The Reliability of HSS Knee Rating System

PURPOSE: The rating system of Hospital for Special Surgery(HSS knee score) has been used to evaluate the clinical results of knee arthroplasty, but it may happen to interobserver bias. The purpose of this study is to detect how much and what it could make the bias. MATERIALS AND METHODS: From Sept 1998 to May 1999, HSS score of 115 cases of knee which were planned for total knee arthroplasty were caku4ted by three observers(knee joint specialist: A, orthopedic specialist: B, orthapedic resident: C) and compared the result with Wilcoxon sided ranks test for the eval-uation of statistical differences and the Kappa statistics for the test of statistical reliability. RESULTS: The mean HSS knee scores of observer A, B, C were 64.8 points, 61.] points and 59.4 points respectively. The average difference were average 4.8 point in total score and it was statistically significant(p<0.05) and The items of pain(walking, at rest) and function(walking distance) showed least agreements(k<0.20). CONCLUSIONS: More objective and quantitative criteria is needed in the items of pain on walking and at rest and distance of walking for accurate evaluation of results using HSS system.

Augmentation of Tibial Bony Defect with Metal Wedge and Block in Primary TKA / 대한정형외과학회잡지

Tibial bony defect causes severe angular deformity and instability, requiring accurate correction of bony defect. The purpose of this study is to analyze the results of TKA with wedge or block in augmenting tibial bony defect, and to find out the adequate method of treatment. Among 301 cases of TKA operated at Asan Medical Center from Sep. 1993 to Sep. 1997, authors analyzed 58 cases of tibial bone defect corrected by metal wedge or block. Mean follow up period was 25.1 months. All cases were divided into two groups; group A (37 cases) with wedge and group B (21 cases) with block. The results were as follows: 1. There were no definite statistical difference between group A and group B in HSS knee score, ROM, and correction of deformity. 2. Loosening of the implant was not noted, but 12 cases of mild bony resorption was found just beneath the wedge or block. It was more prominent in group A (9 cases) than in group B (3 cases). 3. Three cases of deep infection developed only in group A, which were followed by revision TKA. Although further follow up study should be carried out, we concluded that metal augmentation is good substitute to augment tibial bony defect in primary TKA.