Search

Objectives: We aim to evaluate the effect on different ways of classifying pain sensitisation on impact and quality of life (QoL) in knee osteoarthritis (KOA)., Methods: We used baseline data from a cohort of consecutive patients with KOA listed for arthroplasty. We collected demographics and number of painful body sites. We measured pressure pain thresholds at the right forearm (PPT arm ). Pain sensitisation was classified using: (1) widespread pain, (2) lowest 10th percentile of PPT arm and (3) PainDETECT questionnaire ≥13/38. Impact and QoL were assessed using Western Ontario and McMaster Universities Osteoarthritis Index and Short Form-36. Impact and QoL scores in patients with or without pain sensitisation were compared. We evaluated the association of pain sensitisation measures with QoL scores using multivariable regression., Results: 233 patients (80% female, mean age 66 years) included in the analysis; 7.3%, 11.6% and 4.7% were classified as having pain sensitisation by widespread pain, low PPT arm and PainDETECT criteria, respectively. There was minimal overlap of patients as classified as pain sensitisation phenotype by different measures. Patients with pain sensitisation had poorer QoL compared with those without. Low PPT arm identified patients with poorer general health, while widespread pain and PainDETECT identified poorer QoL in more psychological domains. There was weak correlation between number of painful body sites and PainDETECT (rho=0.23, p<0.01), but no significant correlation with PPT arm ., Conclusion: Patients with KOA with pain sensitisation have poorer QoL compared with those without, regardless of classification method. Different criteria defined patients with different pattern of QoL impact., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Patient-specific instrumentation (PSI) utilizes three-dimensional imaging to produce total knee arthroplasty cutting jigs which matches patient's native anatomy. However, there are limited mid- to long-term studies examining its clinical efficacy. The aim of this study was to compare functional outcomes of PSI surgery versus conventional TKA surgery at 5-year follow-up., Materials and Methods: Sixty patients were prospectively recruited into either the MRI-based PSI or conventional TKA group. Functional outcomes were assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS) and Oxford Knee Score (OKS), while quality of life was evaluated with the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 and compared between the two groups at 5-year follow-up., Results: Although the PCS was 7 ± 3 points better in the PSI group preoperatively (p = 0.017), it became 5 ± 2 points worse than the conventional group at 5-year follow-up (p = 0.025). As compared to the PSI group, the conventional group showed a significantly greater improvement in PCS at 5 years as compared to before surgery (p = 0.003). There were no significant differences in KSFS, KSKS, OKS or MCS between the two groups., Conclusions: PSI TKA did not result in improved functional outcomes or better quality of life when compared to conventional TKA. The additional costs and waiting time associated with PSI are not justifiable and therefore not recommended as an alternative to conventional TKA., Level of Evidence: II.

Aims: While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years' follow-up., Methods: Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS., Results: There was no difference in the mean KSKS, KSFS, OKS, and SF-36 PCS at two years or ten years after TKA. Equal proportions of patients in each group attained the minimal clinically important difference for each score. Psychologically distressed patients had a comparable rate of satisfaction (91.8% (47/51) vs 97.1% (69/71); p = 0.193) and fulfilment of expectations (89.8% vs 97.1%; p = 0.094). The proportion of distressed patients declined from 41.8% preoperatively to 29.8% at final follow-up (p = 0.021), and their mean SF-36 MCS improved by 10.4 points (p < 0.001)., Conclusion: Patients with poor mental health undergoing TKA may experience long-term improvements in function and quality of life that are comparable to those experienced by their non-distressed counterparts. These patients also achieved a similar rate of satisfaction and expectation fulfilment. Undergoing TKA was associated with improvements in mental health in distressed patients, although this effect may be due to residual confounding. Cite this article: Bone Joint J 2020;102-B(7):845-851.

Introduction: Hip fractures are a cause of significant morbidity. While rare, ipsilateral hip fractures within 12 months after total knee arthroplasty (TKA) can negatively affect the functional outcome and the quality of life for patients who have had TKA. This aim of this study is to investigate (1) the incidence of hip fracture within 12 months after TKA and (2) the influence of hip fracture after TKA on functional outcome and quality of life in patients., Methods: Between March 1999 and February 2012, 25 patients who sustained an ipsilateral hip fracture within 12 months after TKA were included in this study. A propensity score matching algorithm was used to select a 1:3 control group without hip fracture. All patients were assessed using the Oxford Knee Score (OKS), Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Physical Component Score (PCS) and Mental Component Score (MCS) of SF-36®., Results: The incidence of hip fracture was 0.16% among male patients and 0.20% for female patients. At 24 months after TKA, the OKS was 36 ± 7 in the hip fracture group versus 41 ± 5 in the control group ( p = 0.003). The KSFS was 50 ± 24 in the hip fracture group versus 68 ± 21 in the control group ( p = 0.001), while the KSKS was 83 ± 12 and 87 ± 8, respectively ( p = 0.166). The PCS was 37 ± 12 in the hip fracture group versus 47 ± 11 in the control group ( p < 0.001), while the MCS was 55 ± 10 and 54 ± 11, respectively ( p = 0.664)., Conclusion: Although hip fracture during the rehabilitation period after TKA is uncommon, these patients have poorer functional outcome and quality of life. We recommend additional caution against hip fracture after TKA.

Purpose: Despite reduction in radiological outliers in previous randomized trials comparing robotic-assisted versus conventional total knee arthroplasty (TKA), no differences in short-term functional outcomes were observed. The aim of this study was to determine whether there was improvement in functional outcomes and quality-of-life (QoL) measures between robotic-assisted and conventional TKA., Methods: All 60 knees (31 robotic-assisted; 29 conventional) from a previous randomized trial were available for analysis. Differences in range of motion, Knee Society (KSS) knee and function scores, Oxford Knee scores (OKS), SF-36 subscale and summative (physical PCS/mental component scores MCS) were analysed. In addition, patient satisfaction, fulfilment of expectations and the proportion attaining a minimum clinically important difference (MCID) in KSS, OKS and SF-36 were studied., Results: Both robotic-assisted and conventional TKA displayed significant improvements in majority of the functional outcome scores at 2 years. Despite having a higher rate of complications, the robotic-assisted group displayed a trend towards higher scores in SF-36 QoL measures, with significant differences in SF-36 vitality (p = 0.03), role emotional (p = 0.02) and a larger proportion of patients achieving SF-36 vitality MCID (48.4 vs 13.8 %, p = 0.009). No significant differences in KSS, OKS or satisfaction/expectation rates were noted., Conclusion: Subtle improvements in patient QoL measures were observed in robotic-assisted TKA when compared to conventional TKA. This finding suggests that QoL measures may be more sensitive and clinically important than surgeon-driven objective scores in detecting subtle functional improvements in robotic-assisted TKA patients., Level of Evidence: II.

Background: Recent studies have shown a discrepancy between traditional functional outcomes and patient satisfaction, with some reporting less than 85% satisfaction in older patients undergoing total knee arthroplasty (TKA). As native knee biomechanics are not completely replicated, the resulting functional limitations may cause dissatisfaction in higher-demand individuals. Few studies have recorded patient-reported outcomes, health-related quality of life scores, and patient satisfaction in a young population undergoing TKA., Methods: One hundred thirty-six primary TKAs were performed in 114 patients aged 50 years or younger (mean age, 47.0 years; range, 30-50 years) at a single institution. The main diagnoses were osteoarthritis (85%) and rheumatoid arthritis (10%)., Results: The range of motion, Knee Society Score, Oxford Knee Score, and Physical and Mental Component Scores of Short Form-36 increased significantly (P < .001). At 2 years, 85.3% of patients had good/excellent knee scores, 71.3% had good/excellent function scores, 94.9% met the minimal clinically important difference for the Oxford Knee Score, and 84.6% met the minimal clinically important difference for the Physical Component Score. We found that 88.8% of patients were satisfied with their surgeries, whereas 86.8% had their expectations fulfilled. Survivorship using revision as an end point was 97.8% at a mean of 7 years (range, 3-16 years)., Conclusion: Patients aged 50 years or younger undergoing TKA can experience significant improvements in their quality of life, have their expectations met, and be satisfied with their surgeries, at rates similar to those of non-age-restricted populations. Surgeons should inform them of these benefits and the potential risk of revision surgery in the future, albeit increasingly shown to be low., (Copyright © 2016 Elsevier Inc. All rights reserved.)

This study aims to review the quality of life and physical improvement achieved by total joint arthroplasty surgery, namely unilateral TKA, bilateral TKA and THA. We hypothesize that patients who undergo bilateral TKA should have greater improvement in patient-reported outcome measures, as compared to patients who had unilateral TKA, and their outcomes may be comparable to that of THA. We analyzed prospectively collected data of all patients who underwent unilateral TKA, bilateral TKA and THA (5291, 187 and 529 patients respectively) for end-stage osteoarthritis at a tertiary hospital during the 5-year period. Patients who underwent bilateral TKA had a greater degree of improvement in SF-36 and Knee Society Scores as compared to unilateral TKA at 6 months and 2 years follow-up. Bilateral TKA had the highest proportion of patients who were satisfied and had expectations met by surgery.

Patient-specific instrumentation (PSI) surgery may represent the next advancement in total knee arthroplasty (TKA). In 2011, 60 patients were prospectively recruited and divided into two groups based on the patient's choice: (1) PSI surgery; and (2) conventional TKA. At two years after surgery, the Knee Society Function Score, Oxford Knee Score and SF-36 scores were comparable between the two groups. Although the Knee Society Knee Score (KSKS) was 9 ± 3 points better in the PSI group (P=0.008), the two years improvement in KSKS was comparable between the two groups. None of the patients required revision surgery. These findings cannot justify the additional costs and waiting time incurred by the patients with PSI surgery in the practice of a high volume surgeon., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Patient quality of life scores are commonly used to assess patient-reported satisfaction following orthopedic interventions. Our main aim was to review the satisfaction scores of four common orthopedic interventions in our tertiary institution, primary hallux valgus (HV) corrective surgery, primary single-level transforaminal lumbar interbody fusion (TLIF), primary unilateral total knee arthroplasty (TKA) and primary total hip arthroplasty (THA). We retrospectively reviewed prospectively collected data on patients who underwent four different types of orthopedic surgeries using the SF-36 score and two questions adopted from North American Spine Society Questionnaire. The database of a tertiary hospital between January 2007 and December 2009 was reviewed. There were 3488, 374, 184 and 73 patients who underwent TKA, THA, TLIF and HV surgery, respectively. Patients who underwent primary TLIF, TKA and THA had significant degree of improvement in all aspects of SF-36 scores at 6 months and 2 years of follow-up (p < 0.001). Postoperatively at 2 years, the most satisfied postoperative patients were those who underwent THA (91.9 %), followed by TKA (90.5 %), TLIF (86.1 %) and HV (77.4 %). This study shows a significant degree of postoperative improvement in terms of SF-36 scores for common orthopedic interventions in particular to primary TKA, THA and TLIF at 6 months and 2 years of follow-up. With a significant degree of improvement in SF-36 scores postoperatively, this also translated into patient satisfaction and meeting their expectations of surgery.

Objectives: To compare the responsiveness of the Knee Society (KS) Clinical Rating System, the general health status measure Short Form 36 (SF-36), and both the raw and Rasch-based scores of the condition-specific Oxford Knee Score (OKS) in patients undergoing total knee replacement (TKR) METHODS: Data were prospectively collected as part of routine care from adult patients who underwent TKR between 2001 and 2006. OKS data fit the Rasch partial credit model after removing items regarding limping and kneeling. Responsiveness was assessed using effect size (ES), standardised response mean (SRM), and relative validity (RV)., Results: Among 702 patients with complete data at baseline and two follow-ups, the pain subscale of the KS (KS-P), raw-OKS, and Rasch-OKS consistently had higher levels of responsiveness than all eight SF-36 and the other KS subscales. At 6-month follow-up, Rasch-OKS had the largest ES and KS-P had the largest SRM (2.7 and 2.0, respectively). When compared to raw-OKS, the RVs of KS-P, Rasch-OKS, SF-36 bodily pain, and SF-36 physical functioning were 1.1, 0.66, 0.49, and 0.36, respectively. A similar ordering of responsiveness was observed at 24-month follow-up., Conclusion: The OKS and KS-P are more responsive than most SF-36 subscales in TKR patients. Raw-OKS and Rasch-OKS have comparable responsiveness. Different responsiveness indices may give different results.

The aim of this paper is to assess function and quality of life in patients with recurvatum at 2 years after primary total knee arthroplasty. This prospective study involves 2587 total knee arthroplasty from 2004 to 2008 with 2-year follow-up. Patients' demographics, diagnosis, implants, range of motion, laxity, and knee and SF-36 scores were recorded. Recurvatum deformity of 0°, 1° to 5°, 6° to 10°, and more than 10° were classified as grades 0, 1, 2, and 3, respectively. Grade 1 had similar functional scores to grade 0 but significantly better SF1, SF4, SF5, and SF8 when compared with grades 2 and 3. Patients with mediolateral translation of more than 5 mm were more likely to have grades 2 and 3 recurvatum (P = .01), indicating global laxity. Postoperative recurvatum of more than 5° significantly impacts function and quality of life of patients., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To investigate the influence of response shift (RS) on health-related quality of life (HRQOL) and utility assessment among patients undergoing total knee replacement., Methods: Consenting patients undergoing total knee replacement were interviewed to determine their HRQOL by using the six-dimensional health state short form, derived from SF-36, and the EuroQol five-dimensional questionnaire at baseline (pretest 1) and the six-dimensional health state short form, derived from SF-36, at 6 (pretest 2) and 18 months after surgery (post-test). RS was studied by using a "then-test" approach by contacting participants 18 months after surgery and asking them to evaluate their HRQOL at baseline (then-test 1) and at 6 (then-test 2) and 18 months after surgery. RS was calculated as the score difference between pretest and then-test scores for a given time point. Relationships between RS and external variables were explored by using univariate and multiple liner regression analyses., Results: In 74 subjects (63% response rate, median age 68 years), median (interquantile range) six-dimensional health state short form, derived from SF-36, scores for then-tests at baseline (0.48 [0.42-0.49]) and at 6 months (0.72 [0.66-0.79]) after surgery were significantly different from respective pretest scores (0.61 [0.58-0.68] at baseline, P = 0.000; 0.69 [0.63-0.72] at 6 months, P = 0.000), showing RS at both time points. RS at baseline (0.14 [0.08-0.20]) was significantly larger than that at 6 months (-0.05 [0.14 to 0.00], P = 0.000). EuroQol five-dimensional questionnaire pretest and then-test scores at baseline also differed significantly (0.69 [0.17-0.73] vs. -0.18 [-0.23 to 0.00], P = 0.000). RS at baseline was not affected by assessed demographic or medical variables. RS at 6 months was greater in subjects with more years of education (16% of variance in multiple liner regression, P < 0.01)., Conclusion: RS was present and impacted HRQOL and utility assessment among patients undergoing total knee replacement before and 6 months after surgery., (Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Objective: To compare the EuroQol (EQ-5D) and Short Form 6D (SF-6D) among multiethnic Asian patients with knee osteoarthritis (OA) scheduled for total knee replacement in Singapore., Methods: Patients were asked to complete questionnaires including the EQ-5D, Short Form 36, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne knee index. EQ-5D and SF-6D utility scores were calculated using the scoring algorithms developed from the UK general population. Agreement between the 2 instruments was assessed by comparing their score distributions, means, medians, intraclass correlation coefficients (ICCs), and a Bland-Altman plot. Correlations of the EQ-5D and SF-6D with WOMAC and Lequesne knee index scores were also examined., Results: A consecutive sample of 258 knee OA patients (127 English-speaking and 131 Chinese-speaking) participated. The mean +/- SD EQ-5D utility score was 0.49 +/- 0.31 (range -0.25-1.00) and the mean SF-6D utility score was 0.63 +/- 0.12 (range 0.32-0.89). In a hypothetical example, this 0.14-point difference in mean utility scores yielded a difference of $10,000/quality-adjusted life year (QALY) in cost-effectiveness ratios. The score distribution was bimodal for the EQ-5D and normal for the SF-6D. This poor agreement was also demonstrated by the Bland-Altman plot and the low ICC (range 0.18-0.54). Correlations of the WOMAC and Lequesne index with the EQ-5D were higher than with the SF-6D., Conclusion: Using different preference-based health-related quality of life instruments may yield different utility scores, which could have a great impact on QALY estimates. This highlights the importance of selecting appropriate instruments for economic evaluation. Additional research is needed to determine which instrument (the EQ-5D or the SF-6D) should be used in OA patients.

Elective surgeries were postponed during the COVID-19 pandemic to alleviate healthcare strains, affecting majority of elective orthopaedic surgeries such as total knee arthroplasties (TKAs). The aim of this study is to evaluate the impact on knee function and quality of life of patients who had their planned TKA postponed due to the pandemic. This is a retrospective analysis of data collected in a tertiary hospital. Patients included were diagnosed with primary knee osteoarthritis and they were initially scheduled for primary TKA between January to April 2020 but surgery was postponed by at least 6 months from the initial operative date. 160 patients were included in this study (53 males and 107 females, mean age 68.0 ± 8.1). Patients were assessed prior to initial surgery date and assessed again, prior to the postponed surgery date. Clinical scores included Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee scores (OKS) and Short-Form 36 Physical and Mental Component Scores. (SF36 PCS and MCS). Paired T-test was performed for parametric data whereas Wilcoxon signed-rank analysis was performed for non-parametric data. Comparing initial preoperative versus postponement preoperative scores, the cohort had significantly poorer KSKS (38.4 ± 15.4 and 36.5 ± 15.4, p = 0.034), SF36 PCS (34.3 ± 9.2 and 32.7 ± 8.6, p = 0.02) and OKS (34.9 ± 0.77 and 35.8 ± 8.6, p = 0.02) scores respectively. The postponement of elective TKAs has resulted in a significant deterioration of knee scores and physical quality of live scores of patients in a short span of 6 months. Further studies can evaluate if there are repercussions on long term TKAs outcomes. Retrospective study, Level III. [ABSTRACT FROM AUTHOR]

The preclusion of obese patients from unicompartmental knee arthroplasty (UKA) has increasingly been challenged. This study aimed to evaluate the impact of Body Mass Index (BMI) on UKA at 15-year follow-up. 169 unilateral UKA patients from 2003 to 2007 were followed-up prospectively for at least 15 years. 70 patients were left for analysis after accounting for patient demise, revision surgery and loss to follow-up. 48 of these patients (69%) were in the Control group (BMI <30 kg/m2) and 22 (31%) were in the Obese group (BMI ≥30 kg/m2). Patients were assessed before and after operation using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), and Physical (PCS) and Mental (MCS) component of the Short Form 12. Survivorship analysis was also performed. Obese patients went through UKA at an earlier age than the non-obese patients (54.7 ± 4.7 years compared to 59.9 ± 7.8 years, p = 0.005). At 2, 10, and 15-year follow-up, both groups achieved clinically significant improvements in outcomes. There was no significant association found between obesity and outcome using multiple linear regression. While propensity matching found PCS improvement at 2 years to be greater in obese patients, no significant association between obesity and 15-year outcome was found. All 13 patients who required revision, underwent total knee arthroplasty (TKA). The overall 15-year survivorship was 74.2% within the obese group and 92.4% within the control group. Compared to non-obese patients, obese patients had poorer 15-year survivorship with greater odds of requiring revision surgery. However, assuming implant survival, obese patients can expect a non-inferior outcome relative to their non-obese counterparts in all patient reported outcome measures 15 years after surgery. [ABSTRACT FROM AUTHOR]

Background: Current literature lacks consensus regarding the impact of obesity on clinical outcomes of total hip arthroplasty (THA). The variability of results may reflect the lack of minimal clinically important difference (MCID) analysis, which helps to standardise the interpretation of patient-reported outcome measures (PROMs). We compared the PROMs, patient satisfaction and survivorship between obese and non-obese patients after THA. Methods: Prospectively collected registry data of 192 obese patients and 192 propensity score-matched controls who underwent primary THA at a single institution were reviewed. Clinical outcomes and satisfaction rates were assessed at 6 months and 2 years. Reoperations for surgical complications and revision rates were analysed. Results: Obese patients had a significantly poorer Oxford Hip Score (OHS) at 6 months and WOMAC-Function at 2 years. However, there was no difference in overall WOMAC, WOMAC-Pain, WOMAC-stiffness, SF-36 mental and physical component summary (PCS). A similar proportion of patients in each group achieved the MCID for OHS, WOMAC and SF-36 PCS. At 2 years, 90.3% of obese patients and 91.7% of controls were satisfied (p = 0.755). At a mean follow-up of 9 years, there were 5 reoperations (2.6%) for surgical complications in the obese group and 1 (0.5%) in the control group; whereas 12 revisions (6.3%) were recorded in the obese group and 3 (1.6%) in the control group (p = 0.021). Conclusions: Despite a higher revision rate, obese patients undergoing THA may experience a similar level of clinical meaningful improvement and satisfaction as their non-obese counterparts. This study provides valuable prognostic information for obese patients and guides preoperative counselling. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare functional outcomes, quality of life and survivorship at a minimum of 10 years postoperatively, between MB and AP tibial components in fixed-bearing UKAs. Methods: A retrospective cohort study of 146 Query ID="Q3" Text="Author names: Please confirm if the author names are presented accurately and in the correct sequence (Lo Ngai Nung, Yeo Seng Jin). Also, kindly confirm the details in the metadata are correct." UKAs performed between 2004 and 2007 by a single fellowship-trained arthroplasty surgeon was carried out. 27 UKAs received MB tibial components and 119 UKAs received AP tibial components. The cohort was followed up prospectively for 10 years. Functional outcomes were compared using the Knee Society Functional Score (KSFS), Knee Society Knee Score (KSKS) and Oxford Knee Score (OKS). Quality of life measures were obtained from the Physical Component Summary (PCS) and Mental Component Summary (MCS), derived from the Short Form 36 Health Survey (SF-36). Propensity score matching was performed in a 1:3 ratio of MB versus AP tibial components to account for possible confounding variables. Thereafter, outcomes between the two groups were compared. The proportion of patients who had attained the minimum clinically important difference (MCID) for the abovementioned scores was recorded as well. Results: After propensity score matching, there were 28 UKAs with MB tibial components and 76 UKAs with AP tibial components. There was no significant difference between the two groups in functional outcomes (KSFS, KSKS and OKS), quality of life (PCS and MCS) and survivorship (92.3% vs 91.1%, respectively) at a minimum of 10 years postoperatively. However, a significantly higher proportion of patients in the group with AP tibial components attained the MCID for PCS at 10 years postoperatively, compared to those with MB tibial components (p = 0.031). Conclusion: In conclusion, there were no significant differences in functional outcomes measures, quality of life and survivorship between MP and AP tibial components at a minimum of 10 years postoperatively. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) may negatively influence the rehabilitative course after total knee arthroplasty (TKA). However, functional outcomes in this select group remain poorly defined. We compared complication, mortality and revision rates, as well as patient-reported outcomes, and satisfaction between patients with PD and controls after TKA.Methods: Patients with PD who underwent primary unilateral TKA were identified and matched 1:1 with a control group using propensity scores adjusting for age, sex, body mass index, Charlson Comorbidity Index, baseline range of motion, Knee Society Knee Score, Knee Society Function Score, Oxford Knee Score, and 36-item Short-Form Health Survey Mental and Physical Component Summary. Functional outcomes and patient satisfaction were assessed at 6 months and 2 years. Complications, survivorship, and all-cause mortality were analyzed.Results: In total, 114 patients were included. Majority of PD patients had Hoehn and Yahr stage 1 or 2 disease. Overall complication rate was 26.3% in the PD group and 10.5% in the control group (P = .030). There was no difference in transfusions, length of stay, and discharge to rehabilitation or readmissions. Patients with PD had more flexion contractures, poorer Knee Society Function Score and Oxford Knee Score at 2 years, and poorer 36-item Short-Form Health Survey Physical Component Summary at 6 months. 80.4% of patients with PD were satisfied compared with 85.5% of controls (P = .476). At follow-up of 8.5 ± 2.7 years, one TKA was revised in each group. All-cause mortality was higher in the PD group (15.8% vs 5.3%, P = .067).Conclusion: Although patients with PD had relatively poorer knee function and quality of life, these patients still experienced significant functional gains compared with their preoperative status, and high satisfaction was achieved.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: There is often an assumption by patients that weight loss will occur once their knee pain is relieved by total knee arthroplasty (TKA). This study aims to evaluate (1) the change in patients' body mass index (BMI) after TKA; (2) if postoperative change in BMI influences functional outcome and survival rate of TKA; and (3) the predictive factors associated with change in BMI.Methods: Seven thousand seven hundred thirty-three patients who underwent a primary TKA between 2001 and 2010 were included in this study. Functional outcome scores collected at 2 years after surgery include the Oxford Knee Score, Knee Society Function Score, Knee Society Knee Score, Physical Component Score, and Mental Component Score of short form 36.Results: Among these patients, 1067 (14%) had reduction in BMI, 5045 (65%) maintained their BMI, and 1621 (21%) had gain in BMI. The differences in improvement in Oxford Knee Score, Knee Society Function Score, Knee Society Knee Score, and Physical Component Score among the 3 groups of patients were less than the known minimal clinically important difference of these scores. The 10-year survival rate of TKA was not influenced by patients' change in BMI after surgery (P = .435). Obese class I, II, and III patients were more likely to reduce their BMI after TKA than those with normal preoperative BMI (P = .002, P = .012, and P = .004, respectively), while older patients were less likely to have gain in BMI after surgery (P = .001).Conclusion: A change in BMI after TKA did not influence the functional outcome clinically or the survival rate of the TKA implant. [ABSTRACT FROM AUTHOR]

Background: The detrimental impact of postoperative fixed flexion deformity (FFD) after unicompartmental knee arthroplasty (UKA) is manifold. This study aims to define the amount of postoperative FFD that is clinically relevant after UKA.Methods: Between 2005 and 2012, 803 patients who underwent a primary UKA at a tertiary hospital were prospectively followed up. They were categorized into 3 groups based on the amount of postoperative FFD: (1) 0° (control); (2) 1°-10° (mild FFD); and (3) >10° (severe FFD).Results: There were 26 patients (3%) with severe FFD at 2 years after UKA. The Knee Society Function Score and Knee Score in the severe FFD group were 10 ± 4 and 10 ± 2 points lower than in the control group, respectively (P = .017 and P = .001). Similarly, the Oxford Knee Score and Physical Component Score in the severe FFD group was 5 ± 1 and 7 ± 2 points lower than in the control group, respectively (P = .033 and P < .001).Conclusion: This study suggests that postoperative FFD of >10° after UKA is associated with significantly poorer functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to determine if high-flexion total knee arthroplasty resulted in improved outcomes compared with conventional total knee arthroplasty. This was a prospective, double-blind, randomized controlled trial involving 76 patients over 5 years. We compared the postoperative flexion range, Knee Society scores, Oxford knee scores, and SF-36 scores between 2 groups. The high-flexion group was able to achieve a significant sustainable increase in postoperative knee flexion angle; and this correlated to a significant improvement in the General Health, Vitality, and Physical Functioning scales of SF-36 at 5 years postoperatively. Our results signify that high-flexion total knee arthroplasty has additional benefits to the quality of life in patients who require higher degrees of knee flexion in their activities of daily living. [Copyright &y& Elsevier]

Abstract: Objective: To examine health-related quality of life (HRQoL) after total knee replacement (TKR) or unicompartmental knee arthroplasty (UKA). Methods: Asian adult patients undergoing either TKR or UKA in a hospital in Singapore between 2001 and 2006 were interviewed before surgery and 6 and 24 months postoperatively to obtain demographic information and HRQoL scores using the Short Form-36 Health Survey (SF-36) and the Oxford Knee Score (OKS). Results: Data were collected from 2243, 1715, and 1113 patients at baseline and at 6 and 24 months, respectively. TKR patients had a lower preoperative OKS than UKA patients and lower preoperative scores on four subscales of the SF-36 (P < 0.01). Both TKR and UKA patients'' OKS and SF-36 subscale scores improved 6 months postoperatively except in the general health domain. SF-36 role physical and bodily pain scores showed the most improvement (40.9 and 33.0 points in TKR and 36.9 and 31.4 points in UKA patients, respectively). Two years after surgery, TKR patients'' SF-36 scores and OKSs were not significantly different from those of UKA patients except for physical functioning scores. Multiple regression analysis adjusting for demographics showed that baseline scores were a significant predictor of the postoperative OKSs and scores on all SF-36 subscales (P < 0.01), whereas the type of surgery was not associated with the postoperative scores. Conclusions: Both TKR and UKA patients experienced significant improvements in HRQoL, particularly in the role physical and pain domains. After controlling for potential confounding variables, the type of surgery was not a significant predictor of patients'' postoperative HRQoL scores. [Copyright &y& Elsevier]