Which Oxford Knee Score level represents a satisfactory symptom state after undergoing a total knee replacement?

Ingelsrud, Lina Holm; Terluin, Berend; Gromov, Kirill; Price, Andrew; Beard, David; Troelsen, Anders

doi:10.1080/17453674.2020.1832304

Cited by 27 publications

(19 citation statements)

References 15 publications

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“…Second, we demonstrated how the adjusted predictive modeling method altered the cut-offs as the proportion of patients being importantly improved, feeling satisfactory symptoms, or feeling treatment failure differed greatly from 50% ( 18 ). These findings align with previous studies, and emphasize the preference of the predictive modelling method above the ROC method ( 12 , 13 , 16 ).…”

Section: Discussionsupporting

confidence: 92%

“…The large difference could be explained by the ROC analysis used on a population where the proportion improved was very high (92.7%), possibly causing an upward biased value in the comparative study ( 11 ). However, our adjusted OKS PASS and TF values found at 3 and 12 months postoperatively are within 3 points of the proposed cut-offs previously suggested in a study using the same method for patients undergoing TKA ( 13 ). These findings suggest that the OKS PASS and TF scores are similar in patients undergoing UKA and TKA.…”

Section: Discussionsupporting

confidence: 86%

“…No previous studies have determined MIC or TF values, but a PASS value of 41.5 points for the OKS in people undergoing UKA at 24 months postoperatively has been suggested ( 11 ). Additionally, in people undergoing TKA, a MIC value of 6.9 for the OKS at 6 months’ follow-up and TF values of 27 at 12 and 24 months has been presented ( 12 , 13 ). Although UKA is deemed a viable alternative to TKA it remains to be investigated as to whether PROM scores should be interpreted alike across both patient populations.…”

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confidence: 99%

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Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty

Harris

Troelsen

Terluin³

et al. 2022

ActaO

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Background and purpose: Developing meaningful thresholds for the Oxford Knee Score (OKS) advances its clinical use. We determined the minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) values as meaningful thresholds for the OKS at 3-, 12-, and 24-month follow-up in patients undergoing unicompartmental knee arthroplasty (UKA).Patients and methods: This is a cohort study with data from patients undergoing UKA collected at a hospital in Denmark between February 2016 and September 2021. The OKS was completed preoperatively and at 3, 12, and 24 months postoperatively. Interpretation threshold values were calculated with the anchor-based adjusted predictive modeling method. Non-parametric bootstrapping was used to derive 95% confidence intervals (CI).Results: Complete 3-, 12-, and 24-month postoperative data was obtained for 331 of 423 (78%), 340 of 479 (71%), and 235 of 338 (70%) patients, median age of 68–69 years (58–59% females). Adjusted OKS MIC values were 4.7 (CI 3.3–6.0), 7.1 (CI 5.2–8.6), and 5.4 (CI 3.4– 7.3), adjusted OKS PASS values were 28.9 (CI 27.6–30.3), 32.7 (CI 31.5–33.9), and 31.3 (CI 29.1–33.3), and adjusted OKS TF values were 24.4 (CI 20.7–27.4), 29.3 (CI 27.3–31.1), and 28.5 (CI 26.0–30.5) at 3, 12, and 24 months postoperatively, respectively. All values statistically significantly increased from 3 to 12 months but not from 12 to 24 months.Interpretation: The UKA-specific measurement properties and clinical thresholds for the OKS can improve the interpretation of UKA outcome and assist quality assessment in institutional and national registries.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 86%

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confidence: 99%

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Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty

Harris

Troelsen

Terluin³

et al. 2022

ActaO

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“…The PASS at one-year follow-up was defined as an OKS above 30. 30 Any p-values less than 0.05 were considered statistically significant. All statistics were calculated using R v. 3.6.0 (R Foundation for Statistical Computing, Austria).…”

Section: Methodsmentioning

confidence: 99%

Comparing surgical strategies for end-stage anteromedial osteoarthritis

et al. 2022

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Aims Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for patients undergoing UKA or TKA, when treated by high-volume surgeons, in high-volume centres, using two different clinical guidelines. The two strategies are ‘UKA whenever possible’ vs TKA for all patients with AMOA. Methods A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres’ local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences. Results The matched cohort included 400 patients (mean age 67 years (SD 9.55), 213 (53%) female, mean BMI 30.2 kg/m2, 337 (84%) American Society of Anesthesiologists grade ≤ 2). We found a mean adjusted difference in change score of 3.02 points (95% confidence interval (CI) 1.41 to 4.63; p < 0.001) and a significantly larger likeliness of achieving PASS (odds ratio 3.67 (95% CI 1.73 to 8.45); p = 0.001) both in favour of the UKA strategy. Conclusion UKA and TKA are both good strategies for treating end-stage AMOA. However, when compared as a strategy, UKA achieved larger improvements in OKS, and were more likely to reach the PASS value at one-year follow-up. Cite this article: Bone Jt Open 2022;3(5):441–447.

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“…Total scores range from 12 points (best) to 60 points (worst). Many scholars eventually suggested that these scores be adjusted to range from 0–4, with a maximum possible score of 48 [ 18 ]. Accordingly, the latest revised OKS scoring system rates each item from 0–4, with total possible scores ranging from 0 (worst) to 48 (best).…”

Section: Methodsmentioning

confidence: 99%

Short-term outcomes of Oxford unicompartmental knee arthroplasty with coronal subluxation of the knee: a retrospective case–control study

Wang

et al. 2022

J Orthop Traumatol

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Background The goal of this study was to assess short-term outcomes in single compartment osteoarthritis patients associated with the coronal tibiofemoral subluxation (CTFS) of the knee joint after Oxford unicompartmental knee arthroplasty (OUKA), and to establish the potential impact of the degree of CTFS on operative outcomes. Methods Data pertaining to 183 patients with medial compartment osteoarthritis that underwent OUKA treatment between February 2016 and June 2019 were retrospectively analyzed. The presence and degree of severity of CTFS were assessed using preoperative weight-bearing anteroposterior X-ray images of the knee. Patients were stratified into three subgroups based upon the observed degree of subluxation: a normal group, a mild subluxation group (CTFS < 0.5 cm), and a severe subluxation group (CTFS ≥ 0.5 cm). Anterior and posterior X-ray examination of the knee was conducted at the time of most recent follow-up for each patient to assess the degree of CTFS correction following OUKA. Clinical function was assessed using Oxford knee score (OKS) and Hospital for Special Surgery score (HSS) values, while pain was rated using visual-analog scale (VAS) scores. The mechanical femoral tibial angle (mFTA), range of motion (ROM), and complication rates in these three groups were additionally compared. Results The average follow-up duration for patients in this study was 24.1 months (range: 17–32 months). There were no significant differences in patient age, sex, body mass index (BMI), follow-up duration, mFTA, ROM, OKS, HSS, or VAS scores among these three groups (P > 0.05). After surgery, OKS and HSS scores declined significantly, but no differences in these scores were observed among groups (P > 0.05). Of these patients, 135 (73.8%) were satisfied with the operation, of whom 80 (43.7%) were very satisfied. There were no significant differences in ROM or VAS scores among groups (P > 0.05). The degree of CTFS for patients in the mild and severe subluxation groups was significantly improved following OUKA relative to preoperative values such that the degree of postoperative CTFS did not differ significantly among these groups (P > 0.05). Postoperative mFTA was also significantly improved in these three patient subgroups (P < 0.05). No patients experienced operative complications over the follow-up period. Conclusions OUKA can successfully improve clinical symptoms in patients with single compartmental osteoarthritis. Moreover, OUKA can effectively correct CTFS of the knee in these patients, and the degree of preoperative CTFS has no impact on surgical efficacy. Level of evidence III.

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Which Oxford Knee Score level represents a satisfactory symptom state after undergoing a total knee replacement?

Cited by 27 publications

References 15 publications

Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty

Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty

Comparing surgical strategies for end-stage anteromedial osteoarthritis

Short-term outcomes of Oxford unicompartmental knee arthroplasty with coronal subluxation of the knee: a retrospective case–control study

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