THE EFFECT OF PRE-OPERATIVE SYMPTOM SEVERITY ON OUTCOME OF TOTAL KNEE REPLACEMENT – PATIENTS WITH THE LOWEST PRE-OPERATIVE SCORES ACHIEVE THE LOWEST MARKS.

Abstract

Objective: to determine if the outcome of TKR was affected by the level of pre-operative symptom severity.

Methods Between June 1998 and Nov 2001, 207 primary TKRs (AGC) were performed in 178 patients for OA of the knee. Data on patient demographics, Oxford knee score (OKS), AKSS and ABC health category were collected prospectively pre-operatively and at the 2 year review. For analysis, patients were arbitrarily categorised into four quartile groups with pre-operative OKS of 0–12, 13–24, 25–36 and 37–48.

Results The entire group had a pre-op mean OKS of 18.4. The 2 year post-op mean outcome measures were OKS 38.2 (79.6%), AKSS 87.8, Function 76.3.

Conclusion Rather than all patients achieving a uniform outcome post-TKR, patients with more severe symptoms, as indicated by lower pre-operative Oxford Knee Scores, tend to have the most to gain but achieve poorer absolute outcomes (from both patient’s (OKS) and surgeons’ perspectives (AKSS)). Conversely, at the other end of the spectrum, even patients with relatively high pre-operative OKS, (better than the units post-op mean) achieved better post-op scores . The results suggest that waiting too long before intervention compromises the final outcome.