The Use of Scoring Systems in Knee Arthroplasty: A Systematic Review of the Literature

Background The primary purpose of this systematic review was to clarify and quantify scoring system utilisation in knee arthroplasty literature. Additionally, the study considered the frequency and relationship of score use in papers published across a range of orthopaedic journals, and the influence of study design, level of evidence (LOE), primary research topic, and study country of origin on the scoring system employed. Methods A systematic search of eight electronic databases was performed to identify publications of clinical studies involving knee arthroplasty, in which a scoring system was used to assess patient outcomes. Results Of the 1,994 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 (KSS) was markedly the most utilised scoring system (58.7%). Use of the KSS was significantly associated with orthopaedic journal impact factor (IF) ( p = 0.001), with greater use observed in journals of lower IF. Use of the WOMAC 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. Conclusions 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 outcomes in the knee arthroplasty literature.