Differences in case mix and outcomes between Swiss and Scottish total knee arthroplasty patients

  • Johannes M. GiesingerEmail author
  • Karlmeinrad Giesinger
  • Bruno Federico
  • Colin D. Howie
  • David F. Hamilton



The clinical benefits of total knee arthroplasty (TKA) are well defined, but little attention has been paid to the cross-cultural variation. The objective of this study was to compare case mix and outcomes following TKA in Swiss and Scottish patients.


Data from local registries at a Swiss and a Scottish orthopaedic hospital were extracted to evaluate: (A) age, sex, body mass index (BMI), self-reported health status (EQ-5D), and joint awareness (Forgotten Joint Score-12 (FJS-12)) at pre-surgery, (B) improvement in EQ-5D and FJS-12 scores from pre-surgery to 1 year, and (C) patient satisfaction at 1 year.


Data from 2075 Swiss and 994 Scottish TKA patients were available from the local registries. Swiss and Scottish patients differed in age (69.3 vs 68.8 years, p = 0.046), sex ratio (62.9% vs 56.9% women, p = 0.002) and BMI (29.6 vs 30.9, p < 0.001). At pre-surgery, FJS-12 scores were comparable (Swiss 12.1 vs Scottish 10.9, n.s.), but EQ-5D scores were better in Swiss patients (0.52 vs 0.40, p < 0.001). Post-operative improvement was greater in Switzerland for the FJS-12 (+ 55.1 vs + 32.2, p < 0.001), but not for the EQ-5D (+ 0.31 vs + 0.29, n.s.). The satisfaction rate was similar in both groups (88.3% vs 89.6%, n.s.).


Subtle cross-cultural variation was evident in TKA case-mix factors between the two countries. Satisfaction and improvement in health status were similar, while improvement in joint-specific outcome was notably greater in Switzerland. Understanding cross-cultural variability of the outcome has important implications when interpreting study and registry data from other countries and when counselling a patient in daily practice.

Level of evidence

Retrospective cohort, Level III.


Total knee arthroplasty Comparative study Patient-reported outcome Forgotten Joint Score-12 EQ-5D Cross-cultural 



Body mass index


Confidence interval


EuroQol 5 dimensions


Forgotten Joint Score-12


Patient-reported outcome


Standard deviation


Total knee arthroplasty


United Kingdom


United States


Western Ontario and McMaster Universities Osteoarthritis Index



We thank the patients, the data coordinators and those involved in data collection at the respective hospitals for assistance with this project. In particular, we thank Deborah MacDonald (University of Edinburgh) for assistance with the Scottish dataset.


The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

Two authors are copyright holders of the Forgotten Joint Score-12. Royalties are payable for commercial use of the questionnaire.

Ethical approval

Approval for registry data analysis was obtained from the local ethics committee in Switzerland (EKSG 10/138) and Scotland (16/SS/0026).


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Innsbruck Institute of Patient-centered Outcome Research (IIPCOR)InnsbruckAustria
  2. 2.Department of Orthopaedic SurgeryKantonsspital St. GallenSt. GallenSwitzerland
  3. 3.Department of Human Sciences, Society and HealthUniversity of Cassino and Southern LazioCassinoItaly
  4. 4.Department of Orthopaedic SurgeryUniversity of EdinburghEdinburghUK

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