Gwynne-Jones David P, Iosua Ella E, Stout Kirsten M
Department of Orthopaedic Surgery, Dunedin Hospital, Southern DHB, Dunedin, New Zealand; Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Department of Social and Preventive Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
J Arthroplasty. 2016 May;31(5):957-62. doi: 10.1016/j.arth.2015.11.022. Epub 2015 Nov 26.
There is increasing interest in scoring systems to prioritize patients for hip and knee arthroplasty. The purpose of this study was to determine the effectiveness of the New Zealand Orthopaedic Association (NZOA) score and compare it with patient-reported scores of patients listed for hip and knee arthroplasty.
Over a 1-year period, all patients listed for primary hip and knee arthroplasty were scored by a prioritization nurse. The NZOA score, outcome, preoperative Oxford hip or knee score (OHKS) and reduced Western Ontario McMaster osteoarthritis index (WOMAC) score (RWS) were collected.
Overall, 608 patients were listed for hip (319) or knee (289) arthroplasty. The mean scores for knees were all better than hips (P < .001). On initial scoring, 324 patients (53%) were given certainty (mean NZOA, 80.5; OHKS, 10.0; RWS, 35.1), 90 (15%) given clinical over-ride (NZOA, 69.6; OHKS, 12.0; RWS, 33.2), and 194 (32%) returned to general practitioner (NZOA, 64; OHKS, 14.2; RWS, 30.8). Knees (38%) were more likely to be returned than hips (26%; P = .002). Fifty (26%) were re-referred during the study period (mean, 5 months) and given certainty or over-ride. The difference at final outcome between patients with certainty and clinical over-ride was NZOA, 10.3 points; Oxford, 1.6 points; and RWS, 1.4 points. The difference between clinical over-ride and returned to general practitioner was NZOA, 7.2; Oxford, 4.4; RWS, 5.3.
The NZOA score is an effective tool for rationing for joint arthroplasty. Patients around the threshold score of 70 may not have a clinically important difference compared with those above threshold.
用于确定髋关节和膝关节置换术患者优先级的评分系统越来越受到关注。本研究的目的是确定新西兰骨科协会（NZOA）评分的有效性，并将其与髋关节和膝关节置换术候诊患者的自我报告评分进行比较。
在1年的时间里，由一名负责确定优先级的护士对所有计划进行初次髋关节和膝关节置换术的患者进行评分。收集了NZOA评分、结果、术前牛津髋关节或膝关节评分（OHKS）以及简化的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分（RWS）。
总体而言，608例患者计划进行髋关节（319例）或膝关节（289例）置换术。膝关节的平均评分均优于髋关节（P <.001）。初次评分时，324例患者（53%）被确定为优先（平均NZOA评分80.5；OHKS评分10.0；RWS评分35.1），90例（15%）被临床优先考虑（NZOA评分69.6；OHKS评分12.0；RWS评分33.2），194例（32%）转回全科医生处（NZOA评分64；OHKS评分14.2；RWS评分30.8）。膝关节（38%）比髋关节（26%）更有可能转回全科医生处（P =.002）。50例（26%）在研究期间（平均5个月）被再次转诊，并被确定为优先或优先考虑。最终结果显示，被确定为优先和被临床优先考虑的患者之间的差异为：NZOA评分10.3分；牛津评分1.6分；RWS评分1.4分。被临床优先考虑和转回全科医生处的患者之间的差异为：NZOA评分7.2分；牛津评分4.4分；RWS评分5.3分。
NZOA评分是一种有效的关节置换术配给工具。评分在70分左右的患者与高于该阈值的患者相比，可能没有临床上的显著差异。
