Functional Outcomes After Total Knee Arthroplasty: Comparing Knee Society and Osteoarthritis Outcome Scores
A Comparative Analysis of KSS And KOOS in TKA
DOI:
https://doi.org/10.36283/ziun-pjmd14-1/013Keywords:
Patient Outcome Assessment, Quality of Life, Osteoarthritis, Arthroplasty, Knee JointAbstract
Background: Total knee arthroplasty (TKA) is a regularly performed procedure intended to improve function and relieve discomfort. To assess which Functional outcome tool is better, this study has been used to compare the Knee Society Score (KSS) with the Knee Injury and Osteoarthritis Outcome Score (KOOS) before and after performing a total knee arthroplasty (TKA).
Method: This was a prospective Observational study conducted from 2018 to 2021. All patients who underwent primary TKA at Dr. Ziauddin Hospital, Clifton Campus, Karachi, were evaluated preoperatively and then 6 and 12 months postoperatively. Paired t-tests were used to compare the KSS and KOOS scores preoperatively and 6 months and 12 months postoperatively. A P-value of >0.05 was considered significant.
Results: There was no significant variation in the statistics between the improvement of the two scores. KOOS focuses more on incorporating patient-reported objectives like life quality and everyday activities, while KSS emphasises objective aspects more, including range of motion, alignment, and stability. At 6-month comparison, showed a substantial difference, tilting towards KSS (p=0.002) in all collected measures, except for life quality. However, the changes were not as visible when compared to 12 months. 89% of the individuals responded satisfactorily one year following TKA, expressing their delight with the outcomes of the surgery.
Conclusion: KSS and KOOS have both proven useful tools for computing functional outcomes after TKA. The results show the liveliness of taking the patient-reported outcomes into account and its objectiveness in demonstrating how effective TKA is.
References
Karasavvidis T, Pagan Moldenhauer CA, Lustig S, Vigdorchik JM, Hirschmann MT. Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA)–there is no winner yet. Journal of Experimental Orthopaedics. 2023 Nov 22;10(1):120. doi.org/10.1186/s40634-023-00697-7
Dunbar MJ. Subjective outcomes after knee arthroplasty. Acta Orthopaedica Scandinavica. 2001 Jan 1;72(sup301):1-63. doi.org/10.1080/000164702760300301
Lizaur‐Utrilla A, Gonzalez‐Parreño S, Martinez‐Mendez D, Miralles‐Muñoz FA, Lopez‐Prats FA. Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 May;28(5):1473-8. https://doi.org/10.1007/s00167-019-05543-x
Larsen P, Rathleff MS, Roos EM, Elsoe R. Knee injury and osteoarthritis outcome score (KOOS)–National record-based reference values. The Knee. 2023 Aug 1;43:144-52. https://doi.org/10.1016/j.knee.2023.06.004
Vogel N, Rychen T, Kaelin R, et al. Patient-reported outcome measures (PROMs) following knee arthroplasty: a prospective cohort study protocol. BMJ Open 2020;10:e040811. doi: 10.1136/bmjopen-2020-040811
Walker PS, Walker PS. Evaluations of Designs and Techniques: Which Evaluation Methods Are Applicable, and Are There Differences Between Designs and Techniques?. The Artificial Knee: An Ongoing Evolution. 2020:265-93. doi.org/10.1007/978-3-030-38171-4_14
Zhang H, Zhou Y. Concept verification of a remote automatic scoring system for evaluating knee function after total knee arthroplasty. The Journal of Knee Surgery. 2021 Mar;34(04):464-70. doi: 10.1055/s-0040-1710568.
Noble PC, Scuderi GR, Brekke AC, Sikorskii A, Benjamin JB, Lonner JH, Chadha P, Daylamani DA, Scott WN, Bourne RB. Development of a new Knee Society scoring system. Clinical Orthopaedics and Related Research®. 2012 Jan;470:20-32. doi.org/10.1007/s11999-011-2152-z
Gupta A, Potty AS, Ganta D, Mistovich RJ, Penna S, Cady C, Potty AG. Streamlining the KOOS activities of daily living subscale using machine learning. Orthopaedic journal of sports medicine. 2020 Mar 24;8(3):2325967120910447. doi: 10.1177/2325967120910447.
Steinhoff AK, Bugbee WD. Knee Injury and Osteoarthritis Outcome Score has higher responsiveness and lower ceiling effect than the Knee Society Function Score after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Aug;24:2627-33. doi.org/10.1007/s00167-014-3433-3.
Hamawandi SA, Amin HI, Al-Humairi AK. Effects of the use of tourniquet in total knee arthroplasty on the clinical and functional outcomes with 5 years of follow-up: a randomised controlled trial. The Journal of Knee Surgery. 2023 Jan;36(02):222-30. doi: 10.1055/s-0041-1731719.
Kim J, Min KD, Lee BI, Kim JB, Kwon SW, Chun DI, Kim YB, Seo GW, Lee JS, Park S, Choi HS. Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surgery & Related Research. 2020 Dec;32(1):1-2. doi.org/10.1186/s43019-020-00067-y
Goyal T, Tripathy SK. Does patient-specific instrumentations improve short-term functional outcomes after total knee arthroplasty? A systematic review and meta-analysis. The Journal of Arthroplasty. 2016 Oct 1;31(10):2173-80. doi.org/10.1016/j.arth.2016.03.047
Wendelspiess S, Kaelin R, Vogel N, Rychen T, Arnold MP. No difference in patient-reported satisfaction after 12 months between customised individually made and off-the-shelf total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Sep;30(9):2948-57. doi.org/10.1007/s00167-022-06900-z.
Dagneaux L, Jordan É, Michel E, Karl G, Bourlez J, Canovas F. Are modern knee outcomes scores appropriate for evaluating anterior knee pain and symptoms after total knee arthroplasty?. Orthopaedics & Traumatology: Surgery & Research. 2022 Dec 1;108(8):103292. doi.org/10.1016/j.otsr.2022.103292.
Stucinskas J, Robertsson O, Sirka A, Lebedev A, Wingstrand H, Tarasevicius S. Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength: 91 patients assessed after 1 year. Acta orthopaedica. 2015 Nov 2;86(6):728-33. doi.org/10.3109/17453674.2015.1059689
Roos EM. 30 years with the Knee injury and Osteoarthritis Outcome Score (KOOS). Osteoarthritis and Cartilage. 2024 Apr 1;32(4):421-9. doi.org/10.1016/j.joca.2023.10.002
Batailler C, Swan J, Sappey Marinier E, Servien E, Lustig S. New technologies in knee arthroplasty: current concepts. Journal of Clinical Medicine. 2020 Dec 25;10(1):47. doi.org/10.3390/jcm10010047
Nishitani K, Nakamura S, Kuriyama S. Clinical evaluation of knee joint diseases. Journal of Joint Surgery and Research. 2023 Dec 1;1(1):9-17. doi.org/10.1016/j.jjoisr.2022.12.003
Goh GS, Bin Abd Razak HR, Tay DK, Lo NN, Yeo SJ. Early post-operative oxford knee score and knee society score predict patient satisfaction 2 years after total knee arthroplasty. Archives of orthopaedic and trauma surgery. 2021 Jan;141:129-37. doi.org/10.1007/s00402-020-03612-2
Crizer MP, Kazarian GS, Fleischman AN, Lonner JH, Maltenfort MG, Chen AF. Stepping toward objective outcomes: a prospective analysis of step count after total joint arthroplasty. The Journal of arthroplasty. 2017 Sep 1;32(9):S162-5. doi.org/10.1016/j.arth.2017.02.058
Bohm ER, Kirby S, Trepman E, Hallstrom BR, Rolfson O, Wilkinson JM, Sayers A, Overgaard S, Lyman S, Franklin PD, Dunn J. Collection and reporting of patient-reported outcome measures in arthroplasty registries: multinational survey and recommendations. Clinical Orthopaedics and Related Research®. 2021 Oct 1;479(10):2151-66. doi:10.1097/CORR.0000000000001852
Kwon HM, Lee JA, Koh YG, Park KK, Kang KT. Effects of contact stress on patellofemoral joint and quadriceps force in fixed and mobile-bearing medial unicompartmental knee arthroplasty. Journal of Orthopaedic Surgery and Research. 2020 Dec;15:1-8. doi.org/10.1186/s13018-020-02047-0
Neuprez A, Delcour JP, Fatemi F, Gillet P, Crielaard JM, Bruyère O, Reginster JY. Patients’ expectations impact their satisfaction following total hip or knee arthroplasty. PLoS One. 2016 Dec 15;11(12):e0167911. doi.org/10.1371/journal.pone.0167911
D’Amato M, Kosse NM, Wymenga AB. Restoration of pre-operative joint line orientation and alignment does not affect KSS and KOOS 1 year after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2021 Oct;29:3170-7. doi.org/10.1007/s00167-020-06097-z
Jain D, Nguyen LC, Bendich I, Nguyen LL, Lewis CG, Huddleston JI, Duwelius PJ, Feeley BT, Bozic KJ. Higher patient expectations predict higher patient-reported outcomes, but not satisfaction, in total knee arthroplasty patients: a prospective multicenter study. The Journal of arthroplasty. 2017 Sep 1;32(9):S166-70. doi.org/10.1016/j.arth.2017.01.008
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
