Department of Orthopaedic Surgery, University of Schleswig-Holstein Medical Center, Campus Kiel, Michaelisstrasse 1, 24105 Kiel, Germany.
J Bone Joint Surg Am. 2010 Apr;92(4):814-22. doi: 10.2106/JBJS.H.01359.
The optimal treatment strategy following primary total hip or knee replacement remains unknown. The purpose of this study was to evaluate the effect of ergometer cycling after hip or knee replacement surgery on health-related quality of life and patient satisfaction.
Three hundred and sixty-two patients were randomly assigned to either perform or not perform ergometer cycling beginning two weeks after total hip or knee replacement. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at three, six, twelve, and twenty-four months postoperatively. Results were compared with published thresholds for minimal clinically important improvements.
The baseline characteristics of the two groups were similar. After the hip arthroplasties, all of the outcome parameters were superior in the ergometer cycling group at all follow-up intervals, and the primary outcome, physical function as measured with the WOMAC, was significantly better at three months (21.6 compared with 16.4 points, effect size = 0.33, p = 0.046) and twenty-four months (14.7 compared with 9.0 points, effect size = 0.37, p = 0.019). After the hip arthroplasties, a higher percentage of the ergometer cycling group was "very satisfied" at all follow-up intervals (for example, 92% compared with 80% at three months; p = 0.027). The significant differences in the primary outcome exceeded the absolute minimal clinically important improvement threshold by a factor of 2.0. No significant differences between the study groups were seen after the knee arthroplasties.
Ergometer cycling after total hip arthroplasty is an effective means of achieving significant and clinically important improvement in patients' early and late health-related quality of life and satisfaction. However, this study does not support the use of ergometer cycling after knee arthroplasty.
初次全髋关节或全膝关节置换术后的最佳治疗策略仍不明确。本研究旨在评估髋关节或膝关节置换术后进行健身车运动对健康相关生活质量和患者满意度的影响。
362 例患者被随机分为行或不行健身车运动两组，两组均在全髋关节或全膝关节置换术后 2 周开始运动。主要结局指标为术后 3、6、12 和 24 个月时采用 Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）评估的自我报告的躯体功能。结果与发表的最小临床重要改善阈值进行比较。
两组的基线特征相似。髋关节置换术后，所有的随访时间内，健身车运动组的所有结局指标均优于对照组，主要结局指标 WOMAC 躯体功能在术后 3 个月（21.6 分比 16.4 分，效应量=0.33，p=0.046）和 24 个月（14.7 分比 9.0 分，效应量=0.37，p=0.019）时差异更显著。髋关节置换术后，健身车运动组在所有随访时间内“非常满意”的比例更高（例如，术后 3 个月时为 92%比 80%，p=0.027）。主要结局指标的显著差异超过最小临床重要改善阈值的 2.0 倍。膝关节置换术后两组间无显著差异。
全髋关节置换术后进行健身车运动是一种有效方法，可显著改善患者早期和晚期的健康相关生活质量和满意度。但是，本研究不支持膝关节置换术后进行健身车运动。
