Naylor Justine M, Harmer Alison R, Heard Robert C, Harris Ian A
Whitlam Joint Replacement Centre, UNSW SWS Clinical School, Fairfield Hospital, Sydney, NSW, Australia.
Aust Health Rev. 2009 Feb;33(1):124-35. doi: 10.1071/ah090124.
Most literature reporting the impressive results from knee and hip replacement derives from international data. Few Australian studies have comprehensively compared outcomes after joint replacement up to 1 year. This paper compares the patterns of recovery across physical and patient-centred outcomes following knee or hip replacement in an Australian cohort. One hundred and twenty-two consecutive patients undergoing knee or hip replacement were prospectively followed. Serial assessments were conducted (preoperatively, and 2, 6, 12, 26 and 52 weeks post-surgery). Joint pain, patient's global improvement, timed mobility, and complications were monitored. English-proficient patients completed WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and SF-36v2 (Medical Outcomes Short-Form 36 version 2) questionnaires. At 1 year, 81% (55 knee, 44 hip) were available for follow-up. Significant, large improvements (up to 254%) were evident for most outcomes. Global improvement was reported by 97%. Recovery for both surgical groups was greatest within the first 26 weeks, but hip patients improved more quickly in most outcomes. Wound disturbances were the most common complication (23 in total, 23%) and 13 patients (13%) were readmitted for complications. Recovery patterns were similar to that observed elsewhere. The physical and patient-centred outcomes provide a useful Australian reference for clinicians of the temporal aspects of recovery as well the differences between hip and knee surgeries. Complication and readmission rates appeared high, possibly partly explained by the rigorous capture method.
大多数报道膝关节和髋关节置换术取得显著效果的文献都来自国际数据。澳大利亚很少有研究全面比较关节置换术后长达1年的结果。本文比较了澳大利亚队列中膝关节或髋关节置换术后身体和以患者为中心的各项结果的恢复模式。对122例连续接受膝关节或髋关节置换术的患者进行前瞻性随访。进行了系列评估（术前、术后2周、6周、12周、26周和52周）。监测关节疼痛、患者整体改善情况、定时活动能力和并发症。英语熟练的患者完成了WOMAC（西安大略和麦克马斯特大学骨关节炎指数）和SF - 36v2（医学结果简表36第2版）问卷。1年后，81%（55例膝关节置换、44例髋关节置换）患者可供随访。大多数结果都有显著的大幅改善（高达254%）。97%的患者报告整体情况有所改善。两个手术组的恢复在术后前26周最为明显，但髋关节置换患者在大多数结果方面改善得更快。伤口问题是最常见的并发症（共23例，占23%），13例患者（占13%）因并发症再次入院。恢复模式与其他地方观察到的相似。身体和以患者为中心的结果为临床医生提供了关于澳大利亚恢复时间方面以及髋关节和膝关节手术差异的有用参考。并发症和再次入院率似乎较高，这可能部分是由于严格的记录方法所致。
