Melbourne Knee Surgeon Parminder J Singh uses the Oxford knee score (OKS), which is a joint specific outcome measure tool designed to assess disability in patients suffering from knee pain secondary to arthritis.
The OKS range between zero and 48 points (where zero indicates the most severe problems and higher values indicate better function). The OKS has been shown to be validated measures of pre-surgery disease state and outcomes of knee replacement.
Patients should be referred to specialist to be assessed for a possible knee replacement when pain persists after non-operative care management.
Previous studies have introduced guidelines for referral that have included a maximum pre-surgery OKS, set as a threshold that acts as hard boundary for referral to a specialist or not. The thresholds have varied between 18 and 30 points. Recently the Oxford group published research in 2020 to support the use of score thresholds and provided some evidence-based guidance for the selection of threshold levels.
The upper pre-surgery score threshold, above which individual are less likely to achieve any meaningful benefit from surgery, is 41 for the knee. At lower scores, the likelihood of improvement increases towards a maximum of 88% for knees. This evidence should protect patients against undergoing surgery that is unlikely to be of value.
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