Beverland David
Primary Joint Unit, Musgrave Park Hospital, Belfast, United Kingdom.
Orthopedics. 2010 Sep 7;33(9):657. doi: 10.3928/01477447-20100722-23.
Survivorship following modern total knee arthroplasty (TKA) is good with revision rates generally lower than for total hip arthroplasty (THA). Our experience in Belfast supports that fact with original component survivorship of 99% for the low contact stress rotating platform TKA, which is better than our THA survivorship. It is important to discriminate between survivorship and patient satisfaction. In Belfast, as well as the more familiar outcome scores, we also use a very simple 4-point satisfaction questionnaire: "How would you best describe your satisfaction with your new joint" where 1=very happy, 2=happy, 3=OK but not perfect, and 4=I have never been happy. We applied this questionnaire to our 10-year THA and TKA patients. When we looked specifically at the numbers of patients who were either "very happy" or "never happy," the results were very different. The very happy percentage for hips was much higher than for knees (54% vs 4%) and conversely, the number of never happy knees was much higher than for hips (7% vs 1%). These results are not unique to Belfast. As surgeons, we often think that the knee implant that we use is the best but at present, the implant is no longer the most critical factor. We need to increase the number of very happy patients and decrease the number of never happy ones. In my opinion the two key factors that we should focus on are patient expectation and surgeon education.
现代全膝关节置换术（TKA）后的假体生存率良好，翻修率通常低于全髋关节置换术（THA）。我们在贝尔法斯特的经验证实了这一点，低接触应力旋转平台TKA的初始假体生存率为99%，优于我们的THA生存率。区分假体生存率和患者满意度很重要。在贝尔法斯特，除了更常见的疗效评分外，我们还使用一种非常简单的4分满意度调查问卷：“你如何最好地描述你对新关节的满意度”，其中1=非常满意，2=满意，3=还行但不完美，4=我一直不满意。我们将这份问卷应用于我们的10年THA和TKA患者。当我们具体查看“非常满意”或“一直不满意”的患者数量时，结果差异很大。髋关节“非常满意”的百分比远高于膝关节（54%对4%），相反，一直不满意的膝关节数量远高于髋关节（7%对1%）。这些结果并非贝尔法斯特所独有。作为外科医生，我们常常认为我们使用的膝关节植入物是最好的，但目前，植入物已不再是最关键的因素。我们需要增加非常满意的患者数量，减少一直不满意的患者数量。在我看来，我们应该关注的两个关键因素是患者期望和外科医生培训。
