sequential outcomes following total knee arthroplasty
TRANSCRIPT
8/6/2019 Sequential Outcomes following Total Knee Arthroplasty
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Sequential Improvement In
Clinical Outcomes Post TKA
BA Rogers, L Unitt, SR Cannon, TWR Briggs
The Balancer Study Group
8/6/2019 Sequential Outcomes following Total Knee Arthroplasty
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Intro� Numerous studies highlight
± outcome
± function
� variety of measures/scores
� medium term (3 & 5 year studies)
� long term (5 years +)
� Few show progressive outcome profile of a cohort
8/6/2019 Sequential Outcomes following Total Knee Arthroplasty
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Aim� Assess sequential change in knee outcome
& function in a cohort of patients
undergoing TKA
� Assess the differential outcome profile
depending on the degree on initial
functional impairment
8/6/2019 Sequential Outcomes following Total Knee Arthroplasty
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Methods
� Prospective, multi-centre study
� cemented TKA (Kinemax)
� 526 knees
� Indications OA and RA
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Methods
� Patient assessment
± Pre-op
± 12 months, 2 years & 3 years
� Oxford Knee Score (60 worse, 0 best)
� Knee Society Score (0 ± 100)
� Functional score (0-100)� Range of knee flexion
� Data analysis ± unpaired, 2 tailed T test, SPSS
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Methods
� Pre Op to 1 year change
� Profile for 3 years post op
� Patients categorized into 3 groups� Group 1
± OKS 13 ± 37 «««.MODERATE
� Group 2
± OKS 38 ± 47 «««..POOR
� Group 3
± OKS 47 ± 60««««SEVERE
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Results� GROUP 1«««.MODERATE
± N=112
± Age 70.57yrs (53-84 yrs)� GROUP 2«««..POOR
± N=267
± Age 69.48yrs (40 ± 88 yrs)
� GROUP 3 «««.SEVERE ± N=147
± Age 69.87yrs (40-90 yrs)
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Oxford Knee Score
0
10
20
30
40
50
60
preop 1 yr 2 yr 3 yr
Assessment
S c o r e
Group 1
Group 2
Group 3
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Oxford Knee Score
Pre-op to 1 year Improvement in Oxford Knee Score
0.00
5.00
10.00
15.00
20.00
25.00
30.00
roup 1 roup 2 roup 3
OKS categories
I m p r o v e m e n t i n O K
S
p<0.05
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Knee Society Score
Sequential Knee Society Score
0
20
40
60
80
100
preop 1 yr 2 yr 3 yr
Assessment
S c o r e Group 1
Group 2
Group 3
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Knee Society Score
Preop - 1 year improvement in Knee Society Score
0.00
10.00
20.00
30.00
40.00
50.00
60.00
Gr 1 Gr 2 Gr 3
OKS categories
I m
p r o v e m e n t i n K S
S p>0.05
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Flexion
Sequential Range of Movement
80
85
90
95
100105
110
preop 1 yr 2 yr 3 yr
Assessment
D e g r e e s Group 1
Group 2
Group 3
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Pr t 1 y r impr m t i M m t
0
2
4
6
8
10
12
14
Gr 1 Gr 2 Gr
D
g r
Flexion
P=0.08
P=0.17
P=0.0004
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Discussion
Oxford Knee Score
� All groups improved
� Severe knee s ± improve the most (p<0.05) @ 1 year
± show no further improvement @ 2 -3 yrs
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Discussion
Knee Society Score
� All groups improved
± improvement similar (p>0.05) @ 1 year in all groups ± show no further improvement @ 2 -3 yrs
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� Most improvement in severe knees (p<0.05)
� Suggestion of deterioration from 2 ± 3 yrs ±
but not statistically significant
Discussion
Range of Movement
8/6/2019 Sequential Outcomes following Total Knee Arthroplasty
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1) Comparing mild to severe pre-operative knees:
May be significant difference in functional
Improvement (Oxford Knee Score)««
«..but no difference in clinical improvement
(KSS and range of movement)
2) Is continued improvement limited to 2-3 years ?
Conclusion
8/6/2019 Sequential Outcomes following Total Knee Arthroplasty
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