KNEE Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplasty Arthur J. Kievit • Stefan J. M. Breugem • Inger N. Sierevelt • Petra J. C. Heesterbeek • Sebastiaan A. W. van de Groes • Keetie C. A. L. C. Kremers • Sander Koe ¨ter • Daniel Haverkamp Received: 8 April 2013 / Accepted: 18 August 2013 / Published online: 12 September 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Purpose To translate and validate the Kujala Anterior Knee Pain Scale (AKPS) in patients who have undergone total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and evaluate the internal consistency, construct validity and ceiling or floor effect. Methods After standard forward and backward transla- tion was performed, 302 patients who have received a TKA or UKA filled out the AKPS together with Hospital for Special Surgery (HSS) patella score, visual analogue score (VAS) for pain, the Oxford 12-item questionnaire and the SF-36 at follow-up. The internal consistency was tested using Cronbach’s a coefficient. The construct validity was assessed using Spearman’s rank correlation (R) to test for correlations between the AKPS and VAS HSS, HSS patella score, VAS month, Oxford 12-item questionnaire and SF- 36 subscales. Ceiling or floor effects are given in per- centage of patients giving a maximum or minimum score. Results The internal reliability of the AKPS is acceptable with a Cronbach’s a of 0.81 in patients after TKA or UKA. A high correlation was found between the AKPS and the Oxford 12-item questionnaire (R = 0.81). Moderate correlations were found with the VAS month (R = 0.63), HSS patella score (R = 0.51) and SF-36 subscales physical function- ing (R = 0.59), role-physical (R = 0.59), bodily pain (R = 0.57). Other correlations were poor, therefore indicating a good convergent and divergent validity. Ceiling effects were observed for the HSS patella score (31 %), VAS HSS (51 %), VAS pain (19 %), SF36-RP (46 %), SF36-RE (80 %) and SF36-BP (24 %). No ceiling or floor effect was found for the AKPS, Oxford 12-item and the other SF36 domains. Conclusions The AKPS appears to be reliable and valid in patients after knee arthroplasty, with no ceiling and floor effects, and can be used to assess anterior knee pain in patient who underwent joint replacement surgery. Level of evidence Diagnostic study, Level I. Keywords Total knee arthroplasty (TKA) Á Unicompartmental knee arthroplasty (UKA) Á Kujala Á Patellofemoral pain (PFP) Á Anterior knee pain (AKP) Á Validation study Á Dutch translation Introduction Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are highly effective for treating patients with complaints caused by rheumatoid arthritis or osteoarthritis of the knee [9]. However successfully, A. J. Kievit (&) Department of Orthopedics, Academic Medical Center, Orthopaedic Research Center Amsterdam, Room G4-242, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands e-mail: a.j.kievit@amc.nl S. J. M. Breugem Orthopedium–Orthopedische Kliniek, Olof Palmestraat 20, 2616 LS Delft, The Netherlands I. N. Sierevelt Á D. Haverkamp Department of Orthopedics, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands P. J. C. Heesterbeek Department of Research, Sint Maartenskliniek, Hengstdal 3, 6574 NA Ubbergen (Nijmegen), The Netherlands S. A. W. van de Groes Department of Orthopedics, Sint Maartenskliniek, Hengstdal 3, 6574 NA Ubbergen (Nijmegen), The Netherlands K. C. A. L. C. Kremers Á S. Koe ¨ter Department of Orthopedics, Canisius-Wilhelmina Ziekenhuis, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands 123 Knee Surg Sports Traumatol Arthrosc (2013) 21:2647–2653 DOI 10.1007/s00167-013-2635-4