Joint awareness in osteoarthritis of the hip and knee evaluated with the ‘Forgotten Joint’ Score before and after joint replacement

Jan 8, 2016Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA

Awareness of Hip and Knee Joints in Osteoarthritis Before and After Joint Replacement Using the 'Forgotten Joint' Score

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Abstract

The postoperative Forgotten Joint Score (FJS-12) was significantly higher for total hip arthroplasty (80) compared to total knee arthroplasty (70).

Preoperative FJS-12 scores were similar for hip (22) and knee osteoarthritis (24).
A preoperative floor effect was found in 15% of hip patients, while none were observed in knee patients.
Postoperative ceiling effects were noted in 33% of hip patients and 9% of knee patients.
The FJS-12 showed high reliability for knee assessments with a test-retest reliability of 0.87.
The findings suggest that the FJS-12 may be a useful tool for evaluating outcomes in knee arthroplasty.

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PURPOSE: To utilize the 'Forgotten Joint' Score (FJS), a 12-item questionnaire analysing the ability to forget the joint, for comparing preoperative status in osteoarthritic patients scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA). Higher scores represent a better result with a maximum of 100. The hypothesis of this study was that a preoperative difference in favour of hip arthritis could eventually explain why THA is cited more often as a forgotten joint than TKA.

METHODS: A prospective cohort study was conducted in 150 patients with either tricompartmental knee (n = 75) or hip osteoarthritis (n = 75). Patients completed FJS-12 scores preoperatively and 1 year postoperatively.

RESULTS: A similar preoperative FJS-12 was observed for hip (22 (15)) and knee osteoarthritis (24 (17)) (n.s.). The postoperative FJS-12 score was significantly higher for THA (80 (24)) than for TKA (70 (27)) (p < 0.05). High reliability after 6 weeks was observed for the preoperative FJS-12 test-retest reliability (ICC = 0.87) in TKA. A preoperative floor effect of 15 % in THA and 0 % in TKA was found as well as a postoperative ceiling effect of 33 % in THA and 9 % in TKA.

CONCLUSIONS: The clinical relevance of utilizing the FJS-12 as an instrument to evaluate outcome is strongly proposed for knee arthroplasty. In general, one is not aware of a healthy joint during the ADL, and it can therefore be regarded as 'forgotten'. The preoperative FJS-12 Score is a powerful tool to provide patients with clearer insights into their positive evolution after surgery. The use of the FJS-12 in THA is a topic for further research, as this study found that floor and ceiling effects limit its usefulness in studies evaluating clinical outcome in this area.

LEVEL OF EVIDENCE: II.

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Joint awareness in osteoarthritis of the hip and knee evaluated with the ‘Forgotten Joint’ Score before and after joint replacement

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