Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
J Bone Joint Surg Am. 2011 Oct 19;93(20):e117(1)-(7). doi: 10.2106/JBJS.J.00850.
Although the necessity of long-term follow-up after total knee arthroplasty is unquestioned, this task may become burdensome as greater numbers of total knee arthroplasties are performed. We sought to use comparisons with clinician-assessed values to determine whether patients could reliably assess their own outcome with use of a combination of American Knee Society Score and Oxford Knee Score questionnaires and self-reported knee motion. We hypothesized that patients would self-report worse pain and function and a similar range of knee motion than clinicians would.
One hundred and forty patients (181 knees) scheduled for routine follow-up at two centers after primary total knee arthroplasty were mailed American Knee Society Score and Oxford Knee Score questionnaires, a set of photographs illustrating knee motion in 5° increments for comparison with the patient's range of knee motion, and a goniometer with instructions. The patient's American Knee Society Score, Oxford Knee Score, and knee motion were then independently assessed within two weeks of the self-evaluation by one of three clinicians who had not been involved with the surgery. Patient-reported and clinician-assessed measures were compared with use of a paired-sample t test and the Spearman correlation coefficient.
The mean patient-reported American Knee Society pain subscore was 4 points worse than the clinician-assessed score, and the function subscore was 10 points worse (p < 0.001 for both). The mean Oxford Knee Score did not differ significantly between the patient self-assessment and the clinician assessment (p = 0.05). The mean maximum flexion reported by the patient with use of the photographs differed by <1° from the mean value reported by the patient with use of the goniometer or the mean value measured by the clinician; these differences were not clinically important.
Patients' self-reported American Knee Society pain and function subscores were worse than the corresponding clinician assessments, but the two Oxford Knee Scores were similar. Range of knee motion may reasonably be self-assessed by comparison with photographs. Long-term follow-up of patients after total knee arthroplasty may be possible with use of patient-reported measures, alleviating the burden of clinic visits yet maintaining contact, but further studies involving other validated instruments is warranted.
尽管全膝关节置换术后进行长期随访是毋庸置疑的，但随着全膝关节置换术数量的增加，这项任务可能会变得繁重。我们试图通过与临床医生评估值的比较，来确定患者是否可以通过使用美国膝关节协会评分（American Knee Society Score，AKSS）和牛津膝关节评分（Oxford Knee Score，OKS）问卷以及自我报告的膝关节运动来可靠地评估自己的结果。我们假设患者会自我报告更差的疼痛和功能，以及与临床医生相似的膝关节运动范围。
140 名患者（181 膝）在两个中心接受初次全膝关节置换术后进行常规随访，他们被邮寄了美国膝关节协会评分和牛津膝关节评分问卷、一组说明膝关节运动的照片，这些照片以 5°的增量进行说明，以便与患者的膝关节运动范围进行比较，以及一个带有说明的量角器。在自我评估后的两周内，由三位未参与手术的临床医生中的一位对患者的美国膝关节协会评分、牛津膝关节评分和膝关节运动进行独立评估。使用配对样本 t 检验和斯皮尔曼相关系数比较患者报告和临床医生评估的测量值。
患者报告的美国膝关节协会疼痛亚评分比临床医生评估的评分低 4 分，功能亚评分低 10 分（均<0.001）。患者自我评估的牛津膝关节评分与临床医生评估的评分无显著差异（p=0.05）。患者使用照片报告的最大屈曲平均值与使用量角器或临床医生测量的平均值相差<1°，这些差异无临床意义。
患者自我报告的美国膝关节协会疼痛和功能亚评分低于相应的临床医生评估，但两个牛津膝关节评分相似。膝关节运动范围可以通过与照片进行比较来合理地自我评估。通过使用患者报告的测量值，对全膝关节置换术后的患者进行长期随访可能是可行的，可以减轻就诊的负担，同时保持联系，但需要进一步研究其他经过验证的工具。
