Skip to main content
SpringerLink
Log in

Functional outcome of knee arthroplasty is dependent upon the evaluation method employed

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

It is becoming increasingly important to evaluate surgical procedures beyond pain relief and implant survival. Patient satisfaction and objective functional assessment is now as relevant. The aim of this study was to establish the functional differences and patient perceptions between unicompartmental knee replacement (UKR) and total knee replacement (TKR). In a prospective study 52 TKR patients were compared to 24 UKR (at preoperative, 3, 6 months and 1 year postoperative). The disease specific KSS and Womac (pain and function subscores), the generic SF36 (pain, function and patient perception subscores) and the Dynaport®Knee Test, a validated performance-based knee test using accelerometers to score function during activities of daily living, was utilized. Preoperative UKR patients had significantly higher KSS function and the Dynaport®Knee Test (P < 0.05), but despite being younger, with different indication, they were not different to TKR with regards to function and pain subscores of Womac and SF36. Regarding preoperative perception, UKR patients reported better physical and social function but subjectively felt worse than TKR patients regarding health, emotion and mental status (n.s.). At one year, postoperative perception scores for both groups increased significantly, with UKR retaining functional lead and UKR patients also felt superior regarding health, emotion and mental status (n.s.). Postoperative recovery regarding KSS, Womac, and SF36-pain was steep only during the first 3 months with near equal values for both TKR and UKR. It was found that SF36-Function recovery was not significant, but UKR also scored higher than TKR. Only functional scores by the Dynaport®Knee Test showed continued improvement and maintained the functional advantage of UKR patients throughout recovery. UKR and TKR patients have different age demographics, indications and perceptions, but clinical outcome scores do not equally capture these differences, especially with regards to function. Postoperative functional benefits of UKR seem to be due mainly to the superior preoperative conditions. Appreciation of recovery with generic, disease specific and functional measurements appears invaluable.

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

References

  1. Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, Sprangers MA, te Velde A, Verrips E (1998) Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 51:1055–1068

    Article  PubMed  CAS  Google Scholar 

  2. Angst F, Aeschlimann A, Steiner W, Stucki G (2001) Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis 60:834–840

    PubMed  CAS  Google Scholar 

  3. Barr S, Bellamy N, Buchanan WW, Chalmers A, Ford PM, Kean WF, Kraag GR, Gerecz-Simon E, Campbell J (1994) A comparative study of signal versus aggregate methods of outcome measurement based on the WOMAC Osteoarthritis Index. Western Ontario and McMaster Universities Osteoarthritis Index. J Rheumatol 21:2106–2112

    PubMed  CAS  Google Scholar 

  4. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    PubMed  CAS  Google Scholar 

  5. Bullens PH, van Loon CJ, l Malefijt MC, Laan RF, Veth RP (2001) Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty 16:740–747

    Article  PubMed  CAS  Google Scholar 

  6. Dickstein R, Heffes Y, Shabtai EI, Markowitz E (1998) Total knee arthroplasty in the elderly: patients’ self-appraisal 6 and 12 months postoperatively. Gerontology 44:204–210

    Article  PubMed  CAS  Google Scholar 

  7. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  8. Konig A, Scheidler M, Rader C, Eulert J (1997) The need for a dual rating system in total knee arthroplasty. Clin Orthop Relat Res 345:161–167

    PubMed  Google Scholar 

  9. Kort N (2007) Unicompartmental knee arthroplasty. Thesis. Groningen, The Netherlands

  10. Laurencin CT, Zelicof SB, Scott RD, Ewald FC (1991) Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 273:151–156

    PubMed  Google Scholar 

  11. Maly MR, Costigan PA, Olney SJ (2006) Determinants of self-report outcome measures in people with knee osteoarthritis. Arch Phys Med Rehabil 87:96–104

    Article  PubMed  Google Scholar 

  12. Marx RG, Jones EC, Atwan NC, Closkey RF, Salvati EA, Sculco TP (2005) Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. J Bone Joint Surg Am 87:1999–2005

    Article  PubMed  Google Scholar 

  13. Maxwell S, Delaney H (2003) Designing experiments and analyzing data: a model comparison perspective, 2nd edn. Lawrence Erlbaum, New Jersey

  14. Mokkink LB, Terwee CB, van der Slikke RM, van Lummel RC, Benink RJ, Bouter LM, de Vet HC (2005) Reproducibility and validity of the DynaPort KneeTest. Arthritis Rheum 53:357–363

    Article  PubMed  Google Scholar 

  15. Mokkink LB, Terwee CB, van Lummel RC, de Witte SJ, Wetzels L, Bouter LM, de Vet HC (2005) Construct validity of the DynaPort KneeTest: a comparison with observations of physical therapists. Osteoarthr Cartil 13:738–743

    Article  PubMed  Google Scholar 

  16. Newman JH, Ackroyd CE, Shah NA (1998) Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br 80:862–865

    Article  PubMed  CAS  Google Scholar 

  17. Parent E, Moffet H (2002) Comparative responsiveness of locomotor tests and questionnaires used to follow early recovery after total knee arthroplasty. Arch Phys Med Rehabil 83:70–80

    Article  PubMed  Google Scholar 

  18. Price AJ, Waite JC, Svard U (2005) Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 435:171–180

    Article  PubMed  Google Scholar 

  19. Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, van der Eijken JW, Willems WJ, Heyligers IC, Voaklander DC, Kelly KD, Suarez-Almazor ME (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63:36–42

    Article  PubMed  CAS  Google Scholar 

  20. Rougraff BT, Heck DA, Gibson AE (1991) A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis. Clin Orthop Relat Res 273:157–164

    PubMed  Google Scholar 

  21. Soderman P, Malchau H (2000) Validity and reliability of Swedish WOMAC osteoarthritis index: a self-administered disease-specific questionnaire (WOMAC) versus generic instruments (SF-36 and NHP). Acta Orthop Scand 71:39–46

    Article  PubMed  CAS  Google Scholar 

  22. Trousdale RT, McGrory BJ, Berry DJ, Becker MW, Harmsen WS (1999) Patients’ concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc 74:978–982

    Article  PubMed  CAS  Google Scholar 

  23. van den Akker-Scheek I (2007) Recovery after short-stay total hip and knee arthroplasty. Evaluation of a support program and outcome determination. In: Orthopaedic Surgery. Groningen

  24. van den Dikkenberg N, Meijer OG, van der Slikke RM, van Lummel RC, van Dieen JH, Pijls B, Benink RJ, Wuisman PI (2002) Measuring functional abilities of patients with knee problems: rationale and construction of the DynaPort knee test. Knee Surg Sports Traumatol Arthrosc 10:204–212

    PubMed  Google Scholar 

  25. Weale AE, Halabi OA, Jones PW, White SH (2001) Perceptions of outcomes after unicompartmental and total knee replacements. Clin Orthop Relat Res 382:143–153

    Article  PubMed  Google Scholar 

  26. Witvrouw E, Victor J, Bellemans J, Rock B, Van Lummel R, Van Der Slikke R, Verdonk R (2002) A correlation study of objective functionality and WOMAC in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 10:347–351

    Article  PubMed  CAS  Google Scholar 

  27. Worland RL, Johnson GV, Alemparte J, Jessup DE, Keenan J, Norambuena N (2002) Ten to fourteen year survival and functional analysis of the AGC total knee replacement system. Knee 9:133–137

    Article  PubMed  Google Scholar 

  28. Yang KY, Wang MC, Yeo SJ, Lo NN (2003) Minimally invasive unicondylar versus total condylar knee arthroplasty—early results of a matched-pair comparison. Singapore Med J 44:559–562

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors like to thank Mr. Glenn Ward, Ph.D., for editorial comments on the manuscript.

Conflict of interest statement

All authors have not received and will not receive neither accept any benefit from any third party or industry directly or indirectly related to the outcome of this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Atrium Medical Centre, PO Box 4446, 6401 CX, Heerlen, The Netherlands

    Wouter L. W. van Hemert, Will G. H. Meyers, Lucas L. A. Kleijn, Ide C. Heyligers & Bernd Grimm

Authors
  1. Wouter L. W. van Hemert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Will G. H. Meyers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucas L. A. Kleijn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ide C. Heyligers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernd Grimm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wouter L. W. van Hemert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Hemert, W.L.W., Meyers, W.G.H., Kleijn, L.L.A. et al. Functional outcome of knee arthroplasty is dependent upon the evaluation method employed. Eur J Orthop Surg Traumatol 19, 415–422 (2009). https://doi.org/10.1007/s00590-009-0450-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-009-0450-x

Keywords

Search

Navigation