Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO, 63110, USA,
Clin Orthop Relat Res. 2014 Jan;472(1):86-97. doi: 10.1007/s11999-013-3002-y.
Few data exist regarding the impact of socioeconomic factors on results of current TKA in young patients. Predictors of TKA outcomes have focused primarily on surgical technique, implant details, and individual patient clinical factors. The relative importance of these factors compared to patient socioeconomic status is not known.
QUESTIONS/PURPOSES: We determined whether (1) socioeconomic factors, (2) demographic factors, or (3) implant factors were associated with satisfaction and functional outcomes after TKA in young patients.
We surveyed 661 patients (average age, 54 years; range, 18-60 years; 61% female) 1 to 4 years after undergoing modern primary TKA for noninflammatory arthritis at five orthopaedic centers. Data were collected by an independent third party with expertise in collecting healthcare data for state and federal agencies. We examined specific questions regarding satisfaction, pain, and function after TKA and socioeconomic (household income, education, employment) and demographic (sex, minority status) factors. Multivariable analysis was conducted to examine the relative importance of these factors for each outcome of interest.
Patients reporting incomes of less than USD 25,000 were less likely to be satisfied with TKA outcomes and more likely to have functional limitations after TKA than patients with higher incomes; no other socioeconomic factors were associated with satisfaction. Women were less likely to be satisfied and more likely to have functional limitations than men, and minority patients were more likely to have functional limitations than nonminority patients. Implants were not associated with outcomes after surgery.
Socioeconomic factors, in particular low income, are more strongly associated with satisfaction and functional outcomes in young patients after TKA than demographic or implant factors. Future studies should be directed to determining the causes of this association, and studies of clinical results after TKA should consider stratifying patients by socioeconomic status.
关于社会经济因素对年轻患者当前全膝关节置换术（TKA）结果的影响，相关数据较少。TKA 结果的预测因素主要集中在手术技术、植入物细节和个体患者临床因素上。这些因素与患者社会经济地位的相对重要性尚不清楚。
问题/目的：我们确定了（1）社会经济因素、（2）人口统计学因素还是（3）植入物因素与年轻患者 TKA 后满意度和功能结果相关。
我们调查了五个骨科中心的 661 名（平均年龄 54 岁；范围 18-60 岁；61%为女性）接受现代初次 TKA 治疗非炎症性关节炎的患者，在手术后 1-4 年进行。数据由具有为州和联邦机构收集医疗保健数据专业知识的独立第三方收集。我们调查了与 TKA 后满意度、疼痛和功能相关的具体问题以及社会经济（家庭收入、教育、就业）和人口统计学（性别、少数族裔地位）因素。进行多变量分析以检查这些因素对每个感兴趣结果的相对重要性。
收入低于 25000 美元的患者报告对 TKA 结果的满意度较低，术后功能受限的可能性高于收入较高的患者；没有其他社会经济因素与满意度相关。女性对 TKA 的满意度较低，术后功能受限的可能性较高，少数民族患者的功能受限比非少数民族患者更常见。植入物与术后结果无关。
与人口统计学或植入物因素相比，社会经济因素，特别是低收入，与年轻患者 TKA 后满意度和功能结果的相关性更强。未来的研究应该致力于确定这种关联的原因，而 TKA 后临床结果的研究应该考虑按社会经济地位对患者进行分层。
