Nilsdotter A-K, Toksvig-Larsen S, Roos E M
Research and Development Department, Central Hospital, Halmstad, Sweden.
Osteoarthritis Cartilage. 2009 May;17(5):601-6. doi: 10.1016/j.joca.2008.11.007. Epub 2008 Nov 21.
To prospectively describe self-reported outcomes up to 5 years after total knee replacement (TKR) in Osteoarthritis (OA) and to study which patient-relevant factors may predict outcomes for pain and physical function (PF).
102 consecutive patients with knee OA, 63 women and 39 men, mean age 71 (51-86) assigned for TKR at the Department of Orthopaedics at Lund University Hospital were included in the study. The self-administered questionnaires Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-36 were mailed preoperatively and 6 months, 12 months and at 5 years postoperatively.
Response rate at 5 years was 86%. At 6 months significant improvement was seen in all KOOS and SF-36 scores (P<0.001). The percentage of patients performing more demanding functions related to sports and recreation increased postoperatively. The best postoperative result was reported at the 1 year follow-up. Compared to the 1 year follow-up, a significant (P<or=0.01) decline was seen at 5 years in the KOOS subscale activity of daily living (ADL) function (82-73) and the SF-36 subscale bodily pain (72-63), PF (61-51) and vitality (69-59). Patients who scored in the lowest quartile preoperatively in the KOOS subscales pain and ADL made the greatest improvements to 1 year (18-82, 22-80) but also declined the most from 12 months to 5 years (82-72, 80-66). Being 10 years older pre-operatively predicted 5-7 points worse scores in KOOS pain and KOOS symptoms at 1 and 5 years. When adjusted for age, sex and comorbid conditions, pre-operative SF-36 scores did not predict postoperative KOOS pain or PF scores.
Compared to preoperatively, a significant improvement was still seen 5 years postoperatively. However, the best result was reported at 1 year, indicating a decline from 1 to 5 years after TKR. To fully evaluate the results of TKR with regard to pain and PF, follow-ups longer than 2 years are needed, and items of more demanding PFs should be included. Older age to some extent predicted more postoperative pain and other symptoms, however, no predictors of postoperative PF were found, indicating the difficulty of determining preoperatively who will benefit more or less from the procedure.
前瞻性描述骨关节炎（OA）患者全膝关节置换术（TKR）后长达5年的自我报告结局，并研究哪些与患者相关的因素可预测疼痛和身体功能（PF）的结局。
102例连续的膝关节OA患者，63例女性和39例男性，平均年龄71岁（51 - 86岁），被分配到隆德大学医院骨科进行TKR，纳入本研究。术前、术后6个月、12个月和5年通过邮寄方式发放自我管理问卷膝关节损伤和骨关节炎结局评分（KOOS）及SF - 36问卷。
5年时的回复率为86%。在6个月时，所有KOOS和SF - 36评分均有显著改善（P<0.001）。术后进行与运动和娱乐相关的更具挑战性活动的患者百分比增加。术后最佳结果在1年随访时报告。与1年随访相比，5年时KOOS日常生活活动（ADL）功能子量表（82 - 73）、SF - 36身体疼痛子量表（72 - 63）、PF（61 - 51）和活力子量表（69 - 59）出现显著（P≤0.01）下降。术前在KOOS疼痛和ADL子量表中处于最低四分位数的患者在1年时改善最大（18 - 82，22 - 80），但从12个月到5年下降也最多（82 - 72，80 - 66）。术前年龄每大10岁预测1年和5年时KOOS疼痛和KOOS症状评分差5 - 7分。在对年龄、性别和合并症进行校正后，术前SF - 36评分不能预测术后KOOS疼痛或PF评分。
与术前相比，术后5年仍有显著改善。然而，最佳结果在1年时报告，表明TKR后1至5年出现下降。为了全面评估TKR在疼痛和PF方面的结果，需要进行超过两年的随访，并应纳入更具挑战性的PF项目。年龄较大在一定程度上预测术后疼痛和其他症状更多，然而，未发现术后PF的预测因素，这表明术前难以确定哪些患者将从该手术中或多或少地获益。
