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Hinweis der Redaktion
- Assessing function following knee replacement has always been difficult. Scoring systems were designed in the 1980’s. These scores variously included points for knee flexion, and walking distance. Negative scores were added for fixed flexion deformity, malalignment, residual pain and walking aids. However these scores were developed when residual pain, malalignment and instability were commonplace and the function expectations was to undertake shopping and ADL. These indirect parameters of function are less relevant to the current situation where patients expectations are much greater and sport, recreation, work and longevity are the patients criteria. What is the real measure of function following knee replacement? This must address the functional demands of the relevant population and include parameters for walking speed, walking endurance, standing endurance, stair climbing ability and perhaps extensor muscle strength. There is no such score or assessment. However we can estimate such function crudely and indirectly by the range of motion, and knee score. The early function can reasonably be estimated by the range of early knee flexion, time of hospital discharge and post-op analgesia requirement. However we must be cognisant of the fact that this is a crude low level assessment. Function on stairs, endurance or sports is a current expectation and possibility with a successful knee replacement and these parameters would be a better outcome measure for today's patient. Holistic and satisfaction assessment can be measured by the SF36 or WOMAC scores but again this does not really relate to objective function of the knee. However these are the tools we have.