Department of Orthopaedics, St. Vincent's Hospital Melbourne, Australia.
Osteoarthritis Cartilage. 2012 Oct;20(10):1095-102. doi: 10.1016/j.joca.2012.05.015. Epub 2012 Jul 16.
To assess the influence of pre-operative X-ray changes on the response to total knee joint replacement (TKR).
We included patients from one centre who underwent primary TKR (n = 478) for osteoarthritis in 2006 and 2007. The International Knee Society score (IKSS) and short form health survey were collected pre-operatively and at 1 and 2 years after surgery. Pre-operative radiographs were read to assess Kellgren and Lawrence (K-L) grading, individual radiographic features using the OARSI atlas, and subchondral bone attrition using the Ahlbach method. The main independent variable was a modified (K-L) grade. The outcome variables were the IKSS pain and function scores. Covariates included demographic features, co-morbidities, baseline pain and function, prosthesis type, and the use of patella resurfacing. Multivariable linear regression models were created to assess the relationships between pre-operative X-ray findings and pain and function outcomes.
On average, pain and function improved greatly following surgery. However, pain relief was unsatisfactory in about 30%, and functional improvement suboptimal in about 50%. OR (95% CI) for ongoing moderate-severe pain at 12 months for modified K-L grades; <3: 5.39 (1.23-15.69), 3a: 2.62 (1.21-5.67), 3b: 1.81 (1.00-3.26), 4a: 2.06 (1.05-4.05) when compared to 4b. OR (95% CI) for poor function at 12 months were; 3a: 2.81 (1.23-6.39) and 4a: 2.45 (1.22-4.91), when compared to 4b.
Patients with more severe radiographic knee damage at the time of surgery are most likely to have substantial gains in terms of both pain relief and improved function as a result of a TKR.
评估术前 X 射线变化对全膝关节置换术（TKR）反应的影响。
我们纳入了 2006 年至 2007 年期间在一家中心接受原发性 TKR（n=478）治疗骨关节炎的患者。在术前、术后 1 年和 2 年采集国际膝关节学会评分（IKSS）和简短健康调查。术前阅片评估 Kellgren 和 Lawrence（K-L）分级、使用 OARSI 图谱评估个别影像学特征、以及使用 Ahlbach 方法评估软骨下骨磨损。主要的独立变量是改良（K-L）分级。主要的观察变量是 IKSS 疼痛和功能评分。协变量包括人口统计学特征、合并症、基线疼痛和功能、假体类型以及髌骨再表面化的使用。建立多变量线性回归模型来评估术前 X 射线表现与疼痛和功能结果之间的关系。
平均而言，手术后疼痛和功能有了很大的改善。然而，约 30%的患者疼痛缓解不满意，约 50%的患者功能改善不理想。改良 K-L 分级；<3 级：12 个月时持续中度至重度疼痛的 OR（95%CI）为 5.39（1.23-15.69），3a 级：2.62（1.21-5.67），3b 级：1.81（1.00-3.26），4a 级：2.06（1.05-4.05），与 4b 级相比。12 个月时功能不良的 OR（95%CI）为；3a 级：2.81（1.23-6.39）和 4a 级：2.45（1.22-4.91），与 4b 级相比。
在手术时膝关节放射学损伤更严重的患者，最有可能在 TKR 后在疼痛缓解和功能改善方面获得显著收益。
