膝关节置换术前的胫股关节炎严重程度：来自骨关节炎倡议的多中心数据。
Extent of tibiofemoral osteoarthritis before knee arthroplasty: multicenter data from the osteoarthritis initiative.
机构信息
Department of Physical Therapy, Virginia Commonwealth University, P.O. Box 980224, Richmond, VA 23298, USA.
出版信息
Clin Orthop Relat Res. 2012 Oct;470(10):2836-42. doi: 10.1007/s11999-012-2328-1. Epub 2012 Mar 27.
BACKGROUND
Knee arthroplasty traditionally is recommended for persons with substantial disability and disabling pain attributable to moderate or severe osteoarthritis (OA). Pain and functional status after arthroplasty may be influenced by the extent of knee OA before surgery and recent evidence suggests persons with less severe knee OA before undergoing TKA have greater pain levels and worse function than persons with more severe knee OA.
QUESTIONS/PURPOSES: We determined the proportion of patients undergoing knee arthroplasty who had less than moderate knee OA before surgery and who had either a radiographically normal medial or lateral joint space before surgery.
METHODS
One hundred sixteen persons in the Osteoarthritis Initiative underwent knee arthroplasty during a 3-year period. Ninety-seven of the 116 patients (84%) had radiographs available less than 1 year before surgery and were included. We used Z-tests to determine whether the proportion of patients with a modified Kellgren-Lawrence (KL) grade of 3 or higher differed from literature-based estimates. In addition, we described the proportion of patients with medial and lateral joint space narrowing.
RESULTS
The proportion of patients with a modified KL grade of 3 or higher was 0.81 (95% CI, 0.73-0.89) and was less than the 0.95 estimated population proportion. Of the patients who underwent knee arthroplasty, 85% (82 of 97 knee arthroplasties) had at least one tibiofemoral joint compartment that had no joint space narrowing. One in six patients with OA who underwent knee arthroplasty had a KL grade of 2 or lower.
CONCLUSIONS
Variation in the extent of tibiofemoral OA in patients preparing for joint arthroplasty is greater than previously described. A greater percentage of patients undergoing knee arthroplasty may be at risk for increased pain and poorer function than previously assumed after surgery because of less severe knee OA before surgery.
LEVEL OF EVIDENCE
Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
膝关节置换术传统上推荐用于因中度或重度骨关节炎（OA）而导致严重残疾和疼痛的患者。膝关节置换术后的疼痛和功能状态可能受到术前膝关节 OA 的严重程度以及最近的证据影响，提示接受 TKA 手术的膝关节 OA 程度较轻的患者的疼痛水平和功能比膝关节 OA 程度较重的患者差。
问题/目的：我们确定了在接受膝关节置换术之前患有轻度至中度膝关节 OA 的患者比例，以及在接受膝关节置换术之前膝关节内侧或外侧关节间隙存在放射学正常的患者比例。
方法
Osteoarthritis Initiative 中的 116 人在 3 年内接受了膝关节置换术。在 116 名患者中有 97 名（84%）在术前不到 1 年内有 X 光片可供使用，因此被纳入研究。我们使用 Z 检验来确定患有改良 Kellgren-Lawrence（KL）分级 3 或更高的患者比例是否与基于文献的估计值不同。此外，我们描述了内侧和外侧关节间隙狭窄的患者比例。
结果
患有改良 KL 分级 3 或更高的患者比例为 0.81（95%CI，0.73-0.89），低于估计的 0.95 人群比例。在接受膝关节置换术的患者中，85%（97 例膝关节置换术中有 82 例）至少有一个胫股关节间隙没有关节间隙狭窄。接受膝关节置换术的 OA 患者中，有 1/6 的患者 KL 分级为 2 或更低。
结论
准备接受关节置换术的患者的胫股 OA 严重程度的变化比以前描述的更大。由于术前膝关节 OA 程度较轻，接受膝关节置换术的患者中可能有更大比例的患者在手术后出现疼痛加剧和功能下降的风险，比以前假设的更高。
证据水平
1 级，诊断研究。有关证据水平的完整描述，请参阅作者指南。
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