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Oxford Knee Score reliable for evaluation of knee function after knee replacement
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The Oxford Knee Score is a reliable evaluation of overall knee function before and after surgery for patients who have knee replacement surgery, according to this study.
In the study, 200 patients — 100 scheduled for total or unicompartmental knee replacement and 100 having had knee replacement more than 1 year earlier — completed the Oxford Knee Score (OKS) during the first surgeon visit or during a postoperative follow-up visit. The surgical team completed the American Knee Society (AKS) score on the same day.
Study results showed a mean OKS score of 43.7 before surgery and 20.5 after surgery. In the preoperative group, no OKS scores were lower than 19 and only seven scores were greater than 53. However, in the postoperative group, 33 OKS scores were lower than 18 and no scores were greater than 54.
For the mean AKS knee score, researchers found the preoperative group had a score of 40.3 and the postoperative group had a score of 87.3, while the AKS function score was 61.4 in the preoperative group and 92.9 in the postoperative group. The OKS, AKS and AKS function scores demonstrated a strong negative correlation before surgery, according to study results. After surgery, the OKS and AKS knee scores had a weak negative correlation. The OKS and AKS function score had a strong negative correlation.
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“The lower discriminating performance of the OKS after surgery may preclude the detection of subtle outcome differences, most notably in patients whose outcome is considered favorable,” the researchers stated in the study. “The use of more demanding scores would help to conduct a detailed analysis of outcomes after knee replacement surgery.”
Disclosure: Jenny receives royalties from Aesculap.
Perspective
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Giles R. Scuderi, MD
Measuring the clinical and functional outcome is important in assessing the quality outcome of joint arthroplasty. It has become evident that questionnaires that include both patient and surgeon input more accurately reflect the patient experience and satisfaction.
This particular study by Jenny and Diesinger demonstrates that the Oxford Knee Score is reliable for the evaluation of preoperative knee function, but the score may be less than optimal in detecting very subtle differences in the postoperative performance because of the floor effect with the scoring system. This lower discriminating performance of the postoperative Oxford Knee Score means that the outcomes were generally good, but it was difficult to differentiate between two patients.
Detecting subtle differences is difficult in patients whose outcomes are similar and considered satisfactory. For this reason, there are efforts to develop new outcome measurement tools like The Knee Society Knee Scoring System, which report not only the objective assessment but patient specific standard, advanced and discretionary functional activities along with scores for satisfaction and expectation. The utility of more demanding and discriminating scores will help conduct a more detailed analysis of the outcomes following total knee arthroplasty and identify subtle differences between patients.
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Jenny JY. Orthop Traumatol Surg Res. 2012;98:409-412. doi:10.1016/j.otsr.2012.03.004
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