Jauregui Julio J, Issa Kimona, Cherian Jeffrey J, Harwin Steven F, Given Kristin, Mont Michael A
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland.
Beth Israel Medical Center, Adult Reconstruction and Total Joint Replacement Service, New York, New York.
J Knee Surg. 2016 Jan;29(1):84-90. doi: 10.1055/s-0035-1544192. Epub 2015 Jan 29.
Total knee arthroplasties (TKAs) are reliable procedures for treating end-stage knee osteoarthritis with excellent long-term outcomes. The purpose of this study was to longitudinally evaluate temporal trends of Knee Society Scores (KSS) after TKA and to identify potential demographic and comorbid factors that affect these outcomes. This prospective study evaluated 281 patients (108 men and 173 women) with a mean age of 66 years (range, 39-80 years) who underwent primary TKA (minimum follow-up 5 years). During each follow-up visit, KS objective, function, and total scores were evaluated. The effects of different demographics and comorbidities on outcomes were further analyzed using multivariate regression analysis. Following TKA, peak mean KSS were observed at 1-year follow-up (mean, 92 points), after which there was no significant difference in scores at 5 years compared with 1-year follow-up (mean, 92 points). KS function scores were observed to be unchanged from preoperative levels (mean, 53 points) and at 6 weeks (mean, 56 points). These were significantly higher at 3 months (mean, 78 points) and reached a maximum mean peak at 1 year (mean, 85 points). KS objective scores increased earlier than function scores. The demographic variables and comorbidities that demonstrated a significantly negative impact in KS function scores were increased age, female gender, higher body mass index, and several medical comorbidities including immunological and neurological disease, and neoplasm. Race was the only variable that significantly decreased the KS objective scores. KSS after TKA follow temporal trends with scores initially unchanged from preoperative levels for the objective component, but the scores increased for the functional component. All components demonstrated higher levels compared with preoperative scores by 3 months and peaked at 1-year follow-up. At 5-year follow-up, all mean KSS were unchanged relative to peak scores seen at 1 year. Various patient demographics and comorbidities could potentially have a negative influence on the KSS outcomes. Surgeons should counsel their patients that the full benefit of TKA will be perceived 1 year after surgery, and this level of improvement is likely to remain constant.
全膝关节置换术（TKAs）是治疗终末期膝关节骨关节炎的可靠手术，具有出色的长期效果。本研究的目的是纵向评估全膝关节置换术后膝关节协会评分（KSS）的时间趋势，并确定影响这些结果的潜在人口统计学和合并症因素。这项前瞻性研究评估了281例患者（108例男性和173例女性），平均年龄66岁（范围39 - 80岁），他们接受了初次全膝关节置换术（最短随访5年）。在每次随访中，评估KSS的客观、功能和总分。使用多变量回归分析进一步分析不同人口统计学和合并症对结果的影响。全膝关节置换术后，在1年随访时观察到平均KSS峰值（平均92分），之后5年的评分与1年随访时相比无显著差异（平均92分）。KSS功能评分在术前水平（平均53分）和6周时（平均56分）观察到无变化。这些评分在3个月时显著更高（平均78分），并在1年时达到最大平均峰值（平均85分）。KSS客观评分比功能评分更早增加。在KSS功能评分中显示出显著负面影响的人口统计学变量和合并症包括年龄增加、女性、较高的体重指数以及几种医学合并症，包括免疫和神经疾病以及肿瘤。种族是唯一显著降低KSS客观评分的变量。全膝关节置换术后的KSS遵循时间趋势，客观部分的评分最初与术前水平无变化，但功能部分的评分增加。所有部分在3个月时与术前评分相比显示出更高水平，并在1年随访时达到峰值。在5年随访时，所有平均KSS相对于1年时的峰值评分无变化。各种患者人口统计学和合并症可能对KSS结果产生负面影响。外科医生应告知患者，全膝关节置换术的全部益处将在术后1年显现，并且这种改善水平可能会保持不变。
