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The patient results and satisfaction of knee arthroplasty in a validated grading system

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Abstract

Introduction

The validated Knee Osteoarthritis Grading System (KOGS) was implemented and clinical results were compared with patient satisfaction data and implant survivorship in a multi-centre study with surgeons familiar with unicompartmental knee arthroplasty (UKA), patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA).

This is also the first study to evaluate the prevalence of UKA and TKA in consecutive osteoarthritis (OA) knee arthroplasties assessed by this system..

Method

A consecutive cohort of knees was gathered at three different institutions as categorized by KOGS and surgically treated with the recommended implant unless clinical reasons or patient preference precluded such an option.

One thousand one hundred seventy-seven consecutive knees were evaluated including 311 TKA (26%), 695 medial UKA (59%), 154 lateral UKA (13%) and 17 PFA (2%) and the results of the categories evaluated with the Oxford Knee Score (OKS) and the complications reflected in the different categories.

Results

The failure rate of the UKA (3.5%) or TKA (1.6%) is not higher than accepted results in the literature and the difference in complications is negligible between the UKA (72%) and TKA (26%) cohorts.

Revision of a UKA to a TKA as an endpoint was 0.58% with ipsilateral progression at 0.8% over a period of five to 84 months (mean follow-up of 36 months) despite the ‘excessive’ proportion of UKA in this cohort.

The Oxford Score improvement is significant in TKA and UKA and contributes to the acceptable outcomes (The OKS for TKA improved from 20 pre-operatively to 36 post-operatively and the UKA improved from 22 pre-operatively to 39 post-operatively).

Conclusion

KOGS achieves acceptable early survival and functional results when implemented and is a suitable tool for identifying the preferred implant as was validated.

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Acknowledgements

The authors would like to thank Margaret Houman (Research Manager) and Andricha Viljoen (Researcher).

Author declarations

We, the authors declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. All authors have participated in the research. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

We understand that the Corresponding Author, CR Oosthuizen, is the sole contact for the Editorial process.

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Authors and Affiliations

  1. Private Orthopaedic Practice, Johannesburg, South Africa

    Christiaan Rudolf Oosthuizen

  2. Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa

    Christiaan Rudolf Oosthuizen & Sebastian Magobotha

  3. Head of the Health Innovation and Research Institute, Ghent University Hospital, Ghent, Belgium

    Catherine Van Der Straeten

  4. Faculty of Health Sciences, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

    Innocent Maposa

  5. Private Orthopaedic Practice, Pretoria, South Africa

    Christian Hugo Snyckers & Duwayne Peter Vermaak

Authors
  1. Christiaan Rudolf Oosthuizen
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  2. Catherine Van Der Straeten
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  3. Innocent Maposa
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  4. Christian Hugo Snyckers
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  5. Duwayne Peter Vermaak
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Corresponding author

Correspondence to Christiaan Rudolf Oosthuizen.

Ethics declarations

Conflict of interest

All authors declare that they received no research grants from funding agencies for this research.

Author 1 is an ad hoc paid consultant for Zimmer Biomet and Amplitude. Author 2 has received a speaker honorarium for a presentation on general aspects of Research and Innovation from Smith & Nephew.

No other interests required declaration as no benefits in any form have been received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

Ethical approval was obtained from the Human Research Ethics Committee at the University of the Witwatersrand (WITS) to study the data and X-rays of the individual orthopaedic practices with Clearance Certificate Nos. M1704111 and M1704112. All procedures performed in studies involving human participants were in accordance with the ethical standards of the above named institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Copyright and license term

The appendix containing the synopsis of KOGS and the KOGS flowchart with radiographs was published as an open access article under the Creative Commons Attribution License CC BY-NC-ND. [Oosthuizen CR, Takahashi T, Rogan M, et al. (2019) The Knee Osteoarthritis Grading System for Arthroplasty. J Arthroplasty 34:450–455. https://doi.org/10.1016/j.arth.2018.11.011], which permits unrestricted use, distribution and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source.

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Appendix. Synopsis of KOGS [22]

Appendix. Synopsis of KOGS [22]

The grading system consists of four grades with treatment options to be implemented. Despite the specific grading achieved, there are clinical reasons which can influence the final decision for a particular prosthesis e.g. rheumatoid arthritis, clinically assessed disruption of ligaments, excessive deformities or patient-specific considerations or preferences. KOGS cannot be the only deciding factor.

Grade 1

Single TF or PF joint OA

Degeneration affects any one of the three compartments, with K&L grade 4 degeneration.

Grade 2

Single TF OA and ‘pseudolaxity’

AP view subluxation, isolated K&L grade 4 wear defects cause AP translation without ligament instability (stress X-ray restoration of JLCA < 2°).

On average, above this line would be UKA and below TKA

Grade 3

A: Single TF OA with K&L grade 4 and concomitant ACL instability with sagittal translation.

B: Single TF OA with K&L grade 4 and severe PF joint pathology or patellectomy.

Grade 4

4 A: Both TF joints are K&L grade 3 or 4 (< 5 mm space) with ligament stability.

4 B: Both TF joints

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Oosthuizen, C.R., Van Der Straeten, C., Maposa, I. et al. The patient results and satisfaction of knee arthroplasty in a validated grading system. International Orthopaedics (SICOT) 43, 2747–2755 (2019). https://doi.org/10.1007/s00264-019-04412-z

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