Skip to main content
SpringerLink
Log in

Females, younger patients and patients with high BMI have the highest pre-operative knee awareness measured using the Forgotten Joint Score

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The Forgotten Joint Score (FJS) is a novel measurement for patients’ awareness of their knee in daily life. By identifying factors that could explain pre-operative FJS levels, the clinician could better prioritize and single out patients who would benefit most from TKA. The aim of this study was to identify possible factors that may explain the variance of pre-operative FJS levels and evaluate the relationship between pre-operative FJS and pre-operative Oxford Knee Score (OKS).

Methods

Four-hundred and six individual knees undergoing primary TKA between 2014 and 2016 were included in the study. Age, gender, body mass index (BMI), pre-operative FJS and pre-operative OKS were obtained maximum 2 weeks prior to surgery. Kellgren–Lawrence (K–L) grade, alignment and joint space width (JSW) were evaluated on pre-operative radiographs.

Results

Mean FJS was 21.1 ± 15.6. Females, younger patients and patients with high BMI had significantly the worst pre-operative FJS (p < 0.005). Females scored 6.5 FJS points lower than males. A 0.2-point increase in FJS for every added year indicated improvement in knee awareness with age. A 0.4-point decrease in FJS points for every added BMI point indicated worse knee awareness with higher BMI. There was a strong positive correlation between pre-operative FJS and pre-operative OKS according to the Spearman’s rank order test (p < 0.005).

Conclusions

Females, younger patients and patients with high BMI had significantly the worst pre-operative joint awareness. FJS had a strong positive correlation to OKS in pre-operative patients for primary TKA. This information can be used for improved patient selection; clinically continuous low FJS despite weight loss and/or the passing of time may be indication for TKA.

Level of evidence

Prospective cohort study, Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

TKA:

Total knee arthroplasty

PROM:

Patient-reported outcome measure

OKS:

Oxford Knee Score

FJS:

Forgotten Joint Score

BMI:

Body mass index

JSW:

Joint space width

K–L:

Kellgren–Lawrence

OA:

Osteoarthritis

AP:

Anterior–posterior

KSS:

Knee society score

References

  1. Gossec L, Paternotte S, Maillefert JF et al (2011) The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement. Osteoarthr Cartil 19(2):147–154

    Article  PubMed  CAS  Google Scholar 

  2. 17 Judge A, Arden NK, Price A et al (2011) Assessing patients for joint replacement: can pre-operative Oxford hip and knee scores be used to predict patient satisfaction following joint replacement surgery and to guide patient selection? J Bone Jt Surg Br 93(12):1660–1664

    Article  CAS  Google Scholar 

  3. Behrend H, Giesinger K, Giesinger JM, et al. (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty 27(3):430–436 (e1)

    Article  PubMed  Google Scholar 

  4. Bullens PH, van Loon CJ, de Waal Malefijt MC et al (2001) Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty 16(6):740–747

    Article  PubMed  CAS  Google Scholar 

  5. Baumann F, Ernstberger T, Loibl M et al (2016) Validation of the German Forgotten Joint Score (G-FJS) according to the COSMIN checklist: does a reduction in joint awareness indicate clinical improvement after arthroplasty of the knee? Arch Orthop Trauma Surg 136(2):257–264

    Article  PubMed  Google Scholar 

  6. Giesinger JM, Loth FL, Howie C et al (2015) Validation of the English Version of the Forgotten Joint Score—12 in Patients Undergoing Total Knee or Hip Arthroplasty. Value Health 18(7):A652–A653

    Article  PubMed  CAS  Google Scholar 

  7. Matsumoto M, Baba T, Homma Y et al (2015) Validation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure. Eur J Orthop Surg Traumatol 25(7):1141–1145

    Article  PubMed  Google Scholar 

  8. Shadid MB, Vinken NS, Marting LN et al (2016) The Dutch version of the Forgotten Joint Score: test-retesting reliability and validation. Acta Orthop Belg 82(1):112–118

    PubMed  Google Scholar 

  9. Thomsen MG, Latifi R, Kallemose T et al (2016) Good validity and reliability of the forgotten joint score in evaluating the outcome of total knee arthroplasty. Acta Orthop 87(3):280–285

    Article  PubMed  PubMed Central  Google Scholar 

  10. Harris KK, Dawson J, Jones LD, Beard DJ, Price AJ (2013) Extending the use of PROMs in the NHS–using the Oxford Knee Score in patients undergoing non-operative management for knee osteoarthritis: a validation study. BMJ Open 3(8):e003365

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dunbar MJ, Robertsson O, Ryd L et al (2000) Translation and validation of the Oxford-12 item knee score for use in Sweden. Acta Orthop Scand 71(3):268–274

    Article  PubMed  CAS  Google Scholar 

  12. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Gromov K, Korchi M, Thomsen MG et al (2014) What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop 85(5):480–487

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ritter MA, Davis KE, Meding JB et al (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Jt Surg Am 93(17):1588–1596

    Article  Google Scholar 

  15. Cohen J (1988) Statistical power analysis for behavioral sciences. 2nd edition, Lawrence Erlbaum Associates New Jersey

    Google Scholar 

  16. Birdsall PD, Hayes JH, Cleary R et al (1999) Health outcome after total knee replacement in the very elderly. J Bone Jt Surg Br 81(4):660–662

    Article  CAS  Google Scholar 

  17. Scott CE, Howie CR, MacDonald D et al (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Jt Surg Br 92(9):1253–1258

    Article  CAS  Google Scholar 

  18. Cooper C, Snow S, McAlindon TE et al (2000) Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 43(5):995–1000

    Article  PubMed  CAS  Google Scholar 

  19. Davis MA, Ettinger WH, Neuhaus JM et al (1989) The association of knee injury and obesity with unilateral and bilateral osteoarthritis of the knee. Am J Epidemiol 130(2):278–288

    Article  PubMed  CAS  Google Scholar 

  20. Felson DT (1990) The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. Semin Arthritis Rheum 20(3 Suppl 1):42–50

    Article  PubMed  CAS  Google Scholar 

  21. Reyes C, Leyland KM, Peat G et al (2016) Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: a population-based cohort study. Arthritis Rheumatol 68(8):1869–1875

    Article  PubMed  PubMed Central  Google Scholar 

  22. Coggon D, Reading I, Croft P et al (2001) Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord 25(5):622–627

    Article  PubMed  CAS  Google Scholar 

  23. Messier SP, Loeser RF, Miller GD et al (2004) Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the arthritis, diet, and activity promotion trial. Arthritis Rheum 50(5):1501–1510

    Article  PubMed  Google Scholar 

  24. Salih S, Sutton P. (2013) Obesity, knee osteoarthritis and knee arthroplasty: a review. BMC Sports Sci Med Rehabil 5(1):25

    Article  PubMed  PubMed Central  Google Scholar 

  25. Srikanth VK, Fryer JL, Zhai G et al (2005) A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthr Cartil 3(9):769–781

    Article  Google Scholar 

  26. O’Connor MI (2007) Sex differences in osteoarthritis of the hip and knee. J Am Acad Orthop Surg, 2007, 15 Suppl 1:S22–S25.

    Article  PubMed  Google Scholar 

  27. Tonelli SM, Rakel BA, Cooper NA et al (2011) Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement. Biol Sex Differ 2:12

    Article  PubMed  PubMed Central  Google Scholar 

  28. Neogi T, Felson D, Niu J et al (2009) Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ 339:b2844

    Article  PubMed  PubMed Central  Google Scholar 

  29. Szebenyi B, Hollander AP, Dieppe P et al (2006) Associations between pain, function, and radiographic features in osteoarthritis of the knee. Arthritis Rheum 54(1):230–235

    Article  PubMed  Google Scholar 

  30. Lo GH, Harvey WF, McAlindon TE (2012) Associations of varus thrust and alignment with pain in knee osteoarthritis. Arthritis Rheum 64(7):2252–2259

    Article  PubMed  PubMed Central  Google Scholar 

  31. Thienpont E, Opsomer G, Koninckx A et al (2014) Joint awareness in different types of knee arthroplasty evaluated with the Forgotten Joint score. J Arthroplasty 29(1):48–51

    Article  PubMed  Google Scholar 

  32. Bin Abd Razak HR, Tan CS, Chen YJ et al (2016) Age and preoperative knee society score are significant predictors of outcomes among asians following total knee arthroplasty. J Bone Jt Surg Am 98(9):735–741

    Article  Google Scholar 

  33. Berliner JL, Brodke DJ, Chan V et al (2017) Can preoperative patient-reported outcome measures be used to predict meaningful improvement in function after TKA? Clin Orthop Relat Res 475(1):149–157

    Article  PubMed  Google Scholar 

Download references

Author contribution

All authors contributed significantly to this paper. AT, HH and KG jointly conceived the study, while DL conducted the data analysis and interpretations. DL wrote the main paper. LI designed the study and collected initial data. All authors performed critical revision of the paper and final approval of the version to be published.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Hvidovre Hospital, University of Copenhagen, Kettegaard Alle 30, 2650, Hvidovre, Denmark

    Dana Li, A. Troelsen, L. Ingelsrud, H. Husted & K. Gromov

  2. Sallingvej 31, 2. tv, 2720, Vanløse, Denmark

    Dana Li

Authors
  1. Dana Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Troelsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Ingelsrud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Husted
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Gromov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dana Li.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, D., Troelsen, A., Ingelsrud, L. et al. Females, younger patients and patients with high BMI have the highest pre-operative knee awareness measured using the Forgotten Joint Score. Knee Surg Sports Traumatol Arthrosc 26, 2587–2593 (2018). https://doi.org/10.1007/s00167-017-4446-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4446-5

Keywords

Search

Navigation