Responsiveness, Reliability, and Validity of Arabic Version of Oxford Knee Score for Total Knee Arthroplasty.

BACKGROUND: The Oxford Knee Score (OKS) is a reliable, valid, and sensitive assessment tool for individuals undergoing a total knee arthroplasty (TKA). The published psychometric assessment of the Arabic version of the OKS (OKS-Ar) is limited to male patients and has not been assessed for responsiveness following TKA. The aim of this study was to assess the reliability, validity, and responsiveness of the OKS-Ar in an inclusive population of patients undergoing TKA. METHODS: One hundred Arabic-speaking patients awaiting TKA were assessed with the OKS-Ar, the Arabic version of the Knee injury and Osteoarthritis Outcome Score (KOOS-Ar), and a visual analogue scale for pain (VAS-P) in order to assess the correlation between the OKS-Ar and the KOOS-Ar and VAS-P and determine the construct validity. Repeat assessments were completed 7 to 10 days after the first assessment and 6 months after TKA. RESULTS: Questionnaires were completed by 80 female and 20 male participants with a mean age of 62 ± 8 years. The test and retest median scores showed no significant difference from one another, with a strong Spearman correlation between the 2 measurements (rs = 0.94). Bland-Altman limits of agreement showed no significant bias. The Cronbach alpha was 0.85 indicating high internal consistency. There was no floor or ceiling effect before TKA, and the post-TKA ceiling effect was only 2%. The OKS-Ar pain component correlated strongly with the KOOS-Ar pain subscale (rs = 0.73). The OKS-Ar effect size was 3.09, which was larger than that of all of the KOOS subscales at 6 months after TKA. CONCLUSIONS: To our knowledge, this is the first study to assess reliability, validity, and responsiveness of the OKS-Ar after TKA. The validity and reliability results are similar to those found for both the original English-language OKS and the OKS translated into other languages. We believe that this is also the first study to assess OKS-Ar responsiveness after TKA and to show a large effect size. We found that the OKS-Ar is a feasible, valid, reliable, and sensitive measurement tool to assess pain and function in TKA-treated individuals whose main language is Arabic.

Quantification Analysis of the Intraoperative Bacterial Contamination Rate and Level in Osteochondral Autografts.

BACKGROUND: Inadvertent contamination of osteochondral (OC) autografts during harvesting and preparation can lead to significant complications and can cause the operating team to weigh the infection risk after reimplantation against discarding the OC fragment. The most commonly reported contamination mechanism is the accidental dropping of an OC fragment; however, associated contamination levels remain unclear. The rate and level of contamination during standard harvesting and preparation are also unknown. PURPOSE: To quantitatively evaluate the rate and level of bacterial contamination of OC autografts during harvesting and preparation compared with those of accidently dropped autografts. STUDY DESIGN: Controlled laboratory study. METHODS: Under sterile conditions, 138 fresh OC specimens were harvested and retrieved from 23 primary total knee arthroplasties (TKAs). Six OC fragments were retrieved from each TKA: 3 were used as controls, and 3 were dropped onto the operating room floor. Each specimen was incubated to allow for aerobic and anaerobic growth, and the number of colony-forming units (CFUs) per gram was calculated. RESULTS: Contamination rates (positive cultures) for the control and dropped groups were 29% (n = 20/69) and 42% (n = 29/69), respectively. The difference in the contamination rate between groups was not statistically significant (P = .109). The most common organisms identified were Staphylococcus aureus (40%) in the control group and Staphylococcus epidermidis (24.1%) and Bacillus species (20.7%) in the dropped group. The contamination level (CFUs/g) for both groups was low. The median (range) CFUs/g among the contaminated specimens in the dropped and control groups were 27 (1-120) and 3 (1-15), respectively (P < .0001). CONCLUSION: A relatively high rate of OC autograft contamination can be expected during harvesting and preparation (29%) or after accidentally dropping a specimen (42%). Although the types of organisms isolated differed between specimens contaminated during harvesting and preparation and dropped specimens, the quantification of the autograft contamination level revealed a very low CFUs/g in both cases. CLINICAL RELEVANCE: The intraoperative autograft contamination level is very low. Hence, in cases of grafts with a known contamination incident, saving and reimplanting them after proper decontamination is recommended over discarding them or using an allograft.

Incidence of groin pain after metal-on-metal hip resurfacing.

UNLABELLED: Metal-on-metal hip resurfacing is offered as an alternative to traditional THA for the young and active adult with advanced osteoarthritis. However, patients undergoing hip resurfacing may be predisposed to persistent groin pain due to insufficient head/neck offset, an uncovered acetabular component, or both. We therefore determined the incidence of groin pain after metal-on-metal hip resurfacing, its impact on patient function, and possible risk factors contributing to groin pain. We evaluated 116 patients with a followup of at least 12 months after surgery (mean, 26 months; range, 12-61 months). The mean age was 48.8 years (range, 24.0-66.3 years), with 21 women (18%) and 95 men (82%). All patients were evaluated clinically and radiographically and had a Harris hip score, WOMAC, UCLA Activity Rating Scale, and the RAND-36 General Health measure; they were specifically asked if they experienced groin pain currently or since their surgery. Although all patients had functional improvements postoperatively, 21 of 116 of the patients (18%) reported groin pain; 12 of these (10% of the total) stated the pain limited their activities of daily living and 11 (10%) required medication for pain. Female patients were at greater risk of having groin pain. Of the patients with groin pain, three patients had muscle atrophy with a joint effusion on CT; one of these patients had revision surgery for the pain. Patients with metal-on-metal resurfacing may have a higher incidence of pain than those with conventional THA. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Canadian academic experience with metal-on-metal hip resurfacing.

The current depth and breadth of experience in hip resurfacing in Canadian academic centers is not well known. This study endeavors to increase awareness of the prevalence of programs and current experience in a select number of representative teaching centers by examining the learning curve of high-volume surgeons. A questionnaire was sent to all academic centers in Canada to identify the volume of hip resurfacing, surgical approach, and type of prosthesis. In addition, five surgeons, not fellowship-trained in hip resurfacing, were selected for a detailed review of their first 50 cases, including survey of patient demographics, surgical approach, radiographic evaluation, complications, and revision. Eleven of 14 academic centers are currently performing hip resurfacing. All of these centers had performed more than 50 cases, with 10 of 11 of them having more than one surgeon performing the procedure. The posterior approach was found to be the most commonly utilized in surgeries. The overall revision rate was 3.2% at a mean time of 2 years, with femoral neck fracture (1.6%) being the most common cause for failure. The failure rate was comparable to other centers of expertise and lower than previously published multicenter trials. All surgeons reviewed were in specialized arthroplasty practices, which may contribute to the relatively low complication rates reported.