Hawker Gillian A, Guan Jun, Croxford Ruth, Coyte Peter C, Glazier Richard H, Harvey Bart J, Wright James G, Williams Jack I, Badley Elizabeth M
University of Toronto, Toronto, Ontario, Canada.
Arthritis Rheum. 2006 Oct;54(10):3212-20. doi: 10.1002/art.22146.
To examine prospectively the predictors of time to total joint arthroplasty (TJA).
This was a prospective cohort study with a median followup time of 6.1 years. We included participants from an existing population-based cohort of 2,128 individuals, ages 55 years and older with disabling hip and/or knee arthritis and no prior TJA, from 2 regions of Ontario, Canada, 1 urban with low TJA rates and 1 rural with high rates. The main outcome measure was the occurrence of a TJA based on procedure codes in the hospital discharge abstract database.
At baseline, the mean age of the patients was 71.5 years, 67.9% had a high school education or higher, 73.4% were women, the mean arthritis severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) score was 41.1 (maximum possible score 100), and 20.0% were willing to consider TJA. Greater probability of undergoing TJA was associated with higher (worse) baseline WOMAC scores (hazard ratio [HR] 1.22 per 10-unit increase, P < 0.001), age (compared with age <or=62 years, the HR increased to 1.57 for 63-68 years, 1.46 for 69-74 years, and 1.51 for 75-81 years, and fell to 0.44 for >or=82 years; P < 0.05 for all), better health (HR 1.14 per 10-unit increase in Short Form 36 general health survey score, P < 0.001), and willingness to consider TJA (HR 4.92, P < 0.001). When willingness was excluded from the model, education level, but not sex or income, became a significant predictor of TJA receipt.
Willingness to consider TJA was the strongest predictor of the time to first TJA. Given that previous research indicates that willingness is largely explained by perceptions of the indications for and risks associated with TJA and not disease severity, this finding supports the need for population education about arthritis treatments, including TJA.
前瞻性研究全关节置换术（TJA）时间的预测因素。
这是一项前瞻性队列研究，中位随访时间为6.1年。我们纳入了来自加拿大安大略省2个地区的2128名55岁及以上患有致残性髋部和/或膝部关节炎且未曾接受过TJA的人群队列中的参与者，其中1个城市TJA发生率低，1个农村TJA发生率高。主要结局指标是根据医院出院摘要数据库中的手术编码确定的TJA发生情况。
在基线时，患者的平均年龄为71.5岁，67.9%接受过高中或更高教育，73.4%为女性，平均关节炎严重程度（西安大略和麦克马斯特大学骨关节炎指数[WOMAC]）评分为41.1（满分100分），20.0%愿意考虑接受TJA。接受TJA的可能性更高与基线WOMAC评分更高（更差）相关（每增加10分，风险比[HR]为(1.22)，(P < 0.001)）、年龄相关（与年龄≤62岁相比，63 - 68岁的HR增至(1.57)，69 - 74岁为(1.46)，75 - 81岁为(1.51)，≥82岁降至(0.44)；所有(P < 0.05)）、健康状况更好（简短健康调查问卷36项一般健康调查评分每增加10分，HR为(1.14)，(P < 0.001)）以及愿意考虑接受TJA相关（HR为(4.92)，(P < 0.001)）。当将意愿从模型中排除时，教育水平而非性别或收入成为接受TJA的显著预测因素。
考虑接受TJA的意愿是首次接受TJA时间的最强预测因素。鉴于先前的研究表明，意愿很大程度上由对TJA的适应症和相关风险的认知而非疾病严重程度所解释，这一发现支持了对包括TJA在内的关节炎治疗进行人群教育的必要性。
