Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA.
BMC Med. 2013 Jun 5;11:144. doi: 10.1186/1741-7015-11-144.
Poor pain and function outcomes are undesirable after an elective surgery such as total hip or knee arthroplasty (THA/TKA). Recent studies have indicated that the presence of contralateral joint influences outcomes of THA/TKA, however the impact of ipsilateral knee/hip involvement on THA/TKA outcomes has not been explored. The objective of this study was to assess the association of ipsilateral knee/hip joint involvement on short-term and medium-term pain and function outcomes after THA/TKA.
In this retrospective study of prospectively collected data, we used the data from the Mayo Clinic Total Joint Registry to assess the association of ipsilateral knee or hip joint involvement with moderate to severe pain and moderate to severe activity limitation at 2-year and 5-year follow-up after primary and revision THA and TKA using multivariable-adjusted logistic regression analyses.
At 2 years, 3,823 primary THA, 4,701 primary TKA, 1,218 revision THA and 725 revision TKA procedures were studied. After adjusting for multiple covariates, ipsilateral knee pain was significantly associated with outcomes after primary THA (all P values <0.01): (1) moderate to severe pain: at 2 years, odds ratio (OR), 2.3 (95% confidence interval (CI) 1.5 to 3.6); at 5 years, OR 1.8 (95% CI 1.1 to 2.7); (2) moderate to severe activity limitation: at 2 years, OR 3.1 (95% CI 2.3 to 4.3); at 5 years, OR 3.6 (95% CI 2.6 to 5.0). Ipsilateral hip pain was significantly associated with outcomes after primary TKA (all P values <0.01): (1) moderate to severe pain: at 2 years, OR 3.3 (95% CI 2.3 to 4.7); at 5 years, OR 1.8 (95% CI 1.1 to 2.7); (2) moderate to severe activity limitation: at 2 years, OR 3.6 (95% CI 2.6 to 4.9); at 5 years, OR 2.2 (95% CI 1.6 to 3.2). Similar associations were noted for revision THA and TKA patients.
To the best of our knowledge, this is the first study showing that the presence of ipsilateral joint involvement after THA or TKA is strongly associated with poor pain and function outcomes. A potential way to improve outcomes is to address ipsilateral lower extremity joint involvement.
全髋关节或膝关节置换术（THA/TKA）等择期手术后，疼痛和功能较差的结果不理想。最近的研究表明，对侧关节的存在会影响 THA/TKA 的结果，但是同侧膝关节/髋关节受累对 THA/TKA 结果的影响尚未得到探索。本研究的目的是评估同侧膝关节/髋关节受累对 THA/TKA 后短期和中期疼痛和功能结果的影响。
在这项前瞻性收集数据的回顾性研究中，我们使用 Mayo 诊所全关节登记处的数据，使用多变量调整的逻辑回归分析评估同侧膝关节或髋关节受累与初次和翻修 THA 和 TKA 后 2 年和 5 年随访时中度至重度疼痛和中度至重度活动受限之间的关联。
在 2 年时，研究了 3823 例初次 THA、4701 例初次 TKA、1218 例翻修 THA 和 725 例翻修 TKA 手术。在调整了多个协变量后，同侧膝关节疼痛与初次 THA 后的结果显著相关（所有 P 值均<0.01）：（1）中度至重度疼痛：在 2 年时，比值比（OR）为 2.3（95%置信区间（CI）为 1.5 至 3.6）；在 5 年时，OR 为 1.8（95%CI 为 1.1 至 2.7）；（2）中度至重度活动受限：在 2 年时，OR 为 3.1（95%CI 为 2.3 至 4.3）；在 5 年时，OR 为 3.6（95%CI 为 2.6 至 5.0）。同侧髋关节疼痛与初次 TKA 后的结果显著相关（所有 P 值均<0.01）：（1）中度至重度疼痛：在 2 年时，OR 为 3.3（95%CI 为 2.3 至 4.7）；在 5 年时，OR 为 1.8（95%CI 为 1.1 至 2.7）；（2）中度至重度活动受限：在 2 年时，OR 为 3.6（95%CI 为 2.6 至 4.9）；在 5 年时，OR 为 2.2（95%CI 为 1.6 至 3.2）。在翻修 THA 和 TKA 患者中也观察到类似的关联。
据我们所知，这是第一项表明 THA 或 TKA 后同侧关节受累与疼痛和功能较差结果密切相关的研究。改善结果的一种潜在方法是解决同侧下肢关节受累问题。
