Dowsey Michelle M, Spelman Tim, Choong Peter F M
The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
J Arthroplasty. 2016 Aug;31(8):1654-60. doi: 10.1016/j.arth.2016.02.003. Epub 2016 Feb 9.
Indications for total knee arthroplasty (TKA) currently depend on clinical judgment. Up to one fifth of those who undergo primary TKA do not report a clinically meaningful improvement in pain and function after surgery. Our aim was to develop and internally validate a prognostic tool for predicting the probability of nonresponse to surgery at 12 months.
Patients from 1 center who underwent primary TKA (N = 615) between 2012 and 2013. The Western Ontario and McMaster Universities Arthritis Index was collected pre- and 12 months after TKA from which nonresponse to surgery was determined using the Outcome Measures in Rheumatology-Osteoarthritis Research Society International responder criteria. Using independent prognostic correlates of postoperative nonresponse observed in adjusted modeling, we derived a prognostic nomogram to estimate the probability of nonresponse to TKA based on this suite of explanatory variables.
A total of 90/615 (15%) cases were nonresponders to TKA. The degree of contribution (odds ratio, 95% confidence interval) of each explanatory factor to nonresponse nomogram points was body mass index ≥40 kg/m(2) (3.48; 1.97-6.12), Kellgren and Lawrence <4 (2.59; 1.58-4.24), mental disability on Short Form Health Survey (SF-12) mental component score (3.30; 1.44-7.58), and every 10-point increase in preoperative Western Ontario and McMaster Universities Arthritis Index score (0.81; 0.68-0.97). The concordance index for this model was 0.74.
We have created a prognostic nomogram that displays the predictive probabilities of nonresponse to TKA as a source of decision support for clinicians and patients, about their likely functional outcome from TKA. Although our own internal validation suggested good nomogram performance, external validation in a comparable surgical population is required to confirm generalizability of the nomogram.
全膝关节置换术（TKA）的适应症目前取决于临床判断。接受初次TKA的患者中，多达五分之一的人在术后疼痛和功能方面未出现具有临床意义的改善。我们的目的是开发并在内部验证一种预测工具，以预测术后12个月对手术无反应的概率。
选取2012年至2013年间在1个中心接受初次TKA的患者（N = 615）。在TKA术前和术后12个月收集西安大略和麦克马斯特大学关节炎指数，根据风湿病学-骨关节炎研究协会国际反应标准确定对手术无反应的情况。利用在调整模型中观察到的术后无反应的独立预后相关因素，我们得出了一个预后列线图，用于根据这一系列解释变量估计TKA无反应的概率。
共有90/615（15%）的病例对TKA无反应。每个解释因素对无反应列线图积分的贡献程度（比值比，95%置信区间）为体重指数≥40 kg/m²（3.48；1.97 - 6.12）、凯尔格伦和劳伦斯分级<4（2.59；1.58 - 4.24）、简短健康调查问卷（SF - 12）心理成分评分中的精神残疾（3.30；1.44 - 7.58）以及术前西安大略和麦克马斯特大学关节炎指数评分每增加10分（0.81；0.68 - 0.97）。该模型的一致性指数为0.74。
我们创建了一个预后列线图，可显示TKA无反应的预测概率，为临床医生和患者提供决策支持，帮助他们了解TKA可能的功能结果。尽管我们自己的内部验证表明列线图性能良好，但仍需要在类似手术人群中进行外部验证，以确认列线图的可推广性。
