Responsiveness, Reliability, and Validity of Arabic Version of Oxford Knee Score for Total Knee Arthroplasty.

BACKGROUND: The Oxford Knee Score (OKS) is a reliable, valid, and sensitive assessment tool for individuals undergoing a total knee arthroplasty (TKA). The published psychometric assessment of the Arabic version of the OKS (OKS-Ar) is limited to male patients and has not been assessed for responsiveness following TKA. The aim of this study was to assess the reliability, validity, and responsiveness of the OKS-Ar in an inclusive population of patients undergoing TKA. METHODS: One hundred Arabic-speaking patients awaiting TKA were assessed with the OKS-Ar, the Arabic version of the Knee injury and Osteoarthritis Outcome Score (KOOS-Ar), and a visual analogue scale for pain (VAS-P) in order to assess the correlation between the OKS-Ar and the KOOS-Ar and VAS-P and determine the construct validity. Repeat assessments were completed 7 to 10 days after the first assessment and 6 months after TKA. RESULTS: Questionnaires were completed by 80 female and 20 male participants with a mean age of 62 ± 8 years. The test and retest median scores showed no significant difference from one another, with a strong Spearman correlation between the 2 measurements (rs = 0.94). Bland-Altman limits of agreement showed no significant bias. The Cronbach alpha was 0.85 indicating high internal consistency. There was no floor or ceiling effect before TKA, and the post-TKA ceiling effect was only 2%. The OKS-Ar pain component correlated strongly with the KOOS-Ar pain subscale (rs = 0.73). The OKS-Ar effect size was 3.09, which was larger than that of all of the KOOS subscales at 6 months after TKA. CONCLUSIONS: To our knowledge, this is the first study to assess reliability, validity, and responsiveness of the OKS-Ar after TKA. The validity and reliability results are similar to those found for both the original English-language OKS and the OKS translated into other languages. We believe that this is also the first study to assess OKS-Ar responsiveness after TKA and to show a large effect size. We found that the OKS-Ar is a feasible, valid, reliable, and sensitive measurement tool to assess pain and function in TKA-treated individuals whose main language is Arabic.

Patients' experiences and satisfaction at one year following primary total knee arthroplasty: A focus-group discussion.

OBJECTIVE: To date, no study has explored patients' experiences, outcome expectations and satisfaction 1-year post-total knee arthroplasty (TKA) using focus-group discussion (FGD). The exploration of patients' expectations, functional recovery and limitations may support future modifications and thus improve outcomes post-TKA. METHODS: An FGD was conducted with patients at 1-year post-TKA. Moderators led the discussion using a semistructured discussion guide. The discussion was digitally recorded, transcribed verbatim and analysed to formulate themes. RESULTS: The study identified four main themes: recovery experience post-TKA, experience before TKA, activity of daily living (ADL) changes post-TKA and post-TKA outcome expectations. The recovery experience theme explores the overall experience post-TKA in terms of symptoms and progression issues; their experience with the orthopaedic surgeon and physiotherapy; and the differences between first and second knee replacements. The experience before TKA theme discusses many issues raised by patients that they believed strongly affected TKA outcomes and their satisfaction, such as the referral process, ADL limitations before TKA and their beliefs about post-TKA outcomes. The ADL changes post-TKA theme discusses the diversity of functional improvements, limitations and new functional ability. The outcome expectation theme explores what the patients expected to gain from surgery and the factors that modified those expectations, and whether their expectations were met. CONCLUSIONS: Patient attitude, sufficient preoperative education, outcome expectation modification, communication with the surgeon and patients taking an active role in rehabilitation can all affect post-TKA outcomes and satisfaction. Hence, the recommendation is to address all of these issues before TKA to enhance outcomes and patient satisfaction.

Does free-living physical activity improve one-year following total knee arthroplasty in patients with osteoarthritis: A prospective study.

Objective: Total knee arthroplasty (TKA) is the gold-standard treatment for end-stage knee osteoarthritis, and the primary expectations are reduced pain and improved function. However, there is conflicting evidence regarding functional changes post-TKA. Commonly, functional changes are measured using Oxford Knee Score (OKS). No previous study has investigated physical behaviour (PB) changes in terms of volume and patterns post-TKA. The aims of this study were to explore volume and pattern changes in PB following TKA using an objective tool and to assess the correlation between this and OKS. Design: An activPAL measured the PB of individuals on a waiting list for TKA for a period of 7-8 days pre-TKA, and for the same length of time at 12 months post-TKA. OKS was completed at similar follow-up time points. Results: Thirty-three individuals completed the study, where stepping time, the number of steps and the time spent on moderate to vigorous physical activity (MVPA) (>100 steps/minute) improved significantly post-TKA p = 0.0001. Steps at 12 months post-TKA improved by 45.6% (from 4240 to 6174) and stepping time increased by 38.8% (from 0.98 to 1.36 h). MVPA improved by 35 min at 12 months (from 6.6 to 41.7 min). There were no significant correlations between PB and OKS. Conclusion: This is the first study to explore PB volumes and event-based patterns post-TKA. Activity improved in terms of volume and patterns. No correlation was found between OKS and ActivPAL, which emphasises the need to use objective methods in addition to patient-reported outcome measures.

Management of the first-time lateral patellar dislocation.

BACKGROUND: Little guidance exists on the management of the first-time patellar dislocation. The aim of this article was to review current guidance for management of this condition. METHODS: Recent meta-analyses, systematic reviews and current consensus documents relating to first-time patellar dislocation were sourced. An instructional lecture was then created and delivered at the acute knee injuries session at the British Orthopaedic Association 2019 annual conference, which was presented on behalf of the British Association for Surgery of the Knee. This article has been written based on this lecture. RESULTS: There is a paucity of literature relating to management of the first-time patellar dislocation. Many studies are of poor design, with inadequate follow-up, making it difficult to draw conclusions from them. However, based upon available information and consensus from working groups it is recommended that patients presenting with first-time dislocation should be assessed to ensure they have not sustained an alternative or associated injury that may require surgical intervention, be assessed and counselled for the risk of recurrent dislocation, and be referred for initial conservative treatment. Surgical stabilisation should be reserved for patients with recurrent instability. CONCLUSIONS: Most patients with a first-time patellar dislocation can be managed conservatively, having excluded associated injuries. Due to the poor quality of the literature, care must be taken interpreting the results of studies. It is clear that further research is required in this field.

Replacement for patellofemoral arthritis.

BACKGROUND: Patellofemoral osteoarthritis (PFOA) is relatively common, affecting 24% females and 11% males over the age of 55 years. Most patients can be treated conservatively. Arthroplasty remains the ultimate procedure for end stage PFOA. Debate continues as to whether total knee replacement (TKR) or patellofemoral replacement (PFR) is better for this group of patients. The aim of this article is to review the current evidence for use of these two procedures in this condition. METHODS: Recent meta-analyses, systematic reviews and appropriate cohort publications concerning surgical management of PFOA were sourced. A cohort of patients from the authors' own institution was also reviewed. An instructional lecture was then created and delivered at the British Association for Surgery of the Knee 2019 annual conference, on behalf of the British Patellofemoral Society. This article has been written based on this lecture. RESULTS: It is clear that PFOA is a different disease process than tibiofemoral osteoarthritis (TFOA). There is no doubt that PFR has a higher failure rate than TKR, but evidence suggests that outcomes and recovery may be better in the PFR group. This is complicated by subsets of those with PFOA faring better than others, the reasons for which are likely to be multifactorial. CONCLUSIONS: Both PFR and TKR may be used appropriately for PFOA. In keeping with a shared decision-making process, patients should be counselled appropriately preoperatively when deciding between these procedures. Further research is required to understand the differences in outcome between procedures and in subsets of patients with PFOA.

BASK survey of The Knee readership 2015.

A convenience sample of the attendees of the 2015 annual meeting of the British Association of Knee showed that the majority of the attendees who responded read The Knee, would like a section on surgical tips, more themed supplements and guest editorials. There is still not enough support for purely electronic publication. For those that have submitted papers, the experience with the publication process was positive.