Translation, cross-cultural adaptation, reliability and construct validity of the Dutch Oxford Knee Score - Activity and Participation Questionnaire

Implant stability and clinical performance of a bicruciate-retaining total knee arthroplasty: A radiostereometric analysis up to 7.5 years follow-up

BACKGROUND

A previous randomized controlled trial showed higher tibial migration and more device-related complications in bicruciate-retaining compared to cruciate-retaining total knee arthroplasty, raising concerns about long-term implant stability and prompting this follow-up study to assess migration patterns and clinical outcomes up to 7.5 years postoperatively.

METHODS

In this follow-up study, the bicruciate-retaining group from an initial single-centre randomized controlled trial was monitored at 5 and 7.5 years postoperatively. Implant migration was measured through model-based radiostereometric analysis and reported as total translation and rotation for femoral and tibial components. Clinical outcomes, including multiple patient-reported outcomes and functional assessments, were also evaluated.

FINDINGS

A total of 13 bicruciate-retaining patients participated in this follow-up study, with 12 completing the 7.5-year follow-up. At 5 and 7.5 years postoperatively, the median(interquartile range) total translation and total rotation for the tibial components were 0.24 mm (0.18-0.48) and 0.59° (0.46-1.10) and 0.30 mm (0.18-0.81) and 0.73° (0.50-1.39), respectively. For the femoral components, total translation and total rotation were 0.46 mm (0.34-0.64) and 0.43° (0.25-0.69) at 5 years, and 0.43 mm (0.24-0.74) and 0.36° (0.30-0.83) at 7.5 years. Clinical and functional outcome scores, on average, were high but one patient reported mediolateral instability.

INTERPRETATION

Migration patterns for both bicruciate-retaining components generally stabilized from 2 to 7.5 years postoperatively, although some outliers show migration of >0.2 mm. Given the high frequency of device-related adverse events and potential healthy survivor bias, these findings do not support the routine clinical use of this implant.

Development of a novel clinimetric tool: PAtient Reported Disease Activity Index in Rheumatoid Arthritis (PARDAI-RA) by PANLAR, for the assessment of patients living with rheumatoid arthritis

BACKGROUND

Clinical experience has shown that a single measure is not sufficient to assess disease activity in rheumatoid arthritis (RA). Various clinimetric tools are necessary to address the many clinical situations that can arise.

METHODS

In order to develop a comprehensive measurement tool, the Pan American League of Associations for Rheumatology searched for the most frequent measures of disease activity applied in RA by means of a semi-systematic review of the available literature.

RESULTS

We found that the most frequently reported measures of disease activity were the 28-joint Disease Activity Score, C-reactive protein, and the erythrocyte sedimentation rate, followed by patient-reported measures of pain and stiffness and many other composite indices and patient-reported outcome measures. The most frequent physician-reported sign of disease was the swollen joint count, and the most frequently self-reported feature was the increase in disease activity or flares.

CONCLUSION

In this article, we present a new clinimetric tool developed based on expert consensus and on data retrieved from our search. Disease activity can be better assessed by combining various data sources, such as clinical, laboratory, and self-reported outcomes. These variables were included in our novel clinimetric tool. Key Points • The goal of treatment of RA is to achieve the best possible control of inflammation, or even remission; therefore, disease management should include systematic and regular evaluation of inflammation and health status. • Clinimetric tools evaluate a series of variables (e.g., symptoms, functional capacity, disease severity, quality of life, disease progression) and can reveal substantial prognostic and therapeutic differences between patients. • Our clinimetric tool, which is based on a combination of data (e.g., clinical variables, laboratory results, PROMs), can play a relevant role in patient assessment and care.

Improvement in functional outcome 1 year after nonsurgical multidisciplinary treatment for chronic pain after total knee arthroplasty: A prospective cohort study

PURPOSE

The purpose of this study was to evaluate a multidisciplinary intervention developed for patients with debilitating chronic pain after total knee arthroplasty (TKA) unresponsive to existing treatment options.

METHODS

A treatment-based prospective cohort study was caried out in 30 TKA patients with debilitating chronic pain at least 1 year after TKA. The treatment was a multidisciplinary intervention. Main inclusion criteria: no indication for surgery. Primary outcome was function measured by KOOS-PS, OKS, OKS-APQ and WORQ. Secondary outcome measures were pain, fear of movement, self-efficacy, quality of life (QoL), health care and pain medication use, work rehabilitation and patient satisfaction. The assessments took place pre- and directly posttreatment, at 1, 3 and 12 months follow-up. The clinical relevance was assessed by predefined minimal important clinical change (MCIC).

RESULTS

At baseline patients were on average 64.7 (±7.9) years old, 67% were female, and they had knee pain for 42 (10-360) months. The results at 12-month follow-up: first, a significant improvement was shown in function, pain, fear of movement, self-efficacy and QoL. Second, in 38.5%-69.2% of patients clinical relevant improvement was shown for functional outcome, 31% for pain, and 50% for self-efficacy. Third, 42% of patients reported 'no healthcare use in the past three months'.

CONCLUSION

One year after a multidisciplinary treatment a clinically relevant improvement was shown in terms of function, pain, self-efficacy and QoL. It seems to be a promising treatment option in this difficult-to-treat patient group with debilitating chronic pain after TKA. Future research should examine the effect of the treatment in a larger study population, considering a control group, and focusing on the working population and evaluating cost-efficacy.

LEVEL OF EVIDENCE

Level II.

Fluoroscopic and radiostereometric analysis of a bicruciate-retaining versus a posterior cruciate-retaining total knee arthroplasty: a randomized controlled trial

AIMS

The aim of this study was to compare a bicruciate-retaining (BCR) total knee arthroplasty (TKA) with a posterior cruciate-retaining (CR) TKA design in terms of kinematics, measured using fluoroscopy and stability as micromotion using radiostereometric analysis (RSA).

METHODS

A total of 40 patients with end-stage osteoarthritis were included in this randomized controlled trial. All patients performed a step-up and lunge task in front of a monoplane fluoroscope one year postoperatively. Femorotibial contact point (CP) locations were determined at every flexion angle and compared between the groups. RSA images were taken at baseline, six weeks, three, six, 12, and 24 months postoperatively. Clinical and functional outcomes were compared postoperatively for two years.

RESULTS

The BCR-TKA demonstrated a kinematic pattern comparable to the natural knee's screw-home mechanism in the step-up task. In the lunge task, the medial CP of the BCR-TKA was more anterior in the early flexion phase, while laterally the CP was more posterior during the entire movement cycle. The BCR-TKA group showed higher tibial migration. No differences were found for the clinical and functional outcomes.

CONCLUSION

The BCR-TKA shows a different kinematic pattern in early flexion/late extension compared to the CR-TKA. The difference between both implants is mostly visible in the flexion phase in which the anterior cruciate ligament is effective; however, both designs fail to fully replicate the motion of a natural knee. The higher migration of the BCR-TKA was concerning and highlights the importance of longer follow-up.Cite this article: Bone Joint J 2023;105-B(1):35-46.