Advertisement for orthosearch.org.uk
Results 1 - 12 of 12
Results per page:
Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 62 - 62
7 Aug 2023
Khatri C Harrison C Scott C Clement N MacDonald D Metcalfe A Rodrigues J
Full Access

Abstract

Background

The Forgotten Joint Score (FJS) is a 12-item patient reported outcome measurement instrument. It was developed with classical test theory, without testing assumptions such as unidimensionality (all items reflect one underlying factor), appropriate weighting of each item, no differential item function (DIF, different groups answer the same way), and monotonicity (people with higher function have higher score). We applied item response theory (IRT) to improve the validity of FJS to contemporary standards to optimise it for ongoing use.

Research Questions

Does the FJS reflect one latent trait? Can an IRT model be fitted to the FJS to provide interval-scaled measurement?


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 28 - 28
1 Jul 2022
Yapp L Scott C Macdonald D Howie C Simpson H Clement N
Full Access

Abstract

INTRODUCTION

This study investigates whether primary knee arthroplasty (KA) restores health-related quality of life (HRQoL) to levels expected in the general population.

METHODOLOGY

This retrospective case-control study utilises two sources: patients undergoing primary KA from a University Teaching hospital; and individual-level data from the Health Survey for England which was used to represent the General Population.

Propensity score matching was used to balance covariates (sex, age and body mass index (BMI)) and facilitate group comparisons. Two matched cohorts with 3029 patients each were obtained for the adjusted analyses (median age 70.3 interquartile range (IQR) 64–77; Female sex 3233 (53.4%); median BMI 29.7 IQR 26.5-33.7). HRQoL was measured using the three-level version of the EuroQol 5-Dimensions’ (EQ-5D-3L) Index and EQ-VAS scores.


Bone & Joint Open
Vol. 3, Issue 7 | Pages 573 - 581
1 Jul 2022
Clement ND Afzal I Peacock CJH MacDonald D Macpherson GJ Patton JT Asopa V Sochart DH Kader DF

Aims

The aims of this study were to assess mapping models to predict the three-level version of EuroQoL five-dimension utility index (EQ-5D-3L) from the Oxford Knee Score (OKS) and validate these before and after total knee arthroplasty (TKA).

Methods

A retrospective cohort of 5,857 patients was used to create the prediction models, and a second cohort of 721 patients from a different centre was used to validate the models, all of whom underwent TKA. Patient characteristics, BMI, OKS, and EQ-5D-3L were collected preoperatively and one year postoperatively. Generalized linear regression was used to formulate the prediction models.


The Bone & Joint Journal
Vol. 103-B, Issue 7 | Pages 1254 - 1260
1 Jul 2021
Calabro L Clement ND MacDonald D Patton JT Howie CR Burnett R

Aims

The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee-specific functional outcome (Oxford Knee Score (OKS)) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time.

Methods

A study of 2,393 TKAs was performed in 2,393 patients. Patient demographics, comorbidities, OKS, EuroQol five-dimension score (EQ-5D), and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and compared with those without.


The Bone & Joint Journal
Vol. 103-B, Issue 5 | Pages 846 - 854
3 May 2021
Clement ND Scott CEH Hamilton DF MacDonald D Howie CR

Aims

The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) threshold in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total knee arthroplasty (TKA).

Methods

During a one-year period 484 patients underwent a primary TKA and completed preoperative and six-month FJS and OKS. At six months patients were asked, “How satisfied are you with your operated knee?” Their response was recorded as: very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 44) and satisfied (n = 153) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS threshold. Distribution-based methodology was used to calculate the MDC.


The Bone & Joint Journal
Vol. 101-B, Issue 1 | Pages 41 - 46
1 Jan 2019
Clement ND Howard TA Immelman RJ MacDonald D Patton JT Lawson GM Burnett R

Aims

The primary aim of this study was to compare the knee-specific functional outcome of patellofemoral arthroplasty with total knee arthroplasty (TKA) in the management of patients with patellofemoral osteoarthritis.

Patients and Methods

A total of 54 consecutive Avon patellofemoral arthroplasties were identified and propensity-score-matched to a group of 54 patients undergoing a TKA with patellar resurfacing for patellofemoral osteoarthritis. The Oxford Knee Score (OKS), the 12-Item Short-Form Health Survey (SF-12), and patient satisfaction were collected at a mean follow up of 9.2 years (8 to 15). Survival was defined by revision or intention to revise.


The Bone & Joint Journal
Vol. 99-B, Issue 8 | Pages 1037 - 1046
1 Aug 2017
Scott CEH Turnbull GS MacDonald D Breusch SJ

Aims

Little is known about employment following total knee arthroplasty (TKA). This study aims to identify factors which predict return to work following TKA in patients of working age in the United Kingdom.

Patients & Methods

We prospectively assessed 289 patients (289 TKAs) aged ≤ 65 years who underwent TKA between 2010 and 2013. There were 148 women. The following were recorded pre-operatively: age, gender, body mass index, social deprivation, comorbidities, indication for surgery, work status and nature of employment, activity level as assessed by the University of California, Los Angeles (UCLA) activity score and Oxford Knee Score (OKS). The intention of patients to return to work or to retire was not assessed pre-operatively. At a mean of 3.4 years (2 to 4) post-operatively, the return to work status, OKS, the EuroQol-5 dimensions (EQ-5D) score, UCLA activity score and Work, Osteoarthritis and joint-Replacement (WORQ) score were obtained. Univariate and multivariate analyses were performed.


The Bone & Joint Journal
Vol. 98-B, Issue 12 | Pages 1625 - 1634
1 Dec 2016
Scott CEH Oliver WM MacDonald D Wade FA Moran M Breusch SJ

Aims

Risk of revision following total knee arthroplasty (TKA) is higher in patients under 55 years, but little data are reported regarding non-revision outcomes. This study aims to identify predictors of dissatisfaction in these patients.

Patients and Methods

We prospectively assessed 177 TKAs (157 consecutive patients, 99 women, mean age 50 years; 17 to 54) from 2008 to 2013. Age, gender, implant, indication, body mass index (BMI), social deprivation, range of movement, Kellgren-Lawrence (KL) grade of osteoarthritis (OA) and prior knee surgery were recorded. Pre- and post-operative Oxford Knee Score (OKS) as well as Short Form-12 physical (PCS) and mental component scores were obtained. Post-operative range of movement, complications and satisfaction were measured at one year.


The Bone & Joint Journal
Vol. 95-B, Issue 12 | Pages 1632 - 1639
1 Dec 2013
Clement ND MacDonald D Simpson AHRW Burnett R

This study assessed the effect of concomitant back pain on the Oxford knee score (OKS), Short-Form (SF)-12 and patient satisfaction after total knee replacement (TKR). It involved a prospectively compiled database of demographics and outcome scores for 2392 patients undergoing primary TKR, of whom 829 patients (35%) reported back pain. Compared with those patients without back pain, those with back pain were more likely to be female (odds ratio (OR) 1.5 (95% confidence interval (CI) 1.3 to 1.8)), have a greater level of comorbidity, a worse pre-operative OKS (2.3 points (95% CI 1.7 to 3.0)) and worse SF-12 physical (2.0 points (95% CI 1.4 to 2.6)) and mental (3.3 points (95% CI 2.3 to 4.3)) components.

One year post-operatively, those with back pain had significantly worse outcome scores than those without with a mean difference in the OKS of 5 points (95% CI 3.8 to 5.4), in the SF-12 physical component of 6 points (95% CI 5.4 to 7.1) and in the mental component of 4 points (95% CI 3.1 to 4.9). Patients with back pain were less likely to be satisfied (OR 0.62, 95% CI 0.5 to 0.78).

After adjusting for confounding variables, concomitant back pain was an independent predictor of a worse post-operative OKS, and of dissatisfaction. Clinicians should be aware that patients suffering concomitant back pain pre-operatively are at an increased risk of being dissatisfied post-operatively.

Cite this article: Bone Joint J 2013;95-B:1632–9.


The Bone & Joint Journal
Vol. 95-B, Issue 3 | Pages 360 - 366
1 Mar 2013
Clement ND MacDonald D Burnett R

We assessed the effect of mental disability on the outcome of total knee replacement (TKR) and investigated whether mental health improves post-operatively. Outcome data were prospectively recorded over a three-year period for 962 patients undergoing primary TKR for osteoarthritis. Pre-operative and one year Short-Form (SF)-12 scores and Oxford knee scores (OKS) were obtained. The mental component of the SF-12 was stratified into four groups according to level of mental disability (none ≥ 50, mild 40 to 49, moderate 30 to 39, severe < 30). Patients with any degree of mental disability had a significantly greater subjective physical disability according to the SF-12 (p = 0.06) and OKS (p < 0.001). The improvement in the disease-specific score (OKS) was not affected by a patient’s mental health (p = 0.33). In contrast, patients with mental disability had less of an improvement in their global physical health (SF-12) (p < 0.001). However, patients with any degree of mental disability had a significant improvement in their mental health post-operatively (p < 0.001).

Despite a similar improvement in their disease-specific scores and improvement in their mental health, patients with mental disability were significantly more likely to be dissatisfied with their TKR at one year (p = 0.001). Patients with poor mental health do benefit from improvements in their mental health and knee function after TKR, but also have a higher rate of dissatisfaction.

Cite this article: Bone Joint J 2013;95-B:360–6.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 1 - 1
1 Jul 2012
Scott CEH Howie CR MacDonald D Biant LC
Full Access

Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR), but little is known about the predictors of this dissatisfaction. This study investigated the pre- and post-operative predictors of dissatisfaction in a large cohort of patients undergoing TKR. We assessed 1217 consecutive patients undergoing TKR between 2006 and 2008 both preoperatively and six months after surgery, using the Short-form (SF)-12 health questionnaire and the Oxford Knee Score.

Detailed co-morbidity information was also gathered. Satisfaction was measured at one year and 18.6% (226 of 1217) of patients were unsure or dissatisfied with their replacement, 81.4% (911 of 1217) were satisfied or very satisfied. Multivariate regression analysis was performed to identify independent predictors of dissatisfaction. Significant (p < 0.001) predictors of dissatisfaction at one year included the pre-operative SF-12 mental component score, the co-morbidities of depression and pain in other joints, and the six-month SF-12 score. The most significant independent predictor of dissatisfaction at 1 year was poor improvement in Oxford Knee Score pain element at 6 months. Patient expectations were highly correlated with satisfaction.

Satisfaction following TKR is multifactorial. Managing patient expectations and mental health may reduce dissatisfaction rates. However, the most significant predictor of dissatisfaction is a painful total knee replacement.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 9 | Pages 1253 - 1258
1 Sep 2010
Scott CEH Howie CR MacDonald D Biant LC

Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR). This study investigated the pre- and post-operative predictors of dissatisfaction in a large cohort of patients undergoing TKR. We assessed 1217 consecutive patients between 2006 and 2008 both before operation and six months after, using the Short-form (SF)-12 health questionnaire and the Oxford Knee Score. Detailed information concerning comorbidity was also gathered. Satisfaction was measured at one year when 18.6% (226 of 1217) of patients were unsure or dissatisfied with their replacement and 81.4% (911 of 1217) were satisfied or very satisfied. Multivariate regression analysis was performed to identify independent predictors of dissatisfaction. Significant (p < 0.001) predictors at one year included the pre-operative SF-12 mental component score, depression and pain in other joints, the six-month SF-12 score and poorer improvement in the pain element of the Oxford Knee Score.

Patient expectations were highly correlated with satisfaction. Satisfaction following TKR is multifactorial. Managing the expectations and mental health of the patients may reduce dissatisfaction. However, the most significant predictor of dissatisfaction is a painful total knee replacement.