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Cross-cultural validation of Hindi version Knee Injury and Osteoarthritis Outcome Score (KOOS) in osteoarthritis knee

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



To assess the reliability, validity and responsiveness of the Hindi version of the Knee Injury and Osteoarthritis Outcome Score (H-KOOS) in osteoarthritic knee.


Two hundred and fourteen patients of osteoarthritis knee (OA) between 40 and 80 years of age were evaluated with H-KOOS, Short form health survey (SF12v2) and the WHOQOL-BREF questionnaire. The H-KOOS was re-evaluated after 48 h in 125 patients to assess the test–retest reliability. For responsiveness, 40 patients were treated with the intra-articular hyaluronic acid injection, and the effect was assessed after 6 weeks.


Most of the domains in H-KOOS did not show a ceiling effect. The floor values were observed in 3.75% of patients in sports/recreation function and 2.75% of patients in Quality of life (QoL). The test–retest reliability was excellent with the Intraclass-Correlation-Coefficient (ICC) ranging from 0.89 to 0.94. Internal consistency as assessed using Cronbach‘s alpha coefficient was acceptable for pain, activities of daily living (ADL) and sport/recreation function (range 0.86–0.93); however, symptoms and QoL had weak internal consistency. There were moderate to strong correlations (r = 0.35 to 0.6) between domains measuring similar constructs in H-KOOS, SF12v2 and WHOQOL-BREF indicating good convergent construct validity. The responsiveness as measured by the effect size (ES) and standardized response mean (SRM) was large for pain (ES 0.9, SRM 0.8), moderate for Sport/Rec (ES 0.66, SRM 0.2) and small for ADL, QoL and Symptoms subscales.


The Hindi version KOOS is a valid, reliable and responsive measure to evaluate osteoarthritis knee with minimal ceiling and floor effects.

Level of evidence

Prospective cohort study, level II.

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Authors and Affiliations



This study was conducted in the Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, INDIA as a part of dissertation submitted by Dr. Ranjan Kumar Jha for his M.S. degree in Orthopedics under the guidance of Dr. RK Sen, Dr G Nirmal Raj and Dr SK Sharma. The initial concept was designed by RKS, GNR, SKT, TG and SKS. The data were collected by RKJ, GNR and RKS. The data were analyzed and statistical analysis was performed by SKS and TG. The final draft was prepared by SKT, TG, RKJ and RKS. All the authors have read the final manuscript and approved for publication.

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Correspondence to Sujit Kumar Tripathy.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

The study was conducted in Postgraduate Institute of medical Education and Research, Chandigarh, India. The institutional ethics committee approved the study (IEC approval No: NK/827/MS/3312-13).

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Informed consent was obtained from all individual participants included in the study. Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Jha, R.K., Sen, R.K., Tripathy, S.K. et al. Cross-cultural validation of Hindi version Knee Injury and Osteoarthritis Outcome Score (KOOS) in osteoarthritis knee. Knee Surg Sports Traumatol Arthrosc 29, 1742–1749 (2021).

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