School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
Br J Gen Pract. 2011 Aug;61(589):e459-68. doi: 10.3399/bjgp11X588420.
Individuals with hip or knee osteoarthritis (OA) are referred to orthopaedic surgeons if considered by their GP as potential candidates for total joint replacement (TJR). It is not clear which patients end up having this surgery.
The aim of the study was to investigate symptom variation in individuals with OA newly referred by GPs to an orthopaedic surgeon for consideration for TJR, and to determine the predictors of having this procedure.
A longitudinal study of patients at a regional orthopaedic centre with follow-up at 3, 6, and 12 months by postal questionnaire.
GP referrals of patients with OA to orthopaedic surgeons were consecutively sampled. Of the 431 eligible patients, 257 (59.6%) were recruited. Validated measurement tools were used to measure pain, physical functioning, severity of OA, and health-related quality of life.
Over half the participants were in constant pain, taking pain medication more than once per day. Only 67 of 134 (50%) hip and 40 of 123 (33%) knee patients had a TJR within 12 months. Those who had a replacement had been diagnosed with OAfora shorter time, reported more frequent pain, were more likely to use a walking stick, and had worse pain, stiffness, and physical functioning.
Many individuals considered for TJR ultimately may not have surgery, and more effective strategies of management need to be developed between primary and secondary care to achieve better outcomes and to improve quality of care.
如果全科医生认为髋关节或膝关节骨关节炎（OA）患者可能是全关节置换术（TJR）的潜在候选人，他们会将这些患者转诊给矫形外科医生。目前尚不清楚哪些患者最终会接受这种手术。
本研究旨在调查新由全科医生转诊给矫形外科医生考虑 TJR 的 OA 患者的症状变化，并确定进行该手术的预测因素。
这是一项在区域矫形中心进行的纵向研究，通过邮寄问卷在 3、6 和 12 个月时进行随访。
连续抽样全科医生转诊的 OA 患者到矫形外科医生处就诊。在 431 名符合条件的患者中，招募了 257 名（59.6%）患者。使用经过验证的测量工具来测量疼痛、身体功能、OA 严重程度和健康相关生活质量。
超过一半的参与者经常感到疼痛，每天服用止痛药超过一次。在 134 名髋关节患者中有 67 名（50%）和 123 名膝关节患者中有 40 名（33%）在 12 个月内接受了 TJR。接受置换手术的患者被诊断为 OA 的时间较短，报告疼痛更频繁，更有可能使用手杖，并且疼痛、僵硬和身体功能更差。
许多考虑接受 TJR 的患者最终可能不会接受手术，需要在初级保健和二级保健之间制定更有效的管理策略，以实现更好的结果并提高护理质量。
