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High correlation of the Oxford Knee Score with postoperative pain, but not with performance-based functioning

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The Oxford Knee Score (OKS) is a widely known patient-related outcome measure (PROM) to determine pain and knee functioning before and after total knee arthroplasty (TKA). Self-reported function is mainly influenced by change in pain; therefore, it was hypothesized that the OKS correlates more with pain than with performance-based functioning.

Methods

In a prospective cohort of 88 patients, who had a cementless mobile-bearing TKA, included in a randomized clinical trial, the correlation between the overall OKS, and its subscales for pain (PCS) and function (FCS), with performance-based functioning using the DynaPort® Knee Score (DKS), visual analogue scale score for pain (VAS) and the Knee Society Score (KSS) was evaluated. All scores were measured preoperatively, 6 months and 1 year after surgery. Overall change in outcome over time was analysed until 5 years after surgery.

Results

All scores improved over time. The DKS was influenced by sex, preoperative BMI and age. The internal consistency of the OKS PCS increased over time, whereas the OKS FCS remained the same. The mean postoperative OKS FCS showed moderate correlation with the DKS (r = 0.65, p < 0.001), and the mean postoperative OKS and OKS PCS showed high correlation with the VAS (r = −0.79 and r = −0.82, respectively, p < 0.001). The mean postoperative KSS showed high correlations with the OKS (r = 0.80, p < 0.001), the OKS PCS (r = 0.72 p < 0.001) and OKS FCS (r = 0.74, p < 0.001).

Conclusion

The postoperative OKS and the OKS PCS showed high correlation with pain, but only the postoperative OKS FCS was well correlated with performance-based functioning. This suggests that the OKS is more related to pain and tells us less on postoperative functioning. This is important when the OKS as PROM is used to evaluate the quality of orthopaedic care of patients with TKA.

Level of evidence

III.

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References

  1. Baker PN, Van der Meulen JH, Lewsey J, Gregg PJ (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 89:893–900

    Article  CAS  PubMed  Google Scholar 

  2. Bland JM, Altman DG (1997) Cronbach’s alpha. BMJ 314:572

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Breugem SJ, van Ooij B, Haverkamp D, Sierevelt IN, van Dijk CN (2014) No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years. Knee Surg Sports Traumatol Arthrosc 22:509–516

    Article  PubMed  Google Scholar 

  4. Clement ND, MacDonald D, Simpson AH (2013) The minimal clinically important difference in the Oxford Knee score and short form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:1933–1939

    Article  PubMed  Google Scholar 

  5. Cnaan A, Laird NM, Slasor P (1997) Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. Stat Med 16:2349–2380

    Article  CAS  PubMed  Google Scholar 

  6. Conaghan PG, Emerton M, Tennant A (2007) Internal construct validity of the Oxford Knee Scale: evidence from Rasch measurement. Arthritis Rheum 57:1363–1367

    Article  PubMed  Google Scholar 

  7. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63–69

    Article  CAS  PubMed  Google Scholar 

  8. de Steiger RN, Miller LN, Davidson DC, Ryan P, Graves SE (2013) Joint registry approach for identification of outlier prostheses. Acta Orthop 84:348–352

    Article  PubMed  PubMed Central  Google Scholar 

  9. Deshpande PR, Rajan S, Sudeepthi BL, Abdul Nazir CP (2011) Patient-reported outcomes: a new era in clinical research. Perspect Clin Res 2:137–144

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Dunbar MJ, Robertsson O, Ryd L, Lidgren L (2000) Translation and validation of the Oxford-12 item knee score for use in Sweden. Acta Orthop Scand 71:268–274

    Article  CAS  PubMed  Google Scholar 

  12. Dunbar MJ, Robertsson O, Ryd L, Lidgren L (2001) Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from The Swedish Knee Arthroplasty Registry. J Bone Joint Surg Br 83:339–344

    Article  CAS  PubMed  Google Scholar 

  13. Eun IS, Kim OG, Kim CK, Lee HS, Lee JS (2013) Validation of the Korean version of the Oxford Knee Score in patients undergoing total knee arthroplasty. Clin Orthop Relat Res 471:600–605

    Article  PubMed  Google Scholar 

  14. Farley FA, Weinstein SL (2006) The case for patient-centered care in orthopaedics. J Am Acad Orthop Surg 14:447–451

    Article  PubMed  Google Scholar 

  15. Gallagher EJ, Liebman M, Bijur PE (2001) Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med 38:633–638

    Article  CAS  PubMed  Google Scholar 

  16. Goncalves RS, Tomas AM, Martins DI (2012) Cross-cultural adaptation and validation of the Portuguese version of the Oxford Knee Score (OKS). Knee 19:344–347

    Article  PubMed  Google Scholar 

  17. Harcourt WG, White SH, Jones P (2001) Specificity of the Oxford knee status questionnaire. The effect of disease of the hip or lumbar spine on patients’ perception of knee disability. J Bone Joint Surg Br 83:345–347

    Article  CAS  PubMed  Google Scholar 

  18. Harris K, Dawson J, Doll H, Field RE, Murray DW, Fitzpatrick R, Jenkinson C, Price AJ, Beard DJ (2013) Can pain and function be distinguished in the Oxford Knee Score in a meaningful way? An exploratory and confirmatory factor analysis. Qual Life Res 22:2561–2568

    Article  PubMed  Google Scholar 

  19. Harris KK, Dawson J, Jones LD, Beard DJ, Price AJ (2013) Extending the use of PROMs in the NHS–using the Oxford Knee Score in patients undergoing non-operative management for knee osteoarthritis: a validation study. BMJ Open 3:e003365

    Article  PubMed  PubMed Central  Google Scholar 

  20. Haverkamp D, Breugem SJ, Sierevelt IN, Blankevoort L, van Dijk CN (2005) Translation and validation of the Dutch version of the Oxford 12-item knee questionnaire for knee arthroplasty. Acta Orthop 76:347–352

    PubMed  Google Scholar 

  21. 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 

  22. Jenny JY, Diesinger Y (2012) The Oxford Knee Score: compared performance before and after knee replacement. Orthop Traumatol Surg Res 98:409–412

    Article  PubMed  Google Scholar 

  23. Kleijn LL, van Hemert WL, Meijers WG, Kester AD, Lisowski L, Grimm B, Heyligers IC (2007) Functional improvement after unicompartmental knee replacement: a follow-up study with a performance based knee test. Knee Surg Sports Traumatol Arthrosc 15:1187–1193

    Article  PubMed  Google Scholar 

  24. Ko Y, Lo NN, Yeo SJ, Yang KY, Yeo W, Chong HC, Thumboo J (2009) Rasch analysis of the Oxford Knee Score. Osteoarthritis Cartilage 17:1163–1169

    Article  CAS  PubMed  Google Scholar 

  25. 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 

  26. 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. Osteoarthritis Cartilage 13:738–743

    Article  PubMed  Google Scholar 

  27. Mudelsee M (2003) Estimating Pearson’s correlation coefficient with bootstrap confidence interval from serially dependent time series. Math Geol 35:651–665

    Article  Google Scholar 

  28. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89:1010–1014

    Article  CAS  PubMed  Google Scholar 

  29. Naal FD, Impellizzeri FM, Sieverding M, Loibl M, von Knoch F, Mannion AF, Leunig M, Munzinger U (2009) The 12-item Oxford Knee Score: cross-cultural adaptation into German and assessment of its psychometric properties in patients with osteoarthritis of the knee. Osteoarthritis Cartilage 17:49–52

    Article  CAS  PubMed  Google Scholar 

  30. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41:582–592

    PubMed  Google Scholar 

  31. Padua R, Zanoli G, Ceccarelli E, Romanini E, Bondi R, Campi A (2003) The Italian version of the Oxford 12-item Knee Questionnaire-cross-cultural adaptation and validation. Int Orthop 27:214–216

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Phillips JR, Hopwood B, Arthur C, Stroud R, Toms AD (2014) The natural history of pain and neuropathic pain after knee replacement: a prospective cohort study of the point prevalence of pain and neuropathic pain to a minimum three-year follow-up. Bone Joint J 96-B:1227–1233

    Article  CAS  PubMed  Google Scholar 

  33. Rolfson O, Karrholm J, Dahlberg LE, Garellick G (2011) Patient-reported outcomes in the Swedish Hip Arthroplasty Register: results of a nationwide prospective observational study. J Bone Joint Surg Br 93:867–875

    Article  CAS  PubMed  Google Scholar 

  34. Rosier EM, Iadarola MJ, Coghill RC (2002) Reproducibility of pain measurement and pain perception. Pain 98:205–216

    Article  PubMed  Google Scholar 

  35. Stratford PW, Kennedy DM (2006) Performance measures were necessary to obtain a complete picture of osteoarthritic patients. J Clin Epidemiol 59:160–167

    Article  PubMed  Google Scholar 

  36. Takeuchi R, Sawaguchi T, Nakamura N, Ishikawa H, Saito T, Goldhahn S (2011) Cross-cultural adaptation and validation of the Oxford 12-item knee score in Japanese. Arch Orthop Trauma Surg 131:247–254

    Article  CAS  PubMed  Google Scholar 

  37. Tavakol M, Dennig R (2011) Making sense of Cronbach’s alpha. Int J Med Educ 2:53–55

    Article  PubMed Central  Google Scholar 

  38. Taylor R (1990) Interpretation of the correlation coefficient: a basic review. J Diagn Med Sonog 6:35–39

    Article  Google Scholar 

  39. Terwee CB, van der Slikke RM, van Lummel RC, Benink RJ, Meijers WG, de Vet HC (2006) Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients. J Clin Epidemiol 59:724–731

    Article  PubMed  Google Scholar 

  40. van Hemert WL, Senden R, Grimm B, van der Linde MJ, Lataster A, Heyligers IC (2011) Early functional outcome after subvastus or parapatellar approach in knee arthroplasty is comparable. Knee Surg Sports Traumatol Arthrosc 19:943–951

    Article  PubMed  Google Scholar 

  41. van Hove RP, Brohet RM, van Royen BJ, Nolte PA (2014) No clinical benefit of titanium-nitride coating in cementless mobile bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3359-9

    PubMed  Google Scholar 

  42. Whitehouse SL, Blom AW, Taylor AH, Pattison GT, Bannister GC (2005) The Oxford Knee Score; problems and pitfalls. Knee 12:287–291

    Article  PubMed  Google Scholar 

  43. Xie F, Li SC, Lo NN, Yeo SJ, Yang KY, Yeo W, Chong HC, Fong KY, Thumboo J (2007) Cross-cultural adaptation and validation of Singapore English and Chinese Versions of the Oxford Knee Score (OKS) in knee osteoarthritis patients undergoing total knee replacement. Osteoarthritis Cartilage 15:1019–1024

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank T. van der Ploeg for his valuable assistance during statistical analysis.

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Authors and Affiliations

  1. Department of Orthopaedics, Spaarne Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands

    Ruud P. van Hove & Peter A. Nolte

  2. Research Center Linnaeus Institute, Spaarne Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands

    Richard M. Brohet & Peter A. Nolte

  3. Department of Orthopaedics, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, Netherlands

    Barend J. van Royen

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  1. Ruud P. van Hove
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Correspondence to Ruud P. van Hove.

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van Hove, R.P., Brohet, R.M., van Royen, B.J. et al. High correlation of the Oxford Knee Score with postoperative pain, but not with performance-based functioning. Knee Surg Sports Traumatol Arthrosc 24, 3369–3375 (2016). https://doi.org/10.1007/s00167-015-3585-9

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