Elmallah Randa D K, Cherian Jeffrey J, Robinson Kristin, Harwin Steven F, Mont Michael A
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
Clinical Research Department, Stryker Orthopaedics, Mahwah, New Jersey.
J Knee Surg. 2015 Oct;28(5):411-6. doi: 10.1055/s-0035-1549023. Epub 2015 Apr 18.
To enhance the success of total knee arthroplasty (TKA), clinicians must identify factors that may impede functional recovery. Multiple comorbidities may affect outcomes, and our purpose was to identify the role of overall disease burden, as well as individual comorbidities, on post-TKA outcomes. We prospectively reviewed 283 TKA patients (172 women, 111 men). Preexisting comorbidities were weighted using the Charlson comorbidity index (CCI). Patients were divided into four groups: CCI score of 0 to 1, 2, 3, or 4 or more and followed up at 6 weeks, 3 months, 1 year, and annually until 5 years. The most prevalent comorbidities were also individually assessed at these follow-ups. The effect of these on outcomes was evaluated using the Knee Society Score (KSS), Short Form 36 (SF-36), and lower extremity activity scale (LEAS). Patients who had lower CCI scores had significant improvements in KSS at 2- and 5-year follow-up (+34 and +38 points, respectively; p < 0.01). CCI scores of 0 to l demonstrated significantly greater improvement in the SF-36 physical component score (PCS) at final follow-up (+16 points; p < 0.05) and higher LEAS scores at 2 years postoperatively (p = 0.001), compared with the remaining cohorts. Endocrine disease and hypertension yielded significantly lower KSS at follow-up (-5 and -5 points, respectively; p < 0.05). Patients who had hypertension or gastrointestinal disease had significantly lower SF-36 PCS at final follow-up compared with those who did not (45 vs. 48 points and 47 vs. 49 points; p < 0.035 and 0.041, respectively), as well as lower activity scores (11 vs. 12 points for both comorbidities; p < 0.05). Patients who had cardiovascular disease had significantly lower SF-36 MCS (53 vs. 56 points, respectively; p = 0.03) at 4 years postoperatively than those without, as well as lower activity scores (11 vs. 12 points, respectively; p = 0.024). Patients who have lower CCIs may have improved activity and functional levels following TKA. Hypertension, cardiovascular disease, endocrine disease, and gastrointestinal disease may correlate with poorer functional and activity outcomes postoperatively.
为提高全膝关节置换术（TKA）的成功率，临床医生必须识别可能阻碍功能恢复的因素。多种合并症可能影响手术结果，我们的目的是确定总体疾病负担以及个体合并症对TKA术后结果的作用。我们前瞻性地评估了283例TKA患者（172例女性，111例男性）。使用Charlson合并症指数（CCI）对已存在的合并症进行加权。患者被分为四组：CCI评分为0至1、2、3或4及以上，并在6周、3个月、1年及之后每年进行随访，直至5年。在这些随访中还分别评估了最常见的合并症。使用膝关节协会评分（KSS）、简明健康状况调查量表（SF-36）和下肢活动量表（LEAS）评估这些合并症对结果的影响。CCI评分较低的患者在2年和5年随访时KSS有显著改善（分别提高34分和38分；p<0.01）。与其他组相比，CCI评分为0至1的患者在最终随访时SF-36身体成分评分（PCS）有显著更大的改善（提高16分；p<0.05），且术后2年LEAS评分更高（p=0.001）。内分泌疾病和高血压在随访时KSS显著更低（分别降低5分和5分；p<0.05）。与无高血压或胃肠道疾病的患者相比，有高血压或胃肠道疾病的患者在最终随访时SF-36 PCS显著更低（分别为45分对48分和47分对49分；p分别为<0.035和0.041），且活动评分也更低（两种合并症均为11分对12分；p<0.05）。有心血管疾病的患者术后4年SF-36心理成分评分（MCS）显著低于无心血管疾病的患者（分别为53分对56分；p=0.03），且活动评分也更低（分别为11分对12分；p=0.024）。CCI较低的患者TKA术后活动和功能水平可能会改善。高血压、心血管疾病、内分泌疾病和胃肠道疾病可能与术后较差的功能和活动结果相关。
