Lungu E, Maftoon S, Vendittoli P-A, Desmeules F
Department of biomedical sciences, faculty of medicine, university of Montreal, Montreal, QC, Canada; Centre de recherche, hôpital Maisonneuve-Rosemont, 5415, boulevard de L'Assomption, H1T 2M4 Montreal, QC, Canada.
Centre de recherche, hôpital Maisonneuve-Rosemont, 5415, boulevard de L'Assomption, H1T 2M4 Montreal, QC, Canada.
Orthop Traumatol Surg Res. 2016 May;102(3):397-403. doi: 10.1016/j.otsr.2015.12.025. Epub 2016 Mar 22.
Although generally considered successful, total hip arthroplasty (THA) can yield suboptimal results in terms of pain and function in up to one forth of patients suffering from hip osteoarthritis (OA). A thorough understanding of the determinants of patient-reported pain and function following THA can help plan interventions directed at improving surgical results. Previously published systematic reviews do not permit to confidently identify the determinants of THA outcomes because of unsatisfactory methodological designs. Therefore, we aimed to answer: (1) which preoperative factors are most consistently associated with postoperative patient-reported pain and function up to 2 years following primary unilateral THA for hip OA. Medline, Pubmed, Embase and CINAHL were screened from their respective inception dates until April 2015 using a combination of keywords and MESH terms. Criteria for inclusion were: (1) participants with primary unilateral THA for hip OA followed for at least 3 months with a maximal follow-up of 2 years; (2) validated disease-specific patient-reported outcome measures assessing pain and/or disability; (3) identification of determinants obtained via multivariate analyses. Methodological quality was assessed using a modified version of the methodology checklist for prognostic studies. Twenty-two manuscripts were included. Mean score of the methodological quality was 81.0±10.3% (66.7% to 100%). Among socioeconomic determinants, a lower educational level was significantly related to worse pain and function (3 out of 3 studies evaluating the relationship). Clinical determinants of poor outcomes included preoperative levels of pain and physical function (9 out of 12 studies), higher body mass index (6 out of 10 studies), presence/greater level of comorbidities (7 out of 8), worse general health (4 out of 4 studies) and lower radiographic OA severity (3 out of 4 studies). Study heterogeneity limited the pooled assessment of the strength of associations between the preoperative variables and THA outcomes. Studies with moderate-to-high methodological quality allowed to identify 6 preoperative variables consistently associated with medium term pain and function following THA. This knowledge may assist the management of patients at risk of poor results. Further research is required to clarify the force of associations between determinants and THA outcomes.
Level II. Systematic review of cohort studies.
尽管全髋关节置换术（THA）通常被认为是成功的，但在多达四分之一的髋骨关节炎（OA）患者中，就疼痛和功能而言，其结果可能并不理想。深入了解THA术后患者报告的疼痛和功能的决定因素有助于规划旨在改善手术效果的干预措施。由于方法学设计不尽人意，先前发表的系统评价无法可靠地确定THA结果的决定因素。因此，我们旨在回答：（1）哪些术前因素与初次单侧THA治疗髋OA术后长达2年患者报告的疼痛和功能最一致相关。从各自创刊日期至2015年4月，使用关键词和医学主题词（MESH）术语组合对Medline、Pubmed、Embase和CINAHL进行筛选。纳入标准为：（1）接受初次单侧THA治疗髋OA的参与者，随访至少3个月，最长随访2年；（2）经过验证的针对特定疾病的患者报告结局测量指标，用于评估疼痛和/或残疾；（3）通过多变量分析确定决定因素。使用预后研究方法学清单的修订版评估方法学质量。纳入22篇手稿。方法学质量的平均得分为81.0±10.3%（66.7%至100%）。在社会经济决定因素中，较低的教育水平与较差的疼痛和功能显著相关（评估该关系的3项研究中有3项）。不良结局的临床决定因素包括术前疼痛水平和身体功能（12项研究中有9项）、较高的体重指数（10项研究中有6项）、合并症的存在/更高水平（8项研究中有7项）、较差的总体健康状况（4项研究中有4项）以及较低的放射学OA严重程度（4项研究中有3项）。研究异质性限制了对术前变量与THA结局之间关联强度的汇总评估。方法学质量为中度至高度的研究能够确定6个术前变量与THA术后中期疼痛和功能始终相关。这些知识可能有助于管理有不良结果风险的患者。需要进一步研究以阐明决定因素与THA结局之间关联的强度。
II级。队列研究的系统评价。
