Christen Matthias, Aghayev Emin, Christen Bernhard
Department of Orthopaedic Surgery, Salem Spital, Schänzlistrasse 39, 3000 Bern 25, Switzerland.
BMC Musculoskelet Disord. 2014 Dec 16;15:435. doi: 10.1186/1471-2474-15-435.
The main goals of the standard treatment for advanced symptomatic knee osteoarthritis, total knee arthroplasty (TKA), are pain reduction and restoration of knee motion.The aim of this study was to analyse the outcome of the patient-based Knee Injury and Osteoarthritis Outcome Score (KOOS), and the surgeon-based Knee Society Score (KSS) and its Knee Score (KS) and Knee Functional Score (KFS) components after (TKA) using the Journey knee prosthesis, and to assess the correlation of these scores with range of motion (ROM).
In a prospective case series study between August 1st 2008 and May 31st 2011, 99 patients, all operated by a single surgeon, received Journey bicruciate stabilized total knee prostheses. The female/male ratio was 53/34, the mean patient age at surgery was 68 years (range 41-83 years), and the left/right knee ratio was 55/44. The KOOS, range of motion, and KS and KFS were obtained preoperatively and at 1-year follow-up. The pre- and postoperative levels of the outcome measures were compared using the Wilcoxon signed-rank test. Correlation between ROM and patient outcomes was analysed with the Spearman coefficient.
All KOOS subscores improved significantly. Ninety percent of patients improved by at least the minimum clinically relevant difference of 10 points in stiffness and other symptoms, 94.5% in pain, 94.5% in activities of daily living, 84.9% in sports and recreation, and 90% in knee-related quality of life. The mean passive and active ROM improved from 122.4° (range 90-145°) and 120.4° (range 80-145°) preoperatively to 129.4° (range 90-145°) and 127.1° (range 100-145°) postoperatively. The highest correlation coefficients for ROM and KOOS were observed for the activity and pain subscores. Very low or no correlation was seen for the sport subscore.There was a significant and clinically relevant improvement of KSS (preop/postop 112.2/174.5 points), and its KS (preop/postop 45.6/86.8 points) and KFS (preop/postop 66.6/87.8 points) components.
The Journey bicruciate stabilized knee prosthesis showed good 1-year postoperative results in terms of both functional and patient-based outcome. However, higher knee ROM correlates only moderately with patient-based outcome, implying that functionality afforded by the Journey bicruciate TKA is not equivalent to patient satisfaction.
晚期症状性膝关节骨关节炎的标准治疗方法——全膝关节置换术（TKA）的主要目标是减轻疼痛和恢复膝关节活动度。本研究的目的是分析使用Journey膝关节假体进行TKA术后基于患者的膝关节损伤和骨关节炎疗效评分（KOOS）、基于外科医生的膝关节协会评分（KSS）及其膝关节评分（KS）和膝关节功能评分（KFS）各部分的结果，并评估这些评分与活动范围（ROM）之间的相关性。
在2008年8月1日至2011年5月31日的一项前瞻性病例系列研究中，99例患者均由同一位外科医生进行手术，接受了Journey双交叉稳定型全膝关节假体。女性/男性比例为53/34，手术时患者的平均年龄为68岁（范围41 - 83岁），左/右膝关节比例为55/44。术前及术后1年获取KOOS、活动范围以及KS和KFS。使用Wilcoxon符号秩检验比较术前和术后的结果测量水平。用Spearman系数分析ROM与患者结果之间的相关性。
所有KOOS子评分均显著改善。90%的患者在僵硬和其他症状方面至少改善了10分这一最小临床相关差异，94.5%在疼痛方面，94.5%在日常生活活动方面，84.9%在运动和娱乐方面，90%在膝关节相关生活质量方面。平均被动和主动ROM从术前的122.4°（范围90 - 145°）和120.4°（范围80 - 145°）改善到术后的129.4°（范围90 - 145°）和127.1°（范围100 - 145°）。ROM与KOOS之间的最高相关系数出现在活动和疼痛子评分中。运动子评分的相关性非常低或无相关性。KSS（术前/术后112.2/174.5分）及其KS（术前/术后45.6/86.8分）和KFS（术前/术后66.6/87.8分）各部分有显著且具有临床意义的改善。
Journey双交叉稳定型膝关节假体在术后1年的功能和基于患者的结果方面均显示出良好的效果。然而，较高的膝关节ROM与基于患者的结果仅呈中度相关，这意味着Journey双交叉TKA所提供的功能并不等同于患者满意度。
