Total knee replacement (TKR) is the mainstay of treatment for people with end-stage knee OA among suitably “fit” candidates. As a high cost, high volume procedure with a worldwide demand that continues to grow it has become increasingly popular to measure response to surgery. While the majority who undergo TKR report improvements in pain and function following surgery, a significant proportion of patients report dissatisfaction with surgery as a result of ongoing pain or poor function. Poor outcomes of TKR require care that imposes on already overburdened health systems. Accurate and meaningful capture and interpretation of outcome data are imperative for appropriate patient selection, informing those at risk, and for developing strategies to mitigate the risk of poor results and dissatisfaction. The ways in which TKR outcomes are captured and analysed, the level of follow-up, the types of outcome measures used, and the timing of their application vary considerably within the literature. With this in mind, we reviewed four of the most commonly used joint specific outcome measures in TKR. We report on the utility, strengths, and limitations of the Oxford knee score (OKS), knee injury and osteoarthritis outcome score (KOOS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and knee society clinical rating system (KSS). 1. Background Total knee replacement is a major surgical procedure that requires multidisciplinary input prior to and after surgery to ensure the best possible outcome. Recovery from surgery is optimized with the inclusion of rehabilitation programs which are tailored to restore mobility and independence [1]. Time to recovery can vary following TKR, and most patients will report substantial gains between 3 and 6 months after surgery [2, 3]. Overall, a continuing pattern of improvement can be observed up to 12 months following surgery [4, 5]. While a majority of patients report improvements in pain and function following total knee replacement [6, 7], a substantial number of individuals do not meet the level of improvement expected at 12 months or more after surgery [8, 9]. A number of individual characteristics are known to influence pain and function after surgery [10]. Individual risk factors which impact on patient outcomes after TKR include age and gender [7, 11, 12], antecedent diagnosis [13], body mass index [14, 15], ethnicity [16], psychological distress [13, 17], baseline pain and functional disability [7, 13], comorbidity profile [10, 18], socioeconomic status [19], and radiographic osteoarthritis severity
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