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Prosthetic alignment after total knee replacement is not associated with dissatisfaction or change in Oxford Knee Score: A multivariable regression analysis.
Knee. 2016 Jun; 23(3):535-9.KNEE

Abstract

BACKGROUND

Approximately 18% of the patients are dissatisfied with the result of total knee replacement. However, the relation between dissatisfaction and prosthetic alignment has not been investigated before.

METHODS

We retrospectively analysed prospectively gathered data of all patients who had a primary TKR, preoperative and one-year postoperative Oxford Knee Scores (OKS) and postoperative computed tomography (CT). The CT protocol measures hip-knee-ankle (HKA) angle, and coronal, sagittal and axial component alignment. Satisfaction was defined using a five-item Likert scale. We dichotomised dissatisfaction by combining '(very) dissatisfied' and 'neutral/not sure'. Associations with dissatisfaction and change in OKS were calculated using multivariable logistic and linear regression models.

RESULTS

230 TKRs were implanted in 105 men and 106 women. At one year, 12% were (very) dissatisfied and 10% neutral. Coronal alignment of the femoral component was 0.5 degrees more accurate in patients who were satisfied at one year. The other alignment measurements were not different between satisfied and dissatisfied patients. All radiographic measurements had a P-value>0.10 on univariate analyses. At one year, dissatisfaction was associated with the three-months OKS. Change in OKS was associated with three-months OKS, preoperative physical SF-12, preoperative pain and cruciate retaining design.

DISCUSSION

Neither mechanical axis, nor component alignment, is associated with dissatisfaction at one year following TKR. Patients get the best outcome when pain reduction and function improvement are optimal during the first three months and when the indication to embark on surgery is based on physical limitations rather than on a high pain score.

LEVEL OF EVIDENCE

2.

Authors+Show Affiliations

The Joint Studio, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, WA 6009, Australia; Hollywood Private Hospital, Monash Avenue, Nedlands, WA 6009, Australia. Electronic address: richardhuijbregts@hotmail.com.The Joint Studio, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, WA 6009, Australia; Hollywood Private Hospital, Monash Avenue, Nedlands, WA 6009, Australia; Curtin University, Kent Street, Bentley, WA 6102, Australia; University of Notre Dame, 9 Mouat Street, Fremantle, WA 6959, Australia.The Joint Studio, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, WA 6009, Australia; Hollywood Private Hospital, Monash Avenue, Nedlands, WA 6009, Australia; Curtin University, Kent Street, Bentley, WA 6102, Australia.The Joint Studio, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, WA 6009, Australia.The Joint Studio, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, WA 6009, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26826945

Citation

Huijbregts, Henricus J T A M., et al. "Prosthetic Alignment After Total Knee Replacement Is Not Associated With Dissatisfaction or Change in Oxford Knee Score: a Multivariable Regression Analysis." The Knee, vol. 23, no. 3, 2016, pp. 535-9.
Huijbregts HJ, Khan RJ, Fick DP, et al. Prosthetic alignment after total knee replacement is not associated with dissatisfaction or change in Oxford Knee Score: A multivariable regression analysis. Knee. 2016;23(3):535-9.
Huijbregts, H. J., Khan, R. J., Fick, D. P., Jarrett, O. M., & Haebich, S. (2016). Prosthetic alignment after total knee replacement is not associated with dissatisfaction or change in Oxford Knee Score: A multivariable regression analysis. The Knee, 23(3), 535-9. https://doi.org/10.1016/j.knee.2015.12.007
Huijbregts HJ, et al. Prosthetic Alignment After Total Knee Replacement Is Not Associated With Dissatisfaction or Change in Oxford Knee Score: a Multivariable Regression Analysis. Knee. 2016;23(3):535-9. PubMed PMID: 26826945.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prosthetic alignment after total knee replacement is not associated with dissatisfaction or change in Oxford Knee Score: A multivariable regression analysis. AU - Huijbregts,Henricus J T A M, AU - Khan,Riaz J K, AU - Fick,Daniel P, AU - Jarrett,Olivia M, AU - Haebich,Samantha, Y1 - 2016/01/27/ PY - 2015/09/29/received PY - 2015/12/07/revised PY - 2015/12/19/accepted PY - 2016/2/1/entrez PY - 2016/2/2/pubmed PY - 2017/9/12/medline KW - Alignment KW - Mechanical axis KW - Oxford knee Score KW - Regression KW - Satisfaction KW - Total knee replacement SP - 535 EP - 9 JF - The Knee JO - Knee VL - 23 IS - 3 N2 - BACKGROUND: Approximately 18% of the patients are dissatisfied with the result of total knee replacement. However, the relation between dissatisfaction and prosthetic alignment has not been investigated before. METHODS: We retrospectively analysed prospectively gathered data of all patients who had a primary TKR, preoperative and one-year postoperative Oxford Knee Scores (OKS) and postoperative computed tomography (CT). The CT protocol measures hip-knee-ankle (HKA) angle, and coronal, sagittal and axial component alignment. Satisfaction was defined using a five-item Likert scale. We dichotomised dissatisfaction by combining '(very) dissatisfied' and 'neutral/not sure'. Associations with dissatisfaction and change in OKS were calculated using multivariable logistic and linear regression models. RESULTS: 230 TKRs were implanted in 105 men and 106 women. At one year, 12% were (very) dissatisfied and 10% neutral. Coronal alignment of the femoral component was 0.5 degrees more accurate in patients who were satisfied at one year. The other alignment measurements were not different between satisfied and dissatisfied patients. All radiographic measurements had a P-value>0.10 on univariate analyses. At one year, dissatisfaction was associated with the three-months OKS. Change in OKS was associated with three-months OKS, preoperative physical SF-12, preoperative pain and cruciate retaining design. DISCUSSION: Neither mechanical axis, nor component alignment, is associated with dissatisfaction at one year following TKR. Patients get the best outcome when pain reduction and function improvement are optimal during the first three months and when the indication to embark on surgery is based on physical limitations rather than on a high pain score. LEVEL OF EVIDENCE: 2. SN - 1873-5800 UR - https://www.unboundmedicine.com/medline/citation/26826945/Prosthetic_alignment_after_total_knee_replacement_is_not_associated_with_dissatisfaction_or_change_in_Oxford_Knee_Score:_A_multivariable_regression_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0968-0160(15)00292-6 DB - PRIME DP - Unbound Medicine ER -