Patient Acceptable Symptom State at 1 and 3 Years After Total Knee Arthroplasty

Connelly, James W.; Galea, Vincent P; Rojanasopondist, Pakdee; Matuszak, Sean J.; Ingelsrud, Lina Holm; Nielsen, Christian Skovgaard; Bragdon, Charles R.; Huddleston, James I.; Malchau, Henrik; Troelsen, Anders

doi:10.2106/jbjs.18.00233

Cited by 64 publications

(52 citation statements)

References 24 publications

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“…The overall clinical results, expressed by WOMAC and KOOS indices, were similar to those reported in the literature [20,21]. The average scores were 16.85 (WOMAC) and 20.05 (KOOS), with 89% of patients showing good and excellent results.…”

Section: Discussionsupporting

confidence: 84%

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

Rissolio

Sabatini

Risitano

et al. 2021

JCM

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Total knee arthroplasty (TKA) is a successful and safe surgical procedure for treating osteoarthritic knees, but despite the overall good results, some patients remain dissatisfied. The aim of this study is to evaluate the influence of patient-related and surgery-related variables in a consecutive group of patients that underwent TKA. Individuals (n = 648) who had TKA performed between 01 January 2013 and 31 December 2017 were enrolled in the study. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint score (FJS-12) were collected at a mean follow-up of 4.79 years. Patient satisfaction was assessed with a questionnaire. Determinants of satisfaction (age, sex, smoking, presence of diabetes or cardiovascular disease, pain in other joints, preoperative arthritic stage) and components of satisfaction (slope variation, mechanical axis variation, outlier final alignment, surgeon experience) were examined to identify which variables correlated with positive outcome. Correlations with septic and mechanicals failures were also evaluated. Thirteen percent of patients were unsatisfied, despite good results in KOOS, WOMAC and FJS-12 tests. Female gender, low Kellgren–Lawrence grade and the presence of back pain and pain in other joints were factors associated with poor clinical results. Poorer clinical results were also reported in younger patients. Infection rate was correlated with active smoking and mechanical failure with an outlier final alignment. Comorbidities, smoking habits and high expectations have a big influence on TKA results and on final satisfaction after surgery.

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Section: Discussionsupporting

confidence: 84%

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

Rissolio

Sabatini

Risitano

et al. 2021

JCM

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“…We found that the PROMS scores were similar between the two systems, with the OMNIbot TKAs reporting slightly higher OKS scores (43 vs 42, p=0.7) while MAKO TKAs reported slightly, higher KOOS scores, with the only significant difference being the KOOS symptoms at more than one year post-operatively (87 vs 82, p=0.02) and the associated PASS rate on the KOOS score. The KOOS difference in symptoms may be due to the difference in follow-up time between the KOOS scores, with the MAKOs being collected later for the KOOS questionnaire (14 vs 20 months, p<0.001), and TKA symptoms having been shown to improve over time [31,32]. It should also be noted that none of the differences came close to the minimal clinical important difference (MCID) for KOOS or OKS scores indicating that there was no clinically significant difference in short-term outcomes between the groups [38,39], and excellent scores in both.…”

Section: Discussionmentioning

confidence: 99%

How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms

Murphy

Shatrov

Duong

et al. 2023

International Orthopaedics (SICOT)

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Purpose This study aimed to compare the effect of an image-based (MAKO) system using a gap-balancing technique with an imageless (OMNIbot) robotic tool utilising a femur-first measured resection technique. Methods A retrospective cohort study was performed on patients undergoing primary TKA with a functional alignment philosophy performed by a single surgeon using either the MAKO or OMNIbot robotic systems. In all cases, the surgeon’s goal was to create a balanced knee and correct sagittal deformity (eliminate any fixed flexion deformity). Intra-operative data and patient-reported outcomes (PROMS) were compared. Results A total of 207 MAKO TKA and 298 OMNIbot TKAs were analysed. MAKO TKA patients were younger (67 vs 69, p=0.002) than OMNIbot patients. There were no other demographic or pre-operative alignment differences. Regarding implant positioning, in MAKO TKAs the femoral component was more externally rotated in relation to the posterior condylar axis (2.3° vs 0.1°, p<0.001), had less valgus femoral cuts (1.6° vs 2.7° valgus, p<0.001) and more varus tibial cuts (2.4° vs 1.9° varus, p<0.001), and had more bone resected compared to OMNIbot TKAs. OMNIbot cases were more likely to require tibial re-cuts than MAKO (15% vs 2%, p<0.001). There were no differences in femur recut rates, soft tissue releases, or rate of achieving target coronal and sagittal leg alignment between robotic systems. A subgroup analysis of 100 MAKO and 100 OMNIbot propensity-matched TKAs with 12-month follow-up showed no significant difference in OKS (42 vs 43, p=0.7) or OKS PASS scores (83% vs 91%, p=0.1). MAKO TKAs reported significantly better symptoms according to their KOOS symptoms score than patients that had OMNIbot TKAs (87 vs 82, p=0.02) with a higher proportion of KOOS PASS rates, at a slightly longer follow-up time (20 months vs 14 months, p<0.001). There were no other differences in PROMS. Conclusion A gap-balanced technique with an image-based robotic system (MAKO) results in different implant positioning and bone resection and reduces tibial recuts compared to a femur-first measured resection technique with an imageless robotic system (OMNIbot). Both systems achieve equal coronal and sagittal deformity correction and good patient outcomes at short-term follow-ups irrespective of these differences.

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“…Although previous studies have examined the PASS for the KOOS and the HOOS and their subdomains 25,26 , to our knowledge, no study to date has performed this investigation for the KOOS JR and the HOOS JR after TJA. Connelly et al determined that the PASS thresholds for the KOOS subdomains of pain, symptoms, activities of daily living, and quality of life at 1 and 3 years after TKA ranged between 66.0 and 84.5 and between 66.0 and 87.5, respectively 25 . Paulsen et al reported that the PASS values for the HOOS pain, physical function, and quality of life outcomes were 91, 88, and 83, respectively, at 1 year after THA 26 .…”

Section: Discussionmentioning

confidence: 99%

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

Kunze

Fontana

MacLean

et al. 2021

Journal of Bone and Joint Surgery

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Background: It is essential to quantify an acceptable outcome after total joint arthroplasty (TJA) in order to understand quality of care. The purpose of this study was to define patient acceptable symptom state (PASS) thresholds for the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR) and the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) after TJA.Methods: A receiver operating characteristic (ROC) curve analysis, leveraging 2-year satisfaction of "moderate improvement" or better as the anchor, was used to establish PASS thresholds among 5,216 patients who underwent primary total hip arthroplasty and 4,036 who underwent primary total knee arthroplasty from 2007 to 2012 with use of an institutional registry. Changes in PASS thresholds were explored by stratifying and recalculating these thresholds by age at the time of surgery (<70 or ‡70 years of age), sex (men or women), body mass index (BMI; <30 or ‡30 kg/m 2 ), and baseline Short Form-36 (SF-36) physical and mental component scores (<50 or ‡50). Results:The HOOS JR PASS threshold was 76.7 (area under the ROC curve [AUC] = 0.91), which was achieved by 4,334 patients (83.1%). The KOOS JR PASS threshold was 63.7 (AUC = 0.89), which was achieved by 3,461 patients (85.8%). Covariate stratification demonstrated that PASS thresholds were higher in men compared with women, and in those with higher preoperative SF-36 physical and mental scores ( ‡50) compared with lower SF-36 scores (<50). Results differed between instruments for BMI and age: higher BMI was associated with a lower PASS threshold for the HOOS JR but a higher PASS threshold for the KOOS JR. The HOOS JR PASS threshold was higher in patients who were <70 years of age compared with those who were ‡70 years of age, but was equivalent for the KOOS JR. Conclusions:The PASS thresholds for the HOOS JR and KOOS JR at 2 years after TJA were 76.7 and 63.7, respectively.The PASS thresholds were associated with certain preoperative covariates, suggesting that an acceptable symptom state after TJA is influenced by patient-specific factors.

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Patient Acceptable Symptom State at 1 and 3 Years After Total Knee Arthroplasty

Cited by 64 publications

References 24 publications

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

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