Clinical Orthopaedics and Related Research®

, Volume 470, Issue 1, pp 20–32 | Cite as

Development of a New Knee Society Scoring System

  • Philip C. NobleEmail author
  • Giles R. Scuderi
  • Adam C. Brekke
  • Alla Sikorskii
  • James B. Benjamin
  • Jess H. Lonner
  • Priya Chadha
  • Daniel A. Daylamani
  • W. Norman Scott
  • Robert B. Bourne
Symposium: Papers Presented at the Annual Meetings of The Knee Society



The Knee Society Clinical Rating System was developed in 1989 and has been widely adopted. However, with the increased demand for TKA, there is a need for a new, validated scoring system to better characterize the expectations, satisfaction, and physical activities of the younger, more diverse population of TKA patients.


We developed and validated a new Knee Society Scoring System.


We developed the new knee scoring system in two stages. Initially, a comprehensive survey of activities was developed and administered to 101 unilateral TKA patients (53 women, 48 men). A prototype knee scoring instrument was developed from the responses to the survey and administered to 497 patients (204 men, 293 women; 243 postoperatively, 254 preoperatively) at 15 medical institutions within the United States and Canada. Objective and subjective data were analyzed using standard statistical and psychometric procedures and compared to the Knee Injury and Osteoarthritis Score and SF-12 scores for validation. Based on this analysis, minor modifications led to the new Knee Society Scoring System.


We found the new Knee Society Scoring System to be broadly applicable and to accurately characterize patient outcomes after TKA. Statistical analysis confirmed the internal consistency, construct and convergent validity, and reliability of the separate subscale measures.


The new Knee Society Scoring System is a validated instrument based on surgeon- and patient-generated data, adapted to the diverse lifestyles and activities of contemporary patients with TKA. This assessment tool allows surgeons to appreciate differences in the priorities of individual patients and the interplay among function, expectation, symptoms, and satisfaction after TKA.


Differential Item Functioning Knee Society Scoring Mental Component Score Discretionary Activity Advanced Activity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors warmly acknowledge the contributions of Richard S. Laskin MD (deceased) to the work of The Knee Society Task Force. They also acknowledge the technical assistance of Dr Michael Conditt, Mr Uche Osadebe, Dr Maureen Dwyer, Mr Sabir Ismaily, Mr Prem Ramkumar, Mr Paul Newhouse, Mr Eugene Stone, and Ms Denise Leon in preparing the manuscript and in performing background studies in support of this work and Dianne Bryant, PhD, and Bert Chesworth, PhD, for their contributions relating to epidemiologic aspects of the study. The authors acknowledge the work of the following members of The Knee Society in contributing patients to the field evaluation of the new Knee Society Score: Keith Berend, MD; Dan Berry, MD; Kim Bertin, MD; Kevin Bozic, MD; David Dalury, MD; Terence Gioe, MD; Arlen Hanssen, MD; Steve Incavo, MD; Carlos Lavernia, MD; David Lewallen, MD; Adolph Lombardi, MD; Bassam Masri, MD; Michael Mont, MD; Mark Pagnano, MD; Michael Reis, MD; Jay Rodrigo, MD; Tad Vail, MD; and Ray Wasielewski, MD. The authors are also indebted to Dr Gerald Engh, who, as President of The Knee Society, appointed the task force to develop a new Knee Society Score, and Ms Olga Foley for organizing its meetings and activities.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Philip C. Noble
    • 1
    Email author
  • Giles R. Scuderi
    • 3
  • Adam C. Brekke
    • 2
  • Alla Sikorskii
    • 4
  • James B. Benjamin
    • 5
  • Jess H. Lonner
    • 6
  • Priya Chadha
    • 3
  • Daniel A. Daylamani
    • 2
  • W. Norman Scott
    • 3
  • Robert B. Bourne
    • 7
  1. 1.Barnhart Department of Orthopedic SurgeryBaylor College of MedicineHoustonUSA
  2. 2.Institute of Orthopedic Research and EducationHoustonUSA
  3. 3.Insall Scott Kelly InstituteNew YorkUSA
  4. 4.Department of Statistics and ProbabilityMichigan State UniversityEast LansingUSA
  5. 5.University Orthopedic SpecialistsTucsonUSA
  6. 6.Rothman InstitutePhiladelphiaUSA
  7. 7.Division of Orthopaedic SurgeryUniversity Hospital, London Health Sciences Centre, University of Western OntarioLondonCanada

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