Harvard Medical School, MS2, 107 Avenue Louis Pasteur, Vanderbilt Box 040, Boston, MA 02115, USA.
Rheumatology (Oxford). 2013 Oct;52(10):1802-8. doi: 10.1093/rheumatology/ket180. Epub 2013 Jun 7.
In developed countries, the functional status scores of patients with poor preoperative scores undergoing total joint replacement (TJR) improve more following TJR than those for patients with better preoperative scores. However, those with better preoperative scores achieve the best postoperative functional outcomes. We determined whether similar associations exist in a developing country.
Dominican patients undergoing total hip or knee replacement completed WOMAC and SF-36 surveys preoperatively and at 12-month follow-up. Patients were stratified into low-, medium- and high-scoring preoperative groups based on their preoperative WOMAC function scores. We examined the associations between the baseline functional status of these groups and two outcomes-improvement in functional status over 12 months and functional status at 12 months-using analysis of variance with multivariable linear regression.
Patients who scored the lowest preoperatively made the greatest gains in function and pain relief following their TJRs. However, there were no significant differences in pain or function at 12-month follow-up between patients who scored low and those who scored high on preoperative WOMAC and SF-36 surveys.
Patients with poor preoperative functional status had greater improvement but similar 12-month functional outcomes compared with patients who had a higher level of function before surgery. These results suggest that a policy of focusing scarce resources on patients with worse functional status in developing countries may optimize improvement following TJR without threatening functional outcome. Additional research is needed to confirm these findings in other developing countries and to understand why these associations vary between patients in the Dominican Republic and patients from developed countries.
在发达国家，术前评分较差的全关节置换术（TJR）患者的功能评分在 TJR 后改善程度大于术前评分较好的患者。然而，术前评分较好的患者获得了最佳的术后功能结局。我们确定在发展中国家是否存在类似的关联。
多米尼加接受全髋关节或膝关节置换术的患者在术前和 12 个月随访时完成了 WOMAC 和 SF-36 调查。患者根据术前 WOMAC 功能评分分为低、中、高术前评分组。我们使用方差分析和多变量线性回归，检查这些组的基线功能状态与两个结果之间的关联——12 个月内功能状态的改善和 12 个月时的功能状态。
术前评分最低的患者在接受 TJR 后功能和疼痛缓解方面取得了最大的进步。然而，在术前 WOMAC 和 SF-36 调查中得分较低和较高的患者在 12 个月随访时的疼痛或功能方面没有显著差异。
与术前功能状态较高的患者相比，术前功能状态较差的患者改善程度更大，但 12 个月的功能结局相似。这些结果表明，在发展中国家，将稀缺资源集中在功能状态较差的患者身上的政策可能会优化 TJR 后的改善，而不会威胁到功能结局。需要进一步的研究来证实这些发现是否适用于其他发展中国家，并了解为什么这些关联在多米尼加共和国患者和发达国家患者之间存在差异。
