INTRODUCTION: The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to translate and culturally adapt the short musculoskeletal function assessment questionnaire (SMFA) into German and to evaluate the practicability, metric properties, and distribution characteristics of the German version (SMFA-D). METHODS: The SMFA is a questionnaire on the functional status of the musculoskeletal system of patients consisting of a function index (34 items) and bother index (12 items) with a 5-point response format. The SMFA was independently translated by orthopaedic-trained, qualified German- and English-speaking translators. A consensus committee review and selection of an optimally comprehensible German version was performed. Patients checked this version for comprehensibility and time to complete the questionnaire. 40 fluently German-speaking patients with primary osteoarthritis of the knee completed the SMFA-D twice at a one week interval. The test-retest reliability and internal consistency were evaluated. The values are standardized on an scale from 0-100. High values indicate a poor function. RESULTS: The SMFA-D is comprehensible and can be completed within 20 minutes in the mean. There were no skewness and no floor or ceiling effects. The mean function index was 47 (SD 17, range 16-80). The mean bother index was 44 (SD 19, range 5-75). Test-retest reliability were 0.88 (function index) and 0.71 (bother index), respectively. Internal consistency (Cronbach's alpha) was 0.92 (function index) and 0.88 (bother index), respectively. CONCLUSIONS: The SMFA-D is a practical and reliable questionnaire for patient-based evaluation of functional problems of the musculoskeletal system.

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PubMedDate not supplied

[II. Validity and sensitivity to change of the Musculoskeletal Functional Assessment Questionnaire in primary gonarthrosis and total endoprosthetic joint replacement].

INTRODUCTION: Scoring systems used so far in total knee arthroplasty are limited by their non-fulfillment of basic test criteria. The aim of the study was to demonstrate the validity and responsiveness of a German version of the new short musculoskeletal function assessment questionnaire (SMFA-D) in patients with primary osteoarthritis and total knee arthroplasty. METHODS: 66 patients with a tricompartmental cemented PFC-Sigma total knee arthroplasty completed the SMFA-D and the WOMAC questionnaire preoperatively and at 12 to 16 weeks follow-up. Preoperatively, physicians' rating of function of the leg, patients' self-selected walking speed, pain and arthritis severity score were registered for demonstration of criterion validity. Construct validity was evaluated with the WOMAC. Discriminant validity was assessed by comparing patients with or without previous surgery at the knee, use of pain medication and use of walking aids. The function and bother indexes of the SMFA-D were correlated with these parameters. Standardized response means were calculated. RESULTS: The function index correlated with physicians' rating (r = 0.51), walking speed (r = 0.61), pain (r = 0.36) and the arthritis severity index (r = 0.36). The bother index correlated with pain (r = 0.37) and the arthritis severity index (r = 0.25). The function and bother index correlated with the WOMAC (r = 0.77) and (r = 0.81), respectively. Patient groups with or without walking aids (p = 0.02) and with or without pain medication (p = 0.001) differed in the function index. The bother index of patients with or without pain medication (p < 0.001) and with or without walking aids (p < 0.006) differed. Function and bother index improved from 46 (SD 17) to 34 (SD 19, p < 0.001) and 43 (SD 18) to 33 (SD 22 p < 0.001), respectively. The standardized response mean was 0.86 for the function index and 0.53 for the bother index. CONCLUSIONS: The SMFA-D questionnaire is valid and responsive in patients with primary osteoarthritis of the knee and total knee arthroplasty. It measures function and bother from the perspective of these patients.

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PubMedDate not supplied

[Endoprosthetic management of patients with hip arthrodesis].

PURPOSE: Purpose of this retrospective study was to investigate the long-term results of total hip replacement in patients with hip arthrodesis. METHODS: Between 1976 and 1986 conversion of a earlier performed arthrodesis of the hip to total hip replacement was carried out in a total of 20 patients. 15 of these have been followed up postoperatively for an average of 15.7 years. The main preoperative symptoms were pain affecting the lumbar spine, the ipsilateral knee and/or both hip joints. In two cases, the arthrodesis has fractured. RESULTS: With the exception of one female patient, all the patients expressed satisfaction with the postoperative results, pain having been alleviated or eliminated. The difference in leg length presenting preoperatively in 12 patients was partly or completely equalized in ten cases. Specific physiotherapy over a period of several months resulted in an appreciable increase in muscular power in all patients. Postoperatively ten patients had a slight, five a pronounced limp, while 11 patients needed a walking aid. Recurrent dislocations occurred in one patient. We observed one aseptic loosening of the cup after 10 years. CONCLUSION: The results of the study show that conversion of surgically ankylosed hip joints to total hip replacement makes good sense. Provided that the indication is established with care, this major surgical procedure represents a suitable method, not only of improving the patient's quality of life, but also, and in particular, of at least appreciably improving the symptoms developing after hip arthrodesis. There seems no increased rate of aseptic implant loosening.

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