EFAS Score-Validation of Spanish and Estonian Versions by the Score Committee of the European Foot and Ankle Society (EFAS).

BACKGROUND: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in 11 languages (Dutch, English, German, Finnish, French, Italian, Polish, Portuguese, Persian, Swedish, Turkish). From other languages under validation, the Spanish and Estonian versions completed data acquisition and underwent further validation. METHODS: The EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during the initial validation study), 2) item reduction and scale exploration (completed during the initial validation study), 3) confirmatory analyses and responsiveness of the Spanish and Estonian versions (completed during the initial validation study in seven other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory. RESULTS: The internal consistency of the scale was confirmed in the Spanish and Estonian versions (Cronbach's Alpha>0.8). Responsiveness was good, with moderate to large effect sizes in both languages, and evidence of a statistically significant positive association between the EFAS Score and patient-reported improvement. CONCLUSIONS: The Spanish and Estonian EFAS Score versions were successfully validated in orthopaedic ankle and foot surgery patients, with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.

Cross-cultural adaptation and validation of the Estonian version of the Oxford Knee Score.

OBJECTIVE: The aim of this study was to adapt the Estonian version of The Oxford Knee Score (OKS) and test its psychometric properties. METHODS: The original OKS questionnaire was translated into Estonian using the forward and back-translation method recommended in the literature. The face validity of the Estonian OKS was then tested. 150 consecutive patients who had undergone total knee replacement (TKR) received the Estonian version of OKS, the Short Form 36 Health Survey (SF-36), and a visual analogue scale (VAS) for pain by mail twice with an interval of 1 month. OKS total score, its functional, and pain subscales were examined. Floor and ceiling effects were assessed. Reliability was evaluated by measuring test-retest reliability and internal consistency. Construct validity was measured by examining the correlation of OKS, its functional and pain subscales with VAS and the subscales of SF-36. RESULTS: The Estonian version of OKS was assessed equivalent to the original and was satisfactorily accepted by patients on face validity testing. The Estonian OKS performed well on psychometric testing with good test-retest reliability (Spearman's rho 0.8887, P < 0.001, for the overall score) and internal consistency (Cronbach's alpha for the overall score 0.9353 and 0.9177 on the first and second assessment, respectively). It showed expected correlations with SF-36 subscales (strongest with the physical functioning and pain subscales and weakest with the emotional functioning subscale) and a strong correlation (Spearman's rho -0.8618 and -0.6967 on the first and second assessment respectively) with VAS for pain. A small proportion of patients demonstrated a ceiling value on both assessments, whereas a floor effect was not evident. CONCLUSION: The Estonian version of OKS is a reliable and valid instrument providing a standardized measure of patient-reported outcome for evaluating the results of TKR. LEVEL OF EVIDENCE: Level IV, Prognostic Study.

Prevalence of anterior knee pain among patients following total knee arthroplasty with nonreplaced patella: a retrospective study of 1778 knees.

BACKGROUND AND OBJECTIVE: Anterior knee pain (AKP) may compromise the results of total knee arthroplasty in more than quarter of cases. The aim of the current work was to determine the prevalence of AKP and the severity of patellofemoral symptoms among patients who received a total knee arthroplasty with non-replaced patella in East-Tallinn Central Hospital from January 1, 2000 to December 31, 2009. MATERIALS AND METHODS: We carried out a retrospective study involving 1778 consecutive total knee arthroplasties with non-replaced patella. Mean follow-up time was 68 months. We collected data by two patient-reported measures: the knee pain questionnaire and the Kujala score. RESULTS: We diagnosed AKP among 20.2% of patients, 33.6% had pain in the knee from a source other than patellofemoral joint and 46.2% were pain free. In 87.3% of AKP cases the pain emerged within the first five years of knee replacement. AKP was more prevalent among patients with osteoarthritis compared to rheumatoid arthritis and among patients below 60 years. There was no difference in the prevalence of AKP in terms of gender or mobile and fixed bearing implants. The severity of patellofemoral symptoms in case of AKP was moderate. CONCLUSIONS: AKP is a frequent complication of total knee arthroplasty with non-replaced patella and patients undergoing this procedure should be apprised of the high probability of experiencing pain in the anterior part of the replaced knee.

Anterior knee pain following total knee replacement correlates with the OARSI score of the cartilage of the patella.

BACKGROUND: Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP. PATIENTS AND METHODS: We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP. RESULTS: 57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6-20) and that of patients with AKP was 15 (6-20) (p = 0.04). Patients with OARSI scores of 13-24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0-2.3) than patients with OARSI scores of 0-12. INTERPRETATION: The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement.

The patellar shift index: a reliable and valid measure for patellofemoral congruence following total knee arthroplasty with unresurfaced patella.

OBJECTIVE: The aim of this study was to develop a new radiographic measure, the patellar shift index (PSI), for the precise estimation of patellar position relative to the trochlea after a total knee replacement with an unresurfaced patella. METHODS: This study included radiographs of 51 patients suffering from anterior knee pain following total knee arthroplasty. Patellofemoral axial radiographs were analyzed to compare the reliability of the PSI to the classical measures of patellofemoral congruence, the lateral patellar tilt (LPT) and patellar displacement (PD). Intra-rater reliability of the PSI, LPT and PD was estimated using the intraclass correlation coefficient (ICC) and the inter-rater reliability using Krippendorff's alpha (Kα). Agreement proportion of was calculated for the PD. Face validity of the PSI was also tested. RESULTS: The PSI had excellent intra (mean ICC=0.91) and inter-rater (Kα=0.92) reliability, as did LPT (mean ICC=0.96; Kα=0.89). The calculation of PD caused a low level of agreement (47.1%) between evaluators in terms of which images could be measured. The exclusion of these radiographs resulted in a high PD intra (ICC=0.96) and inter-rater (Kα=0.97) reliability. CONCLUSION: The PSI appears to be a reliable and valid measure for patellofemoral congruence in a replaced knee joint with an unresurfaced patella. The superiority of the PSI is the result of its consideration of the geometry and size of the replaced knee joint and independence from radiographic magnification.