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Background <p>Total knee arthroplasty (TKA) is increasingly performed to relieve pain and restore function in patients with advanced knee osteoarthritis. Patient-reported outcome measures (PROMs) such as the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score-12 (FJS-12) are used to assess postoperative recovery, but their comparative psychometric performance in the Indian population remains underexplored.</p> Objectives <p>To evaluate and compare the responsiveness, reliability, convergent validity, measurement error, and floor and ceiling effects of KOOS and FJS-12 in Indian patients undergoing primary TKA over a 1-year follow-up.</p> Methods <p>In this prospective observational cohort study, 150 patients (mean age 61.6 ± 7.7 years; 58% male) undergoing primary TKA were assessed using KOOS and FJS-12 at eight time points from preoperatively to 1 year postoperatively. Translation and cultural adaptation into Kannada were performed for both instruments. Non-parametric statistics were applied to evaluate longitudinal score changes, convergent validity (Spearman’s correlation), test–retest reliability (intraclass correlation coefficient), measurement error (SEM and MDC₉₅), and floor/ceiling effects<i>.</i></p> Results <p>Both KOOS and FJS-12 demonstrated significant postoperative improvement (KOOS: median 33 → 90; FJS-12: median 22.9 → 95.9). KOOS scores plateaued between 9 months and 1 year, whereas FJS-12 continued to improve, indicating superior discriminative capacity at higher functional levels. Convergent validity was moderate-to-strong preoperatively through 6 months (<i>r</i> = 0.325–0.766) but weakened at 9 months and 1 year (<i>r</i> =  − 0.118 to − 0.107), reflecting construct differentiation between functional capacity (KOOS) and joint awareness (FJS-12). Both instruments demonstrated good-to-excellent test–retest reliability, with acceptable measurement error. Ceiling effects were observed earlier in KOOS, whilst FJS-12 exhibited minimal ceiling effects until later follow-up. Floor effects were minimal, but culturally influenced due to high-flexion activities not captured by either instrument.</p> Conclusion <p>KOOS and FJS-12 complement each other in TKA outcome assessment. KOOS is suited for early postoperative evaluation, whereas FJS-12 provides superior discrimination in late recovery, capturing residual joint awareness and enabling patients to “forget” their prosthetic knee. The study validates FJS-12 in an Indian population and highlights the importance of culturally sensitive PROM selection.</p>

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Validation of the Forgotten Joint Score-12 Versus Knee Injury and Osteoarthritis Outcome Score in Postoperative Total Knee Arthroplasty: A Prospective Comparative Study

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Maruthi Chikkaballapura Venkatarayappa,
  • Manoj Bhagirathi Mallikarjunaswamy,
  • Shamanth Krishnapaty Ramesha,
  • Raghavendra Mudalabedu ShivanneGowda,
  • Mruthyunjaya Mruthyunjaya

摘要

Background

Total knee arthroplasty (TKA) is increasingly performed to relieve pain and restore function in patients with advanced knee osteoarthritis. Patient-reported outcome measures (PROMs) such as the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score-12 (FJS-12) are used to assess postoperative recovery, but their comparative psychometric performance in the Indian population remains underexplored.

Objectives

To evaluate and compare the responsiveness, reliability, convergent validity, measurement error, and floor and ceiling effects of KOOS and FJS-12 in Indian patients undergoing primary TKA over a 1-year follow-up.

Methods

In this prospective observational cohort study, 150 patients (mean age 61.6 ± 7.7 years; 58% male) undergoing primary TKA were assessed using KOOS and FJS-12 at eight time points from preoperatively to 1 year postoperatively. Translation and cultural adaptation into Kannada were performed for both instruments. Non-parametric statistics were applied to evaluate longitudinal score changes, convergent validity (Spearman’s correlation), test–retest reliability (intraclass correlation coefficient), measurement error (SEM and MDC₉₅), and floor/ceiling effects.

Results

Both KOOS and FJS-12 demonstrated significant postoperative improvement (KOOS: median 33 → 90; FJS-12: median 22.9 → 95.9). KOOS scores plateaued between 9 months and 1 year, whereas FJS-12 continued to improve, indicating superior discriminative capacity at higher functional levels. Convergent validity was moderate-to-strong preoperatively through 6 months (r = 0.325–0.766) but weakened at 9 months and 1 year (r =  − 0.118 to − 0.107), reflecting construct differentiation between functional capacity (KOOS) and joint awareness (FJS-12). Both instruments demonstrated good-to-excellent test–retest reliability, with acceptable measurement error. Ceiling effects were observed earlier in KOOS, whilst FJS-12 exhibited minimal ceiling effects until later follow-up. Floor effects were minimal, but culturally influenced due to high-flexion activities not captured by either instrument.

Conclusion

KOOS and FJS-12 complement each other in TKA outcome assessment. KOOS is suited for early postoperative evaluation, whereas FJS-12 provides superior discrimination in late recovery, capturing residual joint awareness and enabling patients to “forget” their prosthetic knee. The study validates FJS-12 in an Indian population and highlights the importance of culturally sensitive PROM selection.