University of Edinburgh, Department of Orthopaedics, The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK.
Bone Joint J. 2013 Jan;95-B(1):52-8. doi: 10.1302/0301-620X.95B1.29749.
We assessed the effect of social deprivation upon the Oxford knee score (OKS), the Short-Form 12 (SF-12) and patient satisfaction after total knee replacement (TKR). An analysis of 966 patients undergoing primary TKR for symptomatic osteoarthritis (OA) was performed. Social deprivation was assessed using the Scottish Index of Multiple Deprivation. Those patients that were most deprived underwent surgery at an earlier age (p = 0.018), were more likely to be female (p = 0.046), to endure more comorbidities (p = 0.04) and to suffer worse pain and function according to the OKS (p < 0.001). In addition, deprivation was also associated with poor mental health (p = 0.002), which was assessed using the mental component (MCS) of the SF-12 score. Multivariable analysis was used to identify independent predictors of outcome at one year. Pre-operative OKS, SF-12 MCS, back pain, and four or more comorbidities were independent predictors of improvement in the OKS (all p < 0.001). Pre-operative OKS and improvement in the OKS were independent predictors of dissatisfaction (p = 0.003 and p < 0.001, respectively). Although improvement in the OKS and dissatisfaction after TKR were not significantly associated with social deprivation per se, factors more prevalent within the most deprived groups significantly diminished their improvement in OKS and increased their rate of dissatisfaction following TKR.
我们评估了社会剥夺对牛津膝关节评分(OKS)、12 项简短健康调查(SF-12)和全膝关节置换(TKR)后患者满意度的影响。对 966 例因症状性骨关节炎(OA)接受初次 TKR 的患者进行了分析。社会剥夺程度采用苏格兰多维贫困指数进行评估。最贫困的患者接受手术的年龄更早(p = 0.018),女性比例更高(p = 0.046),合并症更多(p = 0.04),OKS 评分的疼痛和功能更差(p < 0.001)。此外,剥夺程度也与心理健康较差相关(p = 0.002),心理健康状况采用 SF-12 评分的心理成分(MCS)进行评估。多变量分析用于确定一年时结局的独立预测因素。术前 OKS、SF-12 MCS、腰痛和 4 种或更多合并症是 OKS 改善的独立预测因素(均 p < 0.001)。术前 OKS 和 OKS 的改善是不满意的独立预测因素(p = 0.003 和 p < 0.001)。尽管 TKR 后 OKS 的改善和不满意与社会剥夺本身并无显著相关性,但最贫困组中更为常见的因素显著降低了他们 OKS 的改善程度,并增加了他们 TKR 后不满意的发生率。