Validation of the French version of two on high-activity knee questionnaires.

INTRODUCTION: Self-administered quality-of-life questionnaires are valuable evaluation tools in orthopedic surgery. The conventional questionnaires are limited by a substantial ceiling effect. We wished to validate a French translation of two English questionnaires for high-activity patients: the High-Activity Arthroplasty Score (HAAS) and the Activity Scale for Arthroplasty Patients (ASAP). One hundred patients operated on for knee replacement were selected. The answers to both questionnaires were analyzed and compared to the Oxford Knee Score (OKS) and to the scoring system of the American Knee Society (AKS). HYPOTHESIS: There is no correlation between the results of both high-activity questionnaires and of the two conventional scoring systems. RESULTS: All questions were easily understood. The mean scores of the HAAS and ASAP questionnaires were 8.2±3.0 and 30.7±9.6, respectively. The distributions were not considered normal. There was no floor effect, but there was a limited ceiling effect (0% and 14%, respectively). The internal coherence of both questionnaires was satisfactory. There was a significant correlation between the high-activity scores and the conventional scores. DISCUSSION: Both high-activity questionnaires in our French translation can potentially measure the overall function of a patient after knee replacement as accurately as the index English version. It is self-administered, easy to use, can collect patients' answers by postage mailing, and involves no ceiling effect. All these points should allow its routine use for evaluation after knee replacement. The HAAS evaluation seems to be superior to the ASAP evaluation. LEVEL OF EVIDENCE: Case-control study, level III.

Diagnostic accuracy of intra-articular C-reactive protein assay in periprosthetic knee joint infection--a preliminary study.

BACKGROUND: Periprosthetic joint infection often raises diagnostic challenges, as the published criteria are heterogeneous. New markers for predicting periprosthetic infection have been evaluated. Here, we assessed one of these markers, C-reactive protein (CRP), in joint fluid. HYPOTHESIS: We hypothesised that intra-articular CRP levels would perform better than serum CRP concentrations in diagnosing knee prosthesis infection. PATIENTS AND METHODS: We prospectively included 30 patients including 10 with native-knee effusions, 11 with prosthetic-knee aseptic effusions, and 11 with prosthetic-knee infection defined using 2011 Musculoskeletal Society criteria. Serum CRP was assayed using turbidimetry or nephelometry and intra-articular CRP using nephelometry. Appropriate statistical tests were performed to compare the three groups; P values < 0.05 were considered significant. RESULTS: Serum and intra-articular CRP levels were 5- to 16-fold higher in the group with periprosthetic infection than in the other two groups. Although the areas under the ROC curves were not significantly different, the likelihood ratios associated with the selected cut-offs suggested superiority of intra-articular CRP: a value > 2.78 mg/L suggested possible infection (100% sensitivity and 82% specificity) and a value > 5.37 mg/L probable infection (90% sensitivity and 91% specificity). DISCUSSION: Our findings suggest a possible role for intra-articular CRP assay in diagnosing knee prosthesis infection and perhaps periprosthetic infection at any site. LEVEL OF EVIDENCE: Level III, diagnostic study, development of a diagnostic criterion in consecutive patients comparatively to a reference standard.

Preoperative phlebography in anterior L4-L5 disc approach. Clinical experience about 63 cases.

INTRODUCTION: The anterior approach of the L4-L5 disc requires a perfect knowledge of the venous anatomy. Some configurations make this approach hazardous. The purpose of this study is to classify configurations of the iliocava junction and the iliolumbar vein relative to L4-L5 and to analyze vascular complications. MATERIALS AND METHODS: The preoperative phlebographies of 63 patients (30 men, 33 women, mean age 42years) undergoing a L4-L5 disc replacement were reviewed. The height of the iliocava junction was calculated as a ratio of the distance between the discs L4-L5 and L5-S1. The position of the left iliac vein was classified into three thirds across the width of L5. The number of branches of the iliolumbar vein was noted. Surgical reports were reviewed for complications. RESULTS: The height of the iliocava junction was very high in six, high in 25, low in 26 and very low in six patients. The position of the left iliac vein was medial in 20, intermediate in 28 and lateral in 15 patients. The iliolumbar vein had one branch in 37, two in 20, three in three patients. It was not visualized in three cases. Variants of the venous anatomy included eight duplications of the left iliac vein, four wide diameters and one iliolumbar vein network pattern. Intraoperatively, three lacerations of iliolumbar veins occurred. CONCLUSION: The iliocava anatomy is very variable: the safety of an anterior approach to the L4-L5 disc depends on it. The information of preoperative phlebography can help to plan a more accessible antero-lateral approach or to switch on a posterior fusion if the anatomical situation is deemed too dangerous, such as duplicated left iliac veins. LEVEL OF EVIDENCE: Level IV. Diagnostic study.

The Oxford Knee Score: compared performance before and after knee replacement.

BACKGROUND: Self-administered quality-of-life questionnaires are now crucial to the evaluation of orthopaedic surgical patient-reported outcomes, as they reflect patient satisfaction. The Oxford Knee Score (OKS) is a validated instrument that is widely used to assess outcomes of knee osteoarthritis surgery. HYPOTHESIS: The relevance of the OKS (comprehension and relevance of the items and responses, and internal and external validity) and its discriminating performance measured based on the ceiling and floor threshold effects are better before than after knee replacement surgery. MATERIALS AND METHODS: We included 200 patients (100 scheduled for knee replacement and 100 having had knee replacement more than 1 year earlier). The OKS questionnaire was handed to each patient during the first surgeon visit or during a follow-up visit. The American Knee Society (AKS) score was determined simultaneously. RESULTS: The mean OKS was 43.7 (range, 21-56; SD, 6.9) before surgery and 20.5 (range, 12-45; SD, 5.6) after surgery. The floor effect was absent (0%) before surgery and substantial (33%) after surgery; a weak ceiling effect (7%) was noted before surgery and no ceiling effect after surgery. Internal consistency of the OKS was excellent. The OKS correlated negatively with the AKS knee and functional scores, both before and after surgery. DISCUSSION: The OKS is well-suited to the evaluation of knee function both before and after knee replacement surgery. Before surgery, the absence of substantial floor and ceiling effects lead to excellent discrimination. After surgery, the substantial floor effect limits the ability to discriminate among the best results. Efforts should be made to develop more demanding scoring systems. LEVEL OF EVIDENCE: Level 2. Exploratory cohort study with universally applied reference standards.

Validation of a French version of the Oxford knee questionnaire.

INTRODUCTION: Self-administered quality-of-life questionnaires are a valuable evaluation tool in orthopedic surgery to determine patient satisfaction. The Oxford knee questionnaire has been validated for osteoarthritic patients. The aim of this study was to validate a French version of this English form. One hundred patients waiting for knee replacement were selected. The answers to the questionnaire were analysed and compared to the clinical and functional International Knee Society score (IKS). HYPOTHESIS: There is negative correlation between the results of the Oxford knee questionnaire and the IKS score. RESULTS: None of the patients had difficulty understanding the questions. The mean Oxford knee score was 43.7 (range 21-56, SD 6.9). The distribution was considered normal. There was no floor effect (0%); there was a limited ceiling effect (7%). The internal consistency of the questionnaire was excellent. There was a negative correlation between the Oxford knee score and the IKS knee score, functional score and global score. DISCUSSION: Our results are very similar to the results from the normative English version of the knee questionnaire and to the results from translated questionnaires in other foreign languages. Our French adaptation of the Oxford knee questionnaire can be used to measure the global function of a patient before knee replacement as accurately as the original English version. It is self-administered, easy to use and patients can send their responses by post, which makes it a useful tool for the routine evaluation of patients before knee replacement.