The University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, 29 Regent Street, Fitzroy, Victoria, 3065, Australia; St. Vincent's Hospital Melbourne, Department of Orthopaedics, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
The University of Melbourne, Department of General Practice, 200 Berkeley Street, Carlton, Victoria, 3053, Australia.
Best Pract Res Clin Rheumatol. 2014 Feb;28(1):157-71. doi: 10.1016/j.berh.2014.01.005.
Osteoarthritis (OA) is one of the 10 most disabling diseases in developed countries and worldwide estimates are that 10% of men and 18% of women aged over 60 years have symptomatic OA, including moderate and severe forms. Total joint replacement (TJR) is considered the most effective treatment for end-stage OA in those who have exhausted available conservative interventions. The demand for TJR is continually rising due to the ageing population; in the United States, more than 1 million TJRs were performed in 2010 and the number of procedures is projected to exceed 4 million in the US by 2030. It has been estimated that of all hip and knee replacements performed, approximately one quarter of the patients may be considered inappropriate candidates. Predicting who will benefit from TJR and who will not would seem critical in terms of containing the current and projected expenditure as well as improving satisfaction in TJR recipients. Few formal predictive tools are available to aid referring clinicians to determine those likely to be good or poor responders to surgery and current available tools tend to focus on disease severity alone with little consideration of risk factors that may predict a poor outcome or impede an effective response to surgery. This review examines the tools available to assist with assessing appropriateness for TJR; investigates the modifiable risk factors associated with poor outcome; and identifies areas for future research in selecting those appropriate for joint replacement.
骨关节炎（OA）是发达国家和全球 10 大最致残疾病之一，估计有 10%的 60 岁以上男性和 18%的女性患有症状性 OA，包括中度和重度。对于已用尽现有保守治疗干预措施的终末期 OA 患者，全关节置换术（TJR）被认为是最有效的治疗方法。由于人口老龄化，对 TJR 的需求不断增加；在美国，2010 年进行了超过 100 万例 TJR，预计到 2030 年，美国的手术数量将超过 400 万例。据估计，在所有进行的髋关节和膝关节置换术中，约有四分之一的患者可能被认为不适合手术。在控制当前和预计支出以及提高 TJR 受者满意度方面，预测谁将从 TJR 中受益以及谁不会受益似乎至关重要。几乎没有可用的正式预测工具来帮助转诊临床医生确定那些可能对手术有良好或不良反应的患者，而目前可用的工具往往仅关注疾病严重程度，很少考虑可能预测不良结果或阻碍手术有效反应的风险因素。这篇综述检查了可用的工具，以协助评估 TJR 的适宜性；调查与不良结果相关的可改变的危险因素；并确定在选择适合关节置换的患者方面的未来研究领域。
