Work

Crosscultural adaptation and validation of the simplified Chinese version of the new knee society scoring system

Year: 2025

Type: article

Abstract: Introduction The 2011 Knee Society Score (new-KSS) describes symptom, satisfaction, expectation, and functional activities in patients undergoing total knee arthroplasty (TKA) and is widely recognized for assessing TKA outcomes. Before using this scale in non-English-speaking populations, it must be translated and culturally adapted to suit the specific demographic.Methods The new-KSS was translated and culturally adapted into the new-KSS-CV following international guidelines. Item modifications were informed by the Chinese TKA PROM (CTP), a Delphi expert consensus and cognitive interviews with Chinese TKA patients, aiming to reflect local cultural and activity patterns. The adapted scale was applied in a validation study with preoperative and one-year postoperative assessments. Reliability was assessed using intraclass correlation coefficient (ICC) and Cronbach’s α. Construct validity was tested by comparing the new-KSS-CV with the Chinese versions of the WOMAC and SF-12. Responsiveness was determined by calculating the standardized response means (SRM).Results A total of 226 patients were included, with a mean age of 64.7 ± 5.7 years; 142 (62.8%) were female. All patients completed both preoperative and one-year postoperative assessments. Ceiling effects were observed preoperatively in the expectation dimension (40.7% of patients) and postoperatively in symptom (54.4%), functional (72.1%), and standard activities (19.0%) domains. The new-KSS-CV showed good to excellent test–retest reliability (ICC: 0.88–0.97) and internal consistency (Cronbach’s α: 0.74–0.85). The total score correlated significantly and moderately negatively with WOMAC (r = −0.68, p < 0.001), while the symptom (r = −0.41), satisfaction (r = −0.42), and functional activities (r = −0.66) domains also showed significant weak to moderate negative correlations (all p < 0.001). The expectation domain showed a very weak but significant positive correlation (r = 0.19, p = 0.005). The functional activities domain and total score of the new-KSS-CV correlated significantly and positively with the SF-12 physical component (r = 0.57 and 0.50, respectively; p < 0.001). The new-KSS-CV demonstrated a higher SRM (3.89) than WOMAC (–2.41) and SF-12 (1.69 and 0.33).Conclusion The new-KSS-CV is a reliable, valid, responsive, and consistent outcome measurement tool that can be used to evaluate the outcome of TKA in Chinese patients.

Source: Annals of Medicine

DOI: 10.1080/07853890.2025.2564912