relative under correction from their pre‐arthritic alignment. These results encourage restoring or relatively overcorrecting pre‐arthritic alignment to optimize outcomes following medial UKA, and caution against under correction from the pre‐arthritic alignment. Level of evidenceIV, case series.

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Section: Methodsmentioning

confidence: 99%

Restoration or relative overcorrection of pre-arthritic coronal alignment leads to improved results following medial unicompartmental knee arthroplasty

Bayoumi

Burger

Ruderman

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…The HRQoL utility score captures a broad range of health domains, including both physical and mental health. In comparison, traditional patient outcomes focus on symptoms restricted to the affected anatomy or pathology 58 . The disadvantage with the traditional approach is the neglect to consider wider implications of health that knee arthritis can cause.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, traditional patient outcomes focus on symptoms restricted to the affected anatomy or pathology. 58 The disadvantage with the traditional approach is the neglect to consider wider implications of health that knee arthritis can cause. Furthermore, in the context of health economics, the use of HRQoL utility scores can aid in calculations when performing cost-utility and cost-benefit analyses.…”

Section: Discussionmentioning

confidence: 99%

SMART choice (knee) tool: a patient‐focused predictive model to predict improvement in health‐related quality of life after total knee arthroplasty

Zhou

Dowsey

Spelman

et al. 2023

ANZ Journal of Surgery

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Background Current predictive tools for TKA focus on clinicians rather than patients as the intended user. The purpose of this study was to develop a patient‐focused model to predict health‐related quality of life outcomes at 1‐year post‐TKA. Methods Patients who underwent primary TKA for osteoarthritis from a tertiary institutional registry after January 2006 were analysed. The primary outcome was improvement after TKA defined by the minimal clinically important difference in utility score at 1‐year post‐surgery. Potential predictors included demographic information, comorbidities, lifestyle factors, and patient‐reported outcome measures. Four models were developed, including both conventional statistics and machine learning (artificial intelligence) methods: logistic regression, classification tree, extreme gradient boosted trees, and random forest models. Models were evaluated using discrimination and calibration metrics. Results A total of 3755 patients were included in the study. The logistic regression model performed the best with respect to both discrimination (AUC = 0.712) and calibration (intercept = −0.083, slope = 1.123, Brier score = 0.202). Less than 2% (n = 52) of the data were missing and therefore removed for complete case analysis. The final model used age (categorical), sex, baseline utility score, and baseline Veterans‐RAND 12 responses as predictors. Conclusion The logistic regression model performed better than machine learning algorithms with respect to AUC and calibration plot. The logistic regression model was well calibrated enough to stratify patients into risk deciles based on their likelihood of improvement after surgery. Further research is required to evaluate the performance of predictive tools through pragmatic clinical trials. Level of Evidence Level II, decision analysis.

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“…A total HHS below 70 points is considered poor, 70-80 fair, 80-90 good, and 90-100 excellent outcome [19]. Western Ontario and McMaster University osteoarthritis index (WOMAC) was used to assess the postoperative functional outcome four months after the surgery [20]. WOMAC has been used extensively to assess the hip and knee functions in patients with lower limb osteoarthritis, lower limb fractures and joint replacement studies [20].…”

Section: Methodsmentioning

confidence: 99%

“…Western Ontario and McMaster University osteoarthritis index (WOMAC) was used to assess the postoperative functional outcome four months after the surgery [20]. WOMAC has been used extensively to assess the hip and knee functions in patients with lower limb osteoarthritis, lower limb fractures and joint replacement studies [20]. WOMAC is scored from 0 to 96 in three domains: pain (20 points), stiffness (8 points) and physical function (68 points) where lower scores reflect a better functional outcome.…”

Section: Methodsmentioning

confidence: 99%

The outcome of antegrade intramedullary nail fixation of traumatic diaphyseal fractures of the femur in a tertiary care trauma center in Sri Lanka

2022

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IntroductionWe evaluated the outcome, functional recovery, and complications of intramedullary nailing for fractures of the femoral shaft fractures. MethodsA prospective observational study was conducted at the National Hospital of Sri Lanka. Patients with isolated femoral shaft fractures undergoing intramedullary nailing were followed up prospectively to assess the factors associated with better functional recovery (measured by Harris Hip Score (HHS) and Western Ontario and McMaster University osteoarthritis index (WOMAC)). ResultsOf 46 patients, the median age was 40(IQR=26-59) years. Majority had simple (n=34,73.9%), closed (n=39,84.8%) fractures while seven (15.2%) had Gustilo Type I open fractures. Surgery was performed at a median of 9.5(IQR=6-14) days after the injury. Approximately two-thirds of the patients required reamed nailing (n=30,65.2%). Three patients developed surgical site infections. X-rays obtained at four months demonstrated features of non-union in 13(28.3%). Leg length discrepancy (LLD) was present in 16(34.8%), and rotational deformity in one patient. Full and partial weight-bearing at six weeks was achieved in six and 23 patients respectively while 17 patients were unable to bear weight. The median HHS and WOMAC at four months were 66.5 and 36, respectively. Patients with proximal or distal diaphyseal fractures, female patients and those with full weight-bearing six weeks showed the best WOMAC index. ConclusionProximal or distal diaphyseal fractures, female sex and ability to bear weight at six weeks post-surgery were associated with better functional outcomes at four months postoperatively.

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Development and Validation of Crosswalks Between the Western Ontario & McMaster Universities Osteoarthritis Index and Hip Disability and Osteoarthritis Outcome Score Joint Replacement/Knee Injury and Osteoarthritis Outcome Score Joint Replacement

Cited by 9 publications

References 13 publications

Restoration or relative overcorrection of pre-arthritic coronal alignment leads to improved results following medial unicompartmental knee arthroplasty

Restoration or relative overcorrection of pre-arthritic coronal alignment leads to improved results following medial unicompartmental knee arthroplasty

SMART choice (knee) tool: a patient‐focused predictive model to predict improvement in health‐related quality of life after total knee arthroplasty

The outcome of antegrade intramedullary nail fixation of traumatic diaphyseal fractures of the femur in a tertiary care trauma center in Sri Lanka

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