Nashi Nazrul, Hong Choon Chiet, Krishna Lingaraj
University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2015 Jun;23(6):1841-7. doi: 10.1007/s00167-014-2910-z. Epub 2014 Feb 19.
Total knee arthroplasty (TKA) is a successful and safe elective operation in managing patients with severe osteoarthritis of the knee. However, the presence of residual knee pain (RKP) post-TKA can adversely affect patient satisfaction and functional outcome. Hence, the aim of this paper is to identify the incidence, progression of knee pain, functional outcome post-TKA and possible predictive factors for the development of RKP post-TKA.
A retrospective review of 357 patients was conducted with a minimum follow-up period of 2 years. Predictive factors reviewed include the patients' demographics, co-morbidities, type of implants and patellar management. For functional outcome, the patient's Knee Society Score (KSS) and Western Ontario and McMaster Universities Index of Osteoarthritis scores were analysed. To determine presence and severity of RKP, the sub-score for pain in the KSS was utilised.
In total, 31.1 and 28.9% of the patients were found to have RKP at 1 and 2 years, respectively, though their functional outcome scores continued improving from 1 year. Ischaemic heart disease (IHD) patients were more likely to have RKP and poorer functional outcome at 1 year. Males and patients with posterior-stabilised implants were found to have better functional outcome at 1 and 2 years, respectively.
Almost a third of the patients continued to have RKP at 2 years post-TKA, with factors such as gender, presence of IHD and implant type significantly associated with the development of RKP and/or poorer functional outcome scores. By recognising the incidence and predictive factors for RKP, physicians will be able to better manage their patients' expectations and optimise their pre-morbid status pre-operatively.
III.
全膝关节置换术（TKA）是治疗重度膝关节骨关节炎患者的一种成功且安全的择期手术。然而，TKA术后残留膝关节疼痛（RKP）的存在会对患者满意度和功能结局产生不利影响。因此，本文旨在确定RKP的发生率、膝关节疼痛的进展、TKA术后的功能结局以及TKA术后RKP发生的可能预测因素。
对357例患者进行回顾性研究，最短随访期为2年。回顾的预测因素包括患者的人口统计学特征、合并症、植入物类型和髌骨处理方式。对于功能结局，分析患者的膝关节协会评分（KSS）以及西安大略和麦克马斯特大学骨关节炎指数评分。为了确定RKP的存在和严重程度，使用了KSS中的疼痛子评分。
尽管患者的功能结局评分从1年起持续改善，但分别有31.1%和28.9%的患者在1年和2年时被发现存在RKP。缺血性心脏病（IHD）患者在1年时更有可能出现RKP且功能结局较差。男性和使用后稳定型植入物的患者在1年和2年时分别具有更好的功能结局。
近三分之一的患者在TKA术后2年仍持续存在RKP，性别、IHD的存在和植入物类型等因素与RKP的发生和/或较差的功能结局评分显著相关。通过认识到RKP的发生率和预测因素，医生将能够更好地管理患者的期望，并在术前优化其病前状态。
III级
