Outcome following knee arthroplasty beyond 15 years

Loughead, Jonathan; Malhan, Kaushal; Mitchell, Sheryl; Pinder, I. M.; McCaskie, Andrew W.; Deehan, David J.; Lingard, Elizabeth A.

doi:10.1016/j.knee.2007.11.003

Cited by 37 publications

(22 citation statements)

References 18 publications

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“…The questionnaire of Feller et al [8] includes items on anterior knee pain, quadriceps strength, and ability to rise from a chair and climb stairs; these scores range from 3 to 30 points, with 30 points representing the best possible score. The SF-36 [18] includes a question asking patients to rate their current general health status compared with their status 12 months ago. Patients answer on a scale with five responses ranging from ''much better'' to ''much worse.''…”

Section: Methodsmentioning

confidence: 99%

“…These scoring systems aggregate weighted scores for pain, ROM, stability, alignment, and functional ability. Using these systems, pain and function of the knee after TKA have been reported by numerous investigators [4,6,18,24]. However, discrepancy exists between assessment by these scoring systems and patient satisfaction with the function or symptoms after TKA [14,21].…”

Section: Introductionmentioning

confidence: 99%

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A New High-flexion Knee Scoring System to Eliminate the Ceiling Effect

Lee

2012

Clinical Orthopaedics &Amp; Related Research

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Background Various scoring systems document improvement after TKA, but most are associated with a ceiling effect that may fail to distinguish between patients having different levels of knee function after TKA. We therefore developed a new scoring system for patients with higher levels of flexion to eliminate ceiling effects observed with current systems. Questions/purposes The purposes of this study were (1) to determine whether the high-flexion knee score eliminates the ceiling effect, (2) to assess the validity and responsiveness of the high-flexion knee score, and (3) to determine whether the high-flexion knee score can aid in differentiation of the knee status of patients at the ceiling level. Methods We prospectively studied 165 patients with 201 well-functioning knees who had undergone primary TKA. We obtained Knee Society scores, WOMAC scores, Feller scores, SF-36 scores, and high-flexion knee scores for all patients. The high-flexion knee score includes items that reflect knee function in the high functional range, such as sitting on or rising from the floor, squatting, or kneeling. We determined the ceiling effects and score distributions of various scoring systems. We performed a convergent validity test of the high-flexion knee score by correlation analysis with these various scoring systems. Responsiveness of the high-flexion knee score was assessed by correlation analysis of changes in various scoring systems. To determine whether the high-flexion knee score can aid in differentiation of knee status of patients at the ceiling level, relative responsiveness of the various scores in the ceiling versus below the ceiling range was determined. Results The high-flexion knee score showed no ceiling effect, whereas the other systems did. Addition of the highflexion knee score to the other scoring systems eliminated these ceiling effects and resulted in more normalized score distributions. The high-flexion knee score correlated (r = À0.77) with WOMAC in postoperative scores, and it also correlated with the changes in WOMAC (r = À0.69) and SF-36 physical functioning (r = 0.62).

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A New High-flexion Knee Scoring System to Eliminate the Ceiling Effect

Lee

2012

Clinical Orthopaedics &Amp; Related Research

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“…Despite the ability of TJA to improve the functional status and quality of life for many patients [17,23], 18% of THAs and 8% of TKAs performed annually in the United States are revision procedures [15]. Compared with primary TJA, revision TJA is technically challenging and may require extensive surgical exposure and careful management of periprosthetic bone loss [6].…”

Section: Introductionmentioning

confidence: 99%

Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

Ong

Lau

Suggs

et al. 2010

Clinical Orthopaedics &Amp; Related Research

236

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Background Revision is technically more demanding than primary total joint arthroplasty (TJA) and requires more extensive use of resources. Understanding the relative risk of rerevision and risk factors can help identify patients at high risk who may require closer postsurgical care. Objectives/purposes We therefore evaluated the risk of subsequent revision after primary and revision TJA in the elderly (65 years or older) patient population and identified corresponding patient risk factors. Patients and Methods Using the 5% Medicare claims data set (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), we identified a total of 35,746 patients undergoing primary THA and 72,913 undergoing primary TKA; of these, 1205 who had THAs and 1599 who had TKAs underwent initial revision surgery. The rerevision rate after primary and revision TJAs was analyzed by the Kaplan-Meier method. The relative risk of revision surgery for primary and revision TJAs was compared using hazard ratio analysis. ResultsThe 5-year survival probabilities were 95.9%, 97.2%, 81.0%, and 87.4% for primary THA and TKA and revision THA and TKA, respectively. Patients with revision arthroplasty were five to six times more likely to undergo rerevision (adjusted relative risk, 4.89 for THA; 5.71 for TKA) compared with patients with primary arthroplasty. Age and comorbidities were associated with initial revision after primary THA and TKA. Conclusions Patients should undergo stringent preoperative screening for preexisting health conditions and careful patient management and followup postoperatively so as to minimize the risk of an initial revision, which otherwise could lead to a significantly greater likelihood of subsequent rerevisions.

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“…15 Com respeito à dor, foi observada melhoria em diversos estudos. 11,12,[16][17][18][19] Os efeitos positivos da cirurgia puderam ser observados tão cedo quanto em uma, 10 quatro 20 e seis 11 semanas no período pós-operatório e perduraram por até sete anos após a cirurgia. 19 A melhoria na dor apresentou íntima correlação com a conquista de melhores escores na QV, mas a permanência da dor nas avaliaç ões pós-operatórias reduziu a possibilidade de alcançar bons resultados.…”

Section: Questionário Para Avaliação Da Qualidade De Vidaunclassified