Rating systems for total knee replacement

The objective assessment of outcome of surgical procedures is assuming increasing significance as the culture of audit and revalidation advances. There is a clear need for surgeons in all fields, but especially in Orthopaedics, to be familiar with the available scoring systems and their relative strengths and weaknesses. It is clear from a recent survey of BASK members’ practice that there is little consensus about which system to use (addendum). This review presents a summary of the scoring systems available for the assessment of patients undergoing total knee replacement. These scores are described in detail and their relative merits discussed. None of the systems reviewed is perfect but those developed most recently do appear to offer advantages over older systems. Overall, the Western Ontario and McMaster University Osteoarthritis Index, Short Form 36 and Oxford Knee Score have undergone the most thorough assessment of reliability and validity and are therefore appropriate for the assessment of outcome after total knee replacement.