Department of Physical Therapy, University of Delaware, Newark, DE, USA.
BMC Musculoskelet Disord. 2010 May 6;11:86. doi: 10.1186/1471-2474-11-86.
Arthritis is a leading cause of disability in the United States. Total knee arthroplasty (TKA) has become the gold standard to manage the pain and disability associated with knee osteoarthritis (OA). Although more than 400,000 primary TKA surgeries are performed each year in the United States, not all individuals with knee OA elect to undergo the procedure. No clear consensus exists on criteria to determine who should undergo TKA. The purpose of this study was to determine which clinical factors will predict the decision to undergo TKA in individuals with end-stage knee OA. Knowledge of these factors will aid in clinical decision making for the timing of TKA.
Functional data from one hundred twenty persons with end-stage knee OA were obtained through a database. All of the individuals complained of knee pain during daily activities and had radiographic evidence of OA. Functional and clinical tests, collectively referred to as the Delaware Osteoarthritis Profile, were completed by a physical therapist. This profile consisted of measuring height, weight, quadriceps strength and active knee range of motion, while functional mobility was assessed using the Timed Up and Go (TUG) test and the Stair Climbing Task (SCT). Self-perceived functional ability was measured using the activities of daily living subscale of the Knee Outcome Survey (KOS-ADLS). A logistic regression model was used to identify variables predictive of TKA use.
Forty subjects (33%) underwent TKA within two years of evaluation. These subjects were significantly older and had significantly slower TUG and SCT times (p < 0.05). Persons that underwent TKA were also significantly weaker, had lower self-reported function and had less knee extension than persons who did not undergo TKA. No differences between groups were seen for BMI, gender, knee flexion ROM and unilateral versus bilateral joint disease. Using backward regression, age, knee extension ROM and KOS-ADLS together significantly predicted whether or not a person would undergo TKA (p <or= 0.001, R2 = 0.403).
Younger patients with full knee ROM who have a higher self-perception of function are less likely to undergo TKA. Physicians and clinicians should be aware that potentially modifiable factors, such as knee ROM can be addressed to potentially postpone the need for TKA.
关节炎是美国导致残疾的主要原因。全膝关节置换术（TKA）已成为治疗膝关节骨关节炎（OA）相关疼痛和残疾的金标准。尽管每年在美国进行超过 40 万例初次 TKA 手术，但并非所有膝关节 OA 患者都选择进行该手术。目前尚无明确共识确定哪些患者应接受 TKA。本研究旨在确定哪些临床因素会预测终末期膝关节 OA 患者接受 TKA 的决定。了解这些因素将有助于确定 TKA 的时机。
通过数据库获得 120 名终末期膝关节 OA 患者的功能数据。所有患者在日常活动中均有膝关节疼痛，并具有放射影像学 OA 证据。理疗师完成了功能和临床测试，统称为特拉华州骨关节炎概况。该概况包括测量身高、体重、股四头肌力量和主动膝关节活动范围，同时使用计时起立行走测试（TUG）和爬楼梯任务（SCT）评估功能性移动能力。日常活动能力的自我感知功能通过膝关节结果调查（KOS-ADLS）的日常生活活动子量表进行测量。使用逻辑回归模型确定预测 TKA 使用的变量。
在评估后两年内，有 40 名（33%）患者接受了 TKA。这些患者明显年龄较大，TUG 和 SCT 时间明显较慢（p < 0.05）。接受 TKA 的患者也明显较弱，自我报告的功能较低，并且膝关节伸展度较未接受 TKA 的患者低。两组之间在 BMI、性别、膝关节屈曲 ROM 和单侧与双侧关节疾病方面没有差异。使用向后回归，年龄、膝关节伸展 ROM 和 KOS-ADLS 共同显著预测患者是否会接受 TKA（p <or= 0.001，R2 = 0.403）。
具有完整膝关节 ROM 和更高自我功能感知的年轻患者不太可能接受 TKA。医生和临床医生应该意识到，潜在可改变的因素，如膝关节 ROM，可以解决，以潜在地推迟 TKA 的需要。
