title: The Use of Scoring Systems in Knee Arthroplasty: A Systematic Review of the Literature.
abstract: The primary purpose of this systematic review was to clarify and quantify scoring system utilization in knee arthroplasty literature. In addition, the study considered the frequency and relationship of score use in articles published across a range of orthopedic journals, and the influence of study design, level of evidence, primary research topic, and study country of origin on the scoring system used.
  
  
  
  A systematic search of 8 electronic databases was performed to identify publications of clinical studies involving knee arthroplasty, in which a scoring system was used to assess patient outcomes.
  
  
  
  Of the 1994 unique publications identified, 438 met the selection criteria. Identified articles reported a total of 86 scoring systems, 5 of which were reported in greater than 10.0% of included studies. The 1989 Knee Society Score was markedly the most utilized scoring system (58.7%). Use of the Knee Society Score was significantly associated with orthopedic journal impact factor (IF; P = .001), with greater use observed in journals of lower IF. Use of the Western Ontario and McMaster Universities Osteoarthritis Index escalated with increasing IF; however, no statistically significant association was observed. A preference for scoring systems developed in the country of residence of the first author was also identified.
  
  
  
  A large number of scoring systems are used to assess knee arthroplasty patients; however, 5 scores are consistently reported. By identifying and quantifying scoring system use, this review hopes to stimulate regularity in score usage to allow for improvements in comparability of clinician and patient-reported outcome measures in the knee arthroplasty literature.
authors.affiliation: Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia; International Musculoskeletal Research Institute Inc., Adelaide, South Australia, Australia. Electronic address: annikatheod@gmail.com.
authors.forename: Annika
authors.initials: A
authors.lastname: Theodoulou
authors.affiliation: Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia; International Musculoskeletal Research Institute Inc., Adelaide, South Australia, Australia.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Bramwell
authors.affiliation: Department of Orthopaedic Surgery & Trauma, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Spiteri
authors.affiliation: Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia; International Musculoskeletal Research Institute Inc., Adelaide, South Australia, Australia; Department of Orthopaedic Surgery & Trauma, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Jeganath
authors.initials: J
authors.lastname: Krishnan
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D055811:Journal Impact Factor; D007719:Knee Joint / Q000601:surgery; D018579:Patient Selection; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: knee arthroplasty; knee replacement; patient-reported outcome measure; questionnaire; score; scoring system