欧洲骨科中心因骨关节炎接受初次髋关节置换手术患者的术前状况差异。

Variations in the pre-operative status of patients coming to primary hip replacement for osteoarthritis in European orthopaedic centres.

作者信息

Dieppe Paul, Judge Andrew, Williams Susan, Ikwueke Ifeoma, Guenther Klaus-Peter, Floeren Markus, Huber Joerg, Ingvarsson Thorvaldur, Learmonth Ian, Lohmander L Stefan, Nilsdotter Anna, Puhl Wofhart, Rowley David, Thieler Robert, Dreinhoefer Karsten

机构信息

Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Headington, Oxford, UK.

出版信息

BMC Musculoskelet Disord. 2009 Feb 10;10:19. doi: 10.1186/1471-2474-10-19.

DOI:10.1186/1471-2474-10-19

PMID:19208230

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2654855/

Abstract

BACKGROUND

Total hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA). However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation.

METHODS

A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC - Likert version 3.1). Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA) status. Pre-operative radiographs were read by the same three readers for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Regression analyses were carried out.

RESULTS

Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4%) than men. Most (79%) were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common.Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score); the mean total WOMAC score was 59.2 (SD 16.1). The radiographic severity showed no correlation with WOMAC scores.Significantly higher WOMAC scores (worse disease) were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment.

CONCLUSION

Clinical disease severity varies widely at the time of THR for OA. 2. In advanced hip OA clinical severity shows no correlation with radiographic severity. 3. Simple scores of pain and disability do not reflect the complexity of decision-making about who should have a THR.

摘要

背景

全髋关节置换术（THR）是治疗髋关节骨关节炎（OA）的一种常见且有效的干预措施。然而，其手术指征及预后的决定因素仍不明确。“欧洲髋关节研究联盟”开展了一项队列研究以探究这些问题。本文描述了该队列中疾病严重程度的差异、临床严重程度与影像学严重程度之间的关系，并探讨了部分差异的决定因素。

方法

20个参与研究的骨科中心中，每个中心至少有50例连续的、同意参与研究的因原发性髋关节OA接受初次THR的患者纳入研究。术前数据包括人口统计学资料、就业和教育程度、药物使用情况以及其他关节的受累情况。每位受试者均完成了西安大略和麦克马斯特大学骨关节炎指数（WOMAC - 李克特3.1版）。手术时收集的其他数据包括所使用的假体及美国麻醉医师协会（ASA）分级。术前X线片由三位阅片者采用Kellgren和Lawrence（K&L）分级法及国际骨关节炎研究学会（OARSI）图谱特征进行阅片，并进行回归分析。

结果

已对1327例受试者的数据进行分析。该组患者的平均年龄为65.7岁，女性（53.4%）多于男性。大多数（79%）患者的ASA分级为1或2级。报告的疾病持续时间在69.2%的患者中为5年或更短。其他关节部位患病很常见。1051例受试者有X线片资料，其中95.8%的患者K&L分级为3级或4级。临床严重程度（WOMAC评分）的差异更大；WOMAC总分的平均值为59.2（标准差16.1）。影像学严重程度与WOMAC评分无相关性。在老年人、女性、肥胖者、总体健康状况较差者以及教育程度较低者中观察到WOMAC评分显著更高（疾病更严重）。