Department of Surgery, University of Toronto, Toronto, Ont.
Can J Surg. 2010 Feb;53(1):37-41.
Studies have shown that women present for surgery at an older age and with greater dysfunction than do men; however, the explanation for this finding is unclear. We investigated the impact living status (alone or with another person) and sex on the timing and outcomes of hip and knee replacement surgery.
We surveyed 1722 patients undergoing primary hip or knee replacement surgery. Relevant covariates including demographic data, body mass index, sex, living status and comorbidities were recorded. We assessed joint pain and functional status before surgery and at 3 months and 1 year after surgery using the Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores for pain and function.
In total, 22.9% (395) of all patients (29.3% of women and 14.1% of men) were living alone at the time of surgery. Compared with patients who lived with another person, those who lived alone were significantly older, had greater comorbidity and reported greater joint pain and dysfunction before surgery and 3 months and 1 year after surgery. Living alone and female sex independently predicted a greater preoperative WOMAC score, and living alone predicted an older age at the time of surgery and a poorer 1-year outcome.
Patients who live alone may delay joint replacement surgery until an older age and have greater joint pain and dysfunction than those who live with another person, leading to poorer 1-year outcomes.
研究表明，女性接受手术的年龄比男性大，且功能障碍更严重；然而，对于这一发现的解释尚不清楚。我们研究了生活状况（独自生活或与他人一起生活）和性别对髋部和膝关节置换手术时机和结果的影响。
我们调查了 1722 名接受初次髋部或膝关节置换手术的患者。记录了相关的协变量，包括人口统计学数据、体重指数、性别、生活状况和合并症。我们使用 Western Ontario McMaster University Osteoarthritis Index（WOMAC）评分评估手术前、术后 3 个月和 1 年的关节疼痛和功能状况，该评分用于评估疼痛和功能。
在所有患者中（女性为 29.3%，男性为 14.1%），有 22.9%（395 人）独自生活。与与他人一起生活的患者相比，独自生活的患者年龄更大，合并症更多，手术前、术后 3 个月和 1 年均报告关节疼痛和功能障碍更严重。独自生活和女性性别独立预测术前 WOMAC 评分更高，而独自生活预测手术时年龄更大，1 年预后更差。
独自生活的患者可能会延迟关节置换手术，直到年龄更大，且比与他人一起生活的患者关节疼痛和功能障碍更严重，导致 1 年预后更差。
