Fortin P R, Clarke A E, Joseph L, Liang M H, Tanzer M, Ferland D, Phillips C, Partridge A J, Bélisle P, Fossel A H, Mahomed N, Sledge C B, Katz J N
The Montreal General Hospital Research Institute, and McGill University, Quebec, Canada.
Arthritis Rheum. 1999 Aug;42(8):1722-8. doi: 10.1002/1529-0131(199908)42:8<1722::AID-ANR22>3.0.CO;2-R.
To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better preoperative function.
This study surveyed an observational cohort of 379 consecutive patients with definite OA who were without other inflammatory joint diseases and were undergoing either total hip or knee replacement in a US (Boston) and a Canadian (Montreal) referral center. Questionnaires on health status (the Short Form 36 and Western Ontario and McMaster Universities Osteoarthritis Index) were administered preoperatively and at 3 and 6 months postoperatively. Physical function and pain due to OA were deemed the most significant outcomes to study.
Two hundred twenty-two patients returned their questionnaires. Patients in the 2 centers were comparable in age, sex, time to surgery, and proportion of hip/knee surgery. The Boston group had more education, lower comorbidity, and more cemented knee prostheses. Patients undergoing hip or knee replacement in Montreal had lower preoperative physical function and more pain than their Boston counterparts. In patients with lower preoperative physical function, function and pain were not improved postoperatively to the level achieved by those with higher preoperative function. This was most striking in patients undergoing total knee replacement.
Surgery performed later in the natural history of functional decline due to OA of the knee, and possibly of the hip, results in worse postoperative functional status.
确定术前身体功能较差的膝关节或髋关节骨关节炎（OA）患者术后的状态是否与术前功能较好的患者相似。
本研究调查了379例连续的确诊OA患者组成的观察性队列，这些患者无其他炎性关节疾病，正在美国（波士顿）和加拿大（蒙特利尔）的转诊中心接受全髋关节或膝关节置换手术。在术前以及术后3个月和6个月发放健康状况问卷（简明健康状况调查量表36和西安大略和麦克马斯特大学骨关节炎指数）。OA导致的身体功能和疼痛被视为最重要的研究结果。
222例患者返还了问卷。两个中心的患者在年龄、性别、手术时间以及髋关节/膝关节手术比例方面具有可比性。波士顿组患者受教育程度更高，合并症更少，膝关节置换使用骨水泥固定假体的比例更高。与波士顿的患者相比，在蒙特利尔接受髋关节或膝关节置换的患者术前身体功能更低，疼痛更多。术前身体功能较差的患者，术后功能和疼痛并未改善至术前功能较好患者所达到的水平。这在接受全膝关节置换的患者中最为明显。
在膝关节（可能还有髋关节）OA导致功能下降的自然病程后期进行手术，会导致术后功能状态更差。
