Sensitivity of Total Knee Arthroplasty Physical Function Outcome Measures

The most commonly used clinical outcome measures for assessment of function in total knee arthroplasty (TKA) patients are primarily subjective, and may lack sensitivity to detect functional improvement over time. PURPOSE: The purpose of this investigation was to examine the sensitivity of four different outcome measures in TKA patients. METHODS: We studied the functional performance of 12 (n= 12) TKA patients, before, 6 weeks after, and 3 months after TKA using the traditional, but primarily subjective Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), Knee Society Clinical Rating System (KSCRS), and Short Form Physical Function (SF-36v.2) scales, and a recently developed objective functional assessment test known as the Continuous Scale Physical Function Performance test (CS-PFP10). Patients were 2 males and 10 females with an age range of 53–79. RESULTS: At baseline, the mean values for the CS-PFP10 total score, WOMAC Physical Function Score, affected knee function score of the KSCRS, and SF-36 Physical Composite scores were 33.38±19.52, 42±12.66, 33.38±9.25, and 37.32±9.42, respectively. At baseline, the CS-PFP10 total score and physical domain scores correlated well with the WOMAC, KSCRS, and SF-36 Physical Composite scores. At 6 weeks post-operative (post-op) assessments, all measures revealed functional improvement with mean values of 42.71±15.78 for CS-PFP10, 23.08±11.08 for WOMAC Physical Function, 49.62±9.99 for KSCRS Function Score, and 39.6±8.69 for SF-36 Physical Composite Score (p≤0.05). The CS-PFP10 total score and the KSCRS Function and Knee scores improved further from 6 weeks to 3 months post-op (p≤0.05). Also, CS-PFP10 domain scores of lower body strength, endurance, and balance and coordination further improved from 6 weeks to 3 months (p≤0.05). The mean scores for total CS-PFP10 and KSCRS function were 49.82±14.54 and 66.08±1 3.95, respectively. WOMAC and SF-36 scores did not improve from 6weeks to 3 months post-op. These data suggest that the CS-PFP10 is capturing the information gleaned from the traditional subjective outcome measures applied in TKA, but moreover, the CS-PFP10 appears to be detecting changes in function that occur between 6 weeks and 3 months post-op. CONCLUSION: The CS-PFP10 and KSCRS appear to be superior tests in situations where sensitivity to change in physical function is an important consideration. Continued examination of the CS-PFP10 and KSCRS may provide insight into choice of functional assessment instruments when working with TKA patients.

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