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The KOOS-12 shortform shows no ceiling effect, good responsiveness and construct validity compared to standard outcome measures after total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the validity, responsiveness and ceiling effect of the recently introduced KOOS-12 and compare its performance to the KOOS, OKS, WOMAC and UCLA activity scales.

Methods

Patients from an independent multicentre study examining a medially stabilized knee system prospectively completed the KOOS, OKS, WOMAC and UCLA preoperatively and at 1 year postoperatively. KOOS-12 scores were calculated from the full length KOOS data. Construct validity was assessed using Spearman’s correlation analysis. The ceiling effect was evaluated by calculating the percentage of patients with a maximum score. If the percentage exceeded 15%, a ceiling effect was considered to be present. Responsiveness was evaluated by performing paired t tests on the changes in measures and calculation of Cohen’s d.

Results

A ceiling effect was present for the KOOS Pain, ADL and QoL subscales and the KOOS-JR at 1 year postoperatively. No ceiling effect was observed for the KOOS-12. Correlation of the KOOS-12 was low (0.3 < r < 0.5) with the UCLA, moderate (0.5 < r < 0.7) with the KOOS symptoms, sports and WOMAC stiffness subscales and high (r > 0.7) with all other scores and subscales. Effect size of the UCLA activity scale was moderate (Cohen’s d 0.2–0.8) whereas effect sizes of all other outcome measures were large (d > 0.8).

Conclusion

The KOOS-12 does not exhibit a ceiling effect, has good convergent construct validity and is responsive to changes in pain, function, QoL and knee impact between preoperatively and 1 year postoperatively.

Level of evidence

Diagnostic level III.

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Abbreviations

TKA:

Total knee arthroplasty

PROM:

Patient reported outcome measure

ROM:

Range of motion

KOOS:

Knee injury and osteoarthritis outcome score

KOOS-12:

Knee injury and osteoarthritis outcome score-12

KOOS-JR:

Knee injury and osteoarthritis outcome score joint replacement

KOOS-PS:

Knee injury and osteoarthritis outcome score physical function short form

OKS:

Oxford knee score

WOMAC:

Western Ontario and McMaster Universities osteoarthritis index

UCLA:

University of California, Los Angeles (UCLA) activity scale

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Acknowledgements

The authors would like to thank Robyn Kildey and the Socrates group for the management and collection of data.

Funding

The multicenter study from which the data used in this analysis was derived was funded by MatOrtho Australia Pty Limited, Norwest, NSW, Australia. MatOrtho was not involved in the design of the study, statistical analysis, data interpretation, drafting of this manuscript or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany

    Lukas Eckhard

  2. Australian Institute of Musculoskeletal Research, Sydney, Australia

    Lukas Eckhard, Selin Munir, David Wood & Bill Walter

  3. Orthopaedic Department, Western Health, Melbourne, Australia

    Simon Talbot

  4. Westmead Private Hospital Sydney, Sydney, Australia

    Roger Brighton

  5. Royal North Shore Hospital Sydney, Sydney, Australia

    Bill Walter

  6. Melbourne Orthopaedic Group Melbourne, Melbourne, Australia

    Jonathan Baré

  7. Mater Clinic Suite 1.08, 3-9 Gillies Street, North Sydney, NSW, 2060, Australia

    Selin Munir

  8. North Sydney Orthopaedic and Sports Medicine Centre, Suite 2, Mater Clinic, 25 Rocklands Rd, Wollstonecraft, NSW, 2065, Australia

    David Wood

Authors
  1. Lukas Eckhard
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  2. Selin Munir
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  3. David Wood
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Contributions

All authors have contributed to the conception and design of the study, interpretation of the data, and revising it critically. LE and SM assembled the data and performed the data analysis, developed the study concept and design, and wrote the manuscript. All authors have read and approved the final manuscript and have taken responsibility for the integrity of the work as a whole.

Corresponding author

Correspondence to Selin Munir.

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Conflict of interest

The authors have conflicts of interest to declare. SM reports payment to the Australian Institute of Musculo-Skeletal Research (AIMS) from MatOrtho, for manuscript preparation. SM is employed by AIMS Research. WLW reports personal fees from MatOrtho, outside the submitted work and discloses being a design surgeon for the SAIPH knee. JB, DW, ST and RB report sponsored travel to conferences from MatOrtho, outside the submitted work. LE has no conflicts of interest to declare.

Ethical approval

The study was approved by the St Vincent’s ethics committee (Reference number 151/15) and was carried out in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed consent

Informed consent was obtained from all patients prior to inclusion in the study.

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Eckhard, L., Munir, S., Wood, D. et al. The KOOS-12 shortform shows no ceiling effect, good responsiveness and construct validity compared to standard outcome measures after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 29, 608–615 (2021). https://doi.org/10.1007/s00167-020-05904-x

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  • DOI: https://doi.org/10.1007/s00167-020-05904-x

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