University of Oxford, Headington, Windmill Road, Headington, Oxford, UK.
Arthritis Care Res (Hoboken). 2010 Apr;62(4):480-8. doi: 10.1002/acr.20038.
To identify whether patients have symptomatic improvement 12 months following total hip replacement (THR) surgery.
The European Collaborative Database of Cost and Practice Patterns of Total Hip Replacement study consists of 1,327 patients receiving primary THR for osteoarthritis (OA) across 20 European orthopedic centers. The primary outcome was the difference in Western Ontario and McMaster Universities OA Index (WOMAC) score between preoperative and 12-month postoperative measurements. To classify whether patients responded to THR at 12 months, we used return to normal, Outcome Measures in Rheumatology Clinical Trials (OMERACT)-OA Research Society International (OARSI) criteria, minimum important difference (MID), and minimum clinically important difference. Exposures were age, sex, obesity, employment, educational attainment, American Society of Anesthesiologists status, and radiographs.
On average, there was a large improvement in WOMAC scores 12 months after surgery, but whereas some patients improved, others got worse. The OMERACT-OARSI method classified 85.7% of patients as responders, MID 70.1%, and return to normal 64.1%. In general, each approach classified the same groups of patients as responding to THR. Based on total WOMAC score, patients who were younger, morbidly obese, employed, and better educated were more likely to respond to THR, but the effects were attenuated after adjustment for confounding, with only the effect of education remaining important.
The overall average response to THR was good, but approximately 14-36% of patients did not improve, or were worse, 12 months postsurgery. Although the OMERACT-OARSI criteria were originally designed for use in clinical drug trials, they performed well in classifying patient response 12 months post-THR. Further research is required to understand the determinants of patient outcomes following THR.
确定全髋关节置换术（THR）后 12 个月患者的症状是否改善。
欧洲协作数据库的成本和全髋关节置换术实践模式研究包括 20 个欧洲骨科中心的 1327 名接受原发性 THR 治疗骨关节炎（OA）的患者。主要结果是术前和术后 12 个月 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）评分之间的差异。为了在 12 个月时确定患者对 THR 的反应，我们使用回归正常、骨关节炎临床试验结局测量（OMERACT）-骨关节炎研究协会国际（OARSI）标准、最小重要差异（MID）和最小临床重要差异来分类。暴露因素包括年龄、性别、肥胖、就业、教育程度、美国麻醉师协会状态和影像学检查。
平均而言，手术后 12 个月 WOMAC 评分有较大改善，但有些患者改善，有些患者则恶化。OMERACT-OARSI 方法将 85.7%的患者分类为应答者，MID 为 70.1%，回归正常为 64.1%。一般来说，每种方法都将同一组患者分类为对 THR 有反应。根据 WOMAC 总分，年龄较小、病态肥胖、就业和受教育程度较高的患者更有可能对 THR 有反应，但在调整混杂因素后，这些影响减弱，只有教育程度的影响仍然重要。
总体而言，对 THR 的平均反应良好，但约 14-36%的患者在手术后 12 个月时没有改善或更差。尽管 OMERACT-OARSI 标准最初是为临床药物试验设计的，但它们在分类 THR 后 12 个月患者的反应方面表现良好。需要进一步研究以了解 THR 后患者结局的决定因素。
