The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA,
Clin Orthop Relat Res. 2014 Jan;472(1):133-7. doi: 10.1007/s11999-013-3229-7.
TKA is among the fastest growing interventions in medicine, with procedure incidence increasing the most in younger patients. Global knee scores have a ceiling effect and do not capture the presence of difficulty or dissatisfaction with specific activities important to patients.
QUESTIONS/PURPOSES: We quantified the degree of residual symptoms and specific functional deficits in young patients who had undergone TKA.
In a national multicenter study, we quantified the degree of residual symptoms and specific functional deficits in 661 young patients (mean age, 54 years; range, 19-60 years; 61% female) at 1 to 4 years after primary TKA. To eliminate observer bias, satisfaction and function data were collected by an independent, third-party survey center with expertise in administering medical outcomes questionnaires for federal agencies.
Overall, 89% of patients were satisfied with their ability to perform normal daily living activities, and 91% were satisfied with their pain relief. After TKA, 66% of patients indicated their knees felt normal, 33% reported some degree of pain, 41% reported stiffness, 33% reported grinding/other noises, 33% reported swelling/tightness, 38% reported difficulty getting in and out of a car, 31% reported difficulty getting in and out of a chair, and 54% reported difficulty with stairs. After recovery, 47% reported complete absence of a limp and 50% had participated in their most preferred sport or recreational activity in the past 30 days.
When interviewed by an independent third party, about 1/3 of young patients reported residual symptoms and limitations after modern TKA. We recommend informing patients considering surgery about the high likelihood of residual symptoms and limitations after contemporary TKA, even when performed by experienced surgeons in high-volume centers, and taking specific steps to set patients' expectations to a level that is likely to be met by the procedure as it now is performed.
全膝关节置换术（TKA）是医学领域增长最快的干预手段之一，其手术发生率在年轻患者中增长最快。全球膝关节评分存在上限，无法捕捉到患者对特定活动的困难或不满。
问题/目的：我们量化了接受 TKA 的年轻患者的残留症状和特定功能缺陷的严重程度。
在一项全国多中心研究中，我们对 661 名接受初次 TKA 后 1 至 4 年的年轻患者（平均年龄 54 岁，范围 19-60 岁，61%为女性）的残留症状和特定功能缺陷程度进行了量化。为了消除观察者的偏见，满意度和功能数据由具有为联邦机构管理医疗结果问卷专业知识的独立第三方调查中心收集。
总体而言，89%的患者对其进行日常活动的能力感到满意，91%对其疼痛缓解感到满意。接受 TKA 后，66%的患者表示其膝关节感觉正常，33%报告有一定程度的疼痛，41%报告僵硬，33%报告有摩擦/其他噪音，33%报告肿胀/紧绷，38%报告上下车困难，31%报告上下椅子困难，54%报告上下楼梯困难。康复后，47%报告完全没有跛行，50%在过去 30 天内参加了他们最喜欢的运动或娱乐活动。
当由独立第三方进行采访时，约 1/3的年轻患者报告在现代 TKA 后仍存在残留症状和功能障碍。我们建议在考虑手术时告知患者，即使由经验丰富的外科医生在高容量中心进行手术，他们在接受当代 TKA 后仍很可能存在残留症状和功能障碍，并采取具体措施将患者的期望设定在手术效果可能达到的水平。
