The forgotten joint score-12 is a valid and responsive outcome tool for measuring success following hip arthroscopy for femoroacetabular impingement syndrome

Robinson, Patrick G; Rankin, Conor S.; Murray, Iain R.; Maempel, Julian F.; Gaston, Paul; Hamilton, David F.

doi:10.1007/s00167-020-06138-7

Cited by 15 publications

(19 citation statements)

References 20 publications

(24 reference statements)

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“…Ingelsrud et al reported an MCID of the FJS-12 in TKA between 14 and 23 points [ 27 ]. Robinson et al assessed the MCID of 15 points for FJS-12 in total hip arthroplasty [ 34 ]. Behrend et al calculated an FJS-12′s MCID of 13 in anterior cruciate ligament reconstruction [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Unicompartmental Knee Arthroplasty: Minimal Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score

et al. 2021

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Background and Objectives: Unicompartmental knee arthroplasty (UKA) is a valid alternative to total knee arthroplasties (TKAs) in selected cases. After surgery, patients’ experience and satisfaction were traditionally evaluated by pre- and postsurgical scores and Patient-Reported Outcome Measures (PROMs). Otherwise, a statistically significant change does not necessarily correlate to a clinically meaningful improvement when measured using PROMs. To evaluate the real effect of a specific treatment and understand the difference between groups in a clinical trial, it is necessary to use a meaningful quantum of change on the score assessed. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) can provide this meaningful change. This paper aimed to calculate the MCID and the PASS of the Forgotten Joint Score (FJS-12) after UKA. Materials and Methods: A total of 40 patients with a mean age 72.5 ± 6.4 years undergoing UKA were assessed preoperatively and six months postsurgery using the FJS-12 and the Oxford Knee Score (OKS). The baseline and 6-month postoperative scores were compared using the Wilcoxon signed ranks test. The correlation was calculated with Spearman’s rho. Both distribution-based approaches and anchor approaches were used to estimate MCID for the FJS-12. The 75th percentile and the Receiver operating characteristic (ROC) curve methods were used to calculate the PASS of FJS-12. Results: MCID estimates for normalized FJS-12 for UKA ranged from 5.68 to 19.82. The threshold of the FJS-12 with ROC method was 72.92 (AUC = 0.76). The cut-off value computed with the 75th percentile approach was 92.71. Conclusions: The MCID and PASS represent valid tools to assess the real perception of clinical improvement in patients who underwent UKA. The MCID value of FJS-12 was 12.5 for patients who underwent UKA. The value of the PASS for the FJS-12 in patients who underwent UKA was 72.92.

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Section: Discussionmentioning

confidence: 99%

Unicompartmental Knee Arthroplasty: Minimal Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score

et al. 2021

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“…However, it is also for this reason that this outcome tool is effective in distinguishing good from excellent performers after hip arthroscopy and why it has been recommended for young, active patients. 8 Other outcome tools used to assess hip arthroscopy have demonstrated significant ceiling effects with an inability to distinguish good from excellent outcomes. 33 Our results here present a PASS score in the lower half of possible scores on the 0-100 scale of the FJS-12, suggesting that while not a sports-specific score, the FJS-12 may be useful in assessing high-performing patients.…”

Section: Discussionmentioning

confidence: 99%

“…Demographic data included age, gender, body mass index (BMI), and Scottish Index of Multiple Deprivation (SIMD) vingtile ranking (social deprivation index). 30 Patients completed preoperative FJS-12, 8 , 10 iHOT-12, 31 Tegner and EQ-5D-5L 32 questionnaires 2 weeks before surgery at the pre-assessment clinic and at a minimum of one year postoperatively. Plain anteroposterior radiographs were used to assess for cam and/or pincer lesions as well as to calculate the lateral center edge angle (LCEA), and assess Tönnis classification.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, it captures what is most important to the patient compared with surgeon-defined outcomes. It has now been used in a number of sports surgery studies, including in the field of hip arthroscopy, where it has been shown to be a valid tool with minimal ceiling effect 8,10 and in ACL repair. 11,12 Patient-reported outcome scores are very useful research tools to quantify treatment success.…”

mentioning

confidence: 99%

“… 3 , 4 , 5 , 6 , 7 The concept of joint awareness is well suited for capturing reliable outcomes for young, active patients undergoing hip arthroscopy, and this is particularly true for high-functioning patients. 8 The Forgotten Joint Score (FJS-12) is a well-established tool for the assessment of joint awareness for patients undergoing total hip and knee arthroplasty, and it is has been shown to have the capability to distinguish between high performing patients, which previous described PROMs may have struggled with. 9 It is also being recognized as a useful tool for an athletic population, secondary to its ability to distinguish been good, very good, and excellent outcomes and, hence, is less affected by a ceiling effect.…”

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confidence: 99%

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Defining the Patient Acceptable Symptom State Using the Forgotten Joint Score 12 After Hip Arthroscopy

Robinson¹,

Gaston²,

Williamson³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To contextualize the Forgotten Joint Score (FJS-12) by identifying a patient acceptable symptomatic state (PASS) threshold for patients undergoing hip arthroscopy and to investigate factors which correlated with postoperative FJS-12 score. Methods All patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) under the care of a single surgeon between January 2018 and November 2019 were prospectively identified and included. Exclusion criteria were Tönnis classification grade 2 or greater. Data (including FJS-12, EuroQol-5 Dimension-5L [EQ-5D-5L], visual analog scale (VAS), and 12-item International Hip Outcome Tool (iHOT-12) scores) were available before surgery and at a minimum of 1 year after surgery. PASS was calculated using an anchor-based approach and receiver operator characteristic curve analysis. Pearson correlation analysis was used to correlate preoperative and postoperative factors with postoperative FJS-12 score. Results Seventy-seven patients (54 female, 23 male; mean age 30.3 years [standard deviation {SD} 8.2]) were included. Linked longitudinal follow-up data were available for 65 patients (84%) at a mean of 23.8 months (SD 6.4). Six patients required reoperation. Mean postoperative FJS-12 score was 46.5 (SD 33.1) and mean change in score was 27.2 (SD 30.6, P < .001). The PASS threshold for the FJS-12 was 38.5 (sensitivity 80%, specificity 88%), and the area under the curve was 0.852 (95% confidence interval 0.752-0.951). Overall, 53.8% of patients achieved this score. Postoperative FJS-12 score has moderate correlations with preoperative EQ-5D-5L, iHOT-12, and FJS-12 scores, and strong correlations with EQ-5D-5L, iHOT-12 and VAS scores after surgery. Conclusions We report a postoperative PASS threshold of 38.5 points for the FJS-12 after hip arthroscopy for FAI in a United Kingdom population. This value can act as a quantifiable target for clinicians using the FJS-12 to monitor patient outcomes in practice. FJS-12 has strong correlations with EQ-5D-5L, iHOT-12, and VAS at a minimum 12 months after surgery. Clinical Relevance We have calculated the patient acceptable symptomatic state of the Forgotten Joint Score to be 38.5 points at short-term follow-up. This can assist clinicians in determining whether surgical interventions related to hip arthroscopy for FAI are meaningful to the patient.

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Item‐reduced Forgotten Joint Score provides adequate psychometric properties in ACLR patients

Kekki,

Wörner,

Stålman

et al. 2024

J. exp. orthop.

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PurposeThe purpose of this study was to evaluate content validity, test–retest reliability, internal consistency, construct validity, responsiveness and floor/ceiling effects of Forgotten Joint Score (FJS) for assessing functions in activities of daily living (ADL) following anterior cruciate ligament reconstruction (ACLR) and perform an item reduction of FJS.MethodsSwedish‐speaking ACLR patients in one surgical clinic were eligible. Content validity was evaluated through patient responses and patient and expert clinician relevance ratings, omitting items with low relevance. Principal component factor analysis, Cronbach's ⍺, paired t test, correlations between FJS and Knee Injury and Osteoarthritis Outcome Score (KOOS), Cohen's d effect sizes (ESs) and standardized response mean (SRM) were used to evaluate internal consistency, test–retest reliability, construct validity and responsiveness. Floor/ceiling effects were calculated. FJS was expected to reveal one dominant factor, a Cronbach's ⍺ between 0.70 and 0.95, correlations >0.50 to all KOOS subscores, highest for ADL, moderate ES and SRM, floor/ceiling effects <15%.ResultsOne hundred and seventy‐six participants (103 for assessing internal consistency, construct validity, responsiveness and floor/ceiling effects; 73 for assessing test–retest reliability and content validity) were included. Item reduction yielded a nine‐item FJS (FJS‐9). FJS‐12 and FJS‐9 demonstrated sufficient content validity (95% confidence interval [CI], 2.5–3.1, respectively, 2.9–3.3). FJS‐9 was found unidimensional, and FJS‐12 was multidimensional. Cronbach's ⍺ was 0.94 for FJS, and the intraclass correlation coefficient > 0.90. FJS showed significant correlations >0.65 to all KOOS subscales, moderate ES and SRM > 0.50. No floor/ceiling effects were found.ConclusionFJS‐9 demonstrated adequate validity for the evaluation of joint awareness in ACLR patients and can be a valuable tool to assess ADL and joint awareness.Level of EidenceLevel III.

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The forgotten joint score-12 is a valid and responsive outcome tool for measuring success following hip arthroscopy for femoroacetabular impingement syndrome

Cited by 15 publications

References 20 publications

Unicompartmental Knee Arthroplasty: Minimal Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score

Unicompartmental Knee Arthroplasty: Minimal Important Difference and Patient Acceptable Symptom State for the Forgotten Joint Score

Defining the Patient Acceptable Symptom State Using the Forgotten Joint Score 12 After Hip Arthroscopy

Item‐reduced Forgotten Joint Score provides adequate psychometric properties in ACLR patients

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