Núñez Montserrat, Lozano Luis, Núñez Esther, Segur Josep M, Sastre Sergi, Maculé Francisco, Ortega Raquel, Suso Santiago
Biomedical Research Institute August Pi i Sunyer, Department of Rheumatology, Hospital Clínic, Barcelona, Spain.
Arthritis Rheum. 2009 Aug 15;61(8):1062-9. doi: 10.1002/art.24644.
To evaluate health-related quality of life (HRQOL) in patients with osteoarthritis undergoing total knee replacement (TKR); identify the influence of sociodemographic, clinical, intraoperative, and postoperative variables on HRQOL; and determine patient perceptions at 7 years.
We conducted a prospective study with 7 years of followup. HRQOL measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and Short Form 36 [SF-36]); sociodemographic, clinical, intraoperative, inpatient, and postoperative data; patient perceptions of TKR outcomes; and physical activity at 7 years were determined. Associations were analyzed using linear regression models.
Of 146 eligible patients, 112 (86 women, mean age 67.3 years) completed followup data. There were significant differences between pre- and postoperative WOMAC pain, stiffness, and function scores (P < 0.001). Variables retained in each of the models explained 14-32% (adjusted R(2)) of variability of the WOMAC dimensions. Obesity and postdischarge complications were associated with worse scores in all WOMAC dimensions (P < 0.05). Eighty-six percent of patients were satisfied with TKR, 80% would undergo the operation again, and 56% did regular physical activity and had better WOMAC scores (P < 0.05, except for stiffness [not significant]). Mean +/- SD SF-36 scores for men and women at 7 years were 55.1 +/- 27.1 and 39.5 +/- 22.9 for physical function, 71.2 +/- 36.5 and 51.5 +/- 42.7 for physical role, 66.2 +/- 26 and 55.6 +/- 28.9 for bodily pain, and 60.7 +/- 17.1 and 50.7 +/- 21.2 for general health, respectively.
WOMAC dimension scores, especially pain, significantly improved at 7 years and were negatively influenced by obesity and postdischarge complications. HRQOL measures may help identify an increased risk of negative outcomes after TKR.
评估接受全膝关节置换术（TKR）的骨关节炎患者的健康相关生活质量（HRQOL）；确定社会人口统计学、临床、术中及术后变量对HRQOL的影响；并了解患者7年后的看法。
我们进行了一项为期7年随访的前瞻性研究。确定了HRQOL测量指标（西安大略和麦克马斯特大学骨关节炎指数[WOMAC]和简明健康状况调查量表[SF-36]）；社会人口统计学、临床、术中、住院及术后数据；患者对TKR结果的看法；以及7年后的身体活动情况。使用线性回归模型分析相关性。
146例符合条件的患者中，112例（86名女性，平均年龄67.3岁）完成了随访数据。术前和术后WOMAC疼痛、僵硬和功能评分存在显著差异（P<0.001）。每个模型中保留的变量解释了WOMAC各维度变异性的14%-32%（调整后R²）。肥胖和出院后并发症与所有WOMAC维度的较差评分相关（P<0.05）。86%的患者对TKR满意，80%愿意再次接受手术，56%进行规律体育活动且WOMAC评分更好（P<0.05，僵硬维度除外[无显著性差异]）。7年后男性和女性的平均±标准差SF-36身体功能评分分别为55.1±27.1和39.5±22.9，身体角色评分分别为71.2±36.5和51.5±42.7，身体疼痛评分分别为66.2±26和55.6±28.9，总体健康评分分别为60.7±17.1和50.7±21.2。
7年后WOMAC维度评分，尤其是疼痛评分显著改善，且受肥胖和出院后并发症的负面影响。HRQOL测量指标可能有助于识别TKR后不良结局风险增加的情况。
