Department of Physical Therapy, University of Delaware, 301 McKinly Laboratory, Newark, DE 19716, USA.
Phys Ther. 2010 Jan;90(1):43-54. doi: 10.2522/ptj.20090089. Epub 2009 Dec 3.
Total knee arthroplasty (TKA) has been shown to be an effective surgical intervention for people with end-stage knee osteoarthritis. However, recovery of function is variable, and not all people have successful outcomes.
The aim of this study was to discern which early postoperative functional measures could predict functional ability at 1 year and 2 years after surgery.
One hundred fifty-five people who underwent unilateral TKA participated in the prospective longitudinal study. Functional evaluations were performed at the initial outpatient physical therapy appointment and at 1 and 2 years after surgery. Evaluations consisted of measurements of height, weight, quadriceps muscle strength (force-generating capacity), and knee range of motion; the Timed "Up & Go" Test (TUG); the stair-climbing task (SCT); and the Knee Outcome Survey (KOS) questionnaire. The ability to predict 1- and 2-year outcomes on the basis of early postoperative measures was analyzed with a hierarchical regression. Differences in functional scores were evaluated with a repeated-measures analysis of variance.
The TUG, SCT, and KOS scores at 1 and 2 years showed significant improvements over the scores at the initial evaluation (P<.001). A weaker quadriceps muscle in the limb that did not undergo surgery ("nonoperated limb") was related to poorer 1- and 2-year outcomes even after the influence of the other early postoperative measures was accounted for in the regression. Older participants with higher body masses also had poorer outcomes at 1 and 2 years. Postoperative measures were better predictors of TUG and SCT times than of KOS scores.
Rehabilitation regimens after TKA should include exercises to improve the strength of the nonoperated limb as well as to treat the deficits imposed by the surgery. Emphasis on treating age-related impairments and reducing body mass also might improve long-term outcomes.
全膝关节置换术（TKA）已被证明是治疗终末期膝骨关节炎的有效手术干预措施。然而，功能的恢复是可变的，并非所有人都能取得成功的结果。
本研究旨在确定哪些术后早期功能测量指标可以预测术后 1 年和 2 年的功能能力。
155 名接受单侧 TKA 的患者参与了这项前瞻性纵向研究。在初始门诊物理治疗预约以及术后 1 年和 2 年进行功能评估。评估包括身高、体重、股四头肌力量（产生力量的能力）和膝关节活动范围；计时“站起和行走”测试（TUG）；爬楼梯任务（SCT）；膝关节结局调查（KOS）问卷。通过分层回归分析，根据术后早期测量值预测 1 年和 2 年结果的能力。采用重复测量方差分析评估功能评分的差异。
TUG、SCT 和 KOS 评分在 1 年和 2 年均较初始评估时显著提高（P<.001）。未接受手术的肢体（“非手术肢体”）股四头肌较弱与 1 年和 2 年的较差结果相关，即使在回归中考虑了其他术后早期测量值的影响也是如此。年龄较大、体重较高的患者在 1 年和 2 年的结果也较差。术后测量值是 TUG 和 SCT 时间的更好预测指标，而不是 KOS 评分。
TKA 后的康复方案应包括增强非手术肢体力量以及治疗手术带来的缺陷的锻炼。强调治疗与年龄相关的损伤和减轻体重也可能改善长期结果。
