215 / 242
215
Introduction
In the treatment of osteoarthritis, the evalua
tion of patients before and after surgery is
essential.
With the evolution of medicine, tribology and
patient lifestyles, this evaluation has gradually
extended to all aspects of patient outcomes:
objective data, function, and more recently:
psycho-social context, expectations, patients
satisfaction, and quality of life. These data are
particularly important as younger, more active
and more demanding patients are now
undergoing surgery for arthritis.
Just as for an older patient, a young patient
expects surgery to alleviate their pain, but also
to restore knee function adequatly for the
resumption of professional and sporting
activities. If this is not understood, the patient
may be disappointed even if the objective result
is satisfactory [1, 2]. As such, the quality of the
result is determined by patient satisfaction.
Evaluation requires the use of scoring systems.
Current scores may cover most aspects of patient
assessment, but it is still often necessary to use
more than one instrument. Recent scores involve
the use of self-administered questionnaires to
collect patient reported outcomes, thus
increasing their reliability [3, 4].
Clinical evaluation
and basic functions
The oldest score is the
Hospital for Special
Surgery score
(HSS) created by Insall in 1974.
This evolved into the
Knee Society score
(KSS
or IKS: International Knee Society score) in
1989 [5]. It is currently one of the most used
score worldwide.
The KSS consists of two separate parts
evaluating clinical data and knee function. The
knee score and functional score are each scored
out of 100 points. Objective data include
alignment, range of motion, pain and stability.
The functional assessment includes walking
distance, stair climbing, and use of gait aids.
Higher scores indicate better results. This test
includes a radiographic evaluation [6].
The main advantage of this score is ease of use.
It can be used before and after surgery, and
applies to all stages of osteoarthritis. In
addition, its psychometric properties have been
validated [7].
The
Western Ontario and McMaster
Universities Osteoarthritis Index
(WOMAC)
is a self-administered questionnaire created in
1988 by Bellamy, and is commonly used in its
shortened version [8]. It covers four domains:
symptoms, stiffness, pain, and activities of
Functional assessment:
specificity of young patients
C. Debette, V. Villa, E. Servien,
S. Lustig, O. Raynaud, Ph. Neyret