Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK,
Knee Surg Sports Traumatol Arthrosc. 2013 Nov;21(11):2638-46. doi: 10.1007/s00167-013-2523-y. Epub 2013 May 14.
We hypothesise that patients with a worse post-operative generic physical health, and those with a subclinical improvement, will have a greater rate of dissatisfaction with their total knee arthroplasty (TKA) despite improvement in their knee function.
Prospectively complied data for 2,330 primary TKA were used. Patient demographics, comorbidity, and pre- and post-operative (1 year) Oxford knee scores (OKS) and Short Form (SF-) 12 scores were collected. Patient satisfaction was also assessed 1 year post-operatively. The satisfaction rate of patients with a poor post-operative SF-12 physical component summary (PCS score) (≤40 points) and those with a subclinical improvement (<4 points) in the score were compared to those with a score of more than 40 and a clinically significant improvement, respectively.
More than half of the patients (n = 1,220) had a poor post-operative SF-12 PCS, and a third (n = 722) had a subclinical improvement in their general physical health after TKA. These patients were more likely to be older in age, suffer with concomitant back pain, and pain in other joints, and have a significantly worse pre-operative mental well-being score (SF-12) and OKS (all p < 0.04 on regression analysis). Both groups had a clinically significant improvement in their OKS post-operatively (p < 0.001), but it was 10 and 8 points less, respectively, than those patients with a SF-12 PCS of more than 40, and a clinical significant improvement in their PCS score (p < 0.001). Logistic regression analysis demonstrated that patients who had a poor post-operative SF-12 PCS (odds ratio 7.9, p < 0.001) and those with a subclinical improvement in their general physical health (odds ratio 5.1, p < 0.001) after TKA were significantly less likely to be satisfied.
Despite benefitting from a significant improvement in their OKS after TKA, patients with a poor post-operative SF-12 PCS and those with a subclinical improvement in their general physical well-being are significantly less likely to be satisfied at 1 year.
我们假设，尽管膝关节功能得到改善，但术后一般身体健康状况较差的患者和亚临床改善的患者对全膝关节置换术（TKA）的满意度会更高。
前瞻性收集了 2330 例初次 TKA 的患者数据。收集了患者的人口统计学、合并症以及术前和术后（1 年）牛津膝关节评分（OKS）和 12 项简明健康调查问卷（SF-12）评分。术后 1 年还评估了患者的满意度。比较了术后 SF-12 躯体成分综合评分（PCS 评分）较差（≤40 分）和评分有亚临床改善（<4 分）的患者以及分别具有评分大于 40 分和临床显著改善的患者的满意度率。
超过一半的患者（n=1220）术后 SF-12 PCS 评分较差，三分之一（n=722）在 TKA 后一般身体健康状况有亚临床改善。这些患者年龄较大，患有合并症性腰痛和其他关节疼痛，且术前心理健康评分（SF-12）和 OKS 评分显著更差（回归分析，所有 p<0.04）。两组术后 OKS 均有临床显著改善（p<0.001），但分别比那些术后 SF-12 PCS 评分大于 40 分和 PCS 评分有临床显著改善的患者低 10 分和 8 分（p<0.001）。Logistic 回归分析表明，术后 SF-12 PCS 评分较差（优势比 7.9，p<0.001）和一般身体健康状况有亚临床改善（优势比 5.1，p<0.001）的患者，术后满意度明显较低。
尽管 TKA 后 OKS 显著改善，但术后 SF-12 PCS 评分较差和一般身体健康状况有亚临床改善的患者在 1 年时满意度明显较低。
