Scott C E H, Oliver W M, MacDonald D, Wade F A, Moran M, Breusch S J
Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
Bone Joint J. 2016 Dec;98-B(12):1625-1634. doi: 10.1302/0301-620X.98B12.BJJ-2016-0375.R1.
Risk of revision following total knee arthroplasty (TKA) is higher in patients under 55 years, but little data are reported regarding non-revision outcomes. This study aims to identify predictors of dissatisfaction in these patients.
We prospectively assessed 177 TKAs (157 consecutive patients, 99 women, mean age 50 years; 17 to 54) from 2008 to 2013. Age, gender, implant, indication, body mass index (BMI), social deprivation, range of movement, Kellgren-Lawrence (KL) grade of osteoarthritis (OA) and prior knee surgery were recorded. Pre- and post-operative Oxford Knee Score (OKS) as well as Short Form-12 physical (PCS) and mental component scores were obtained. Post-operative range of movement, complications and satisfaction were measured at one year.
Overall, 44 patients with 44 TKAs (24.9%) under 55 years of age were unsure or dissatisfied with their knee. Significant predictors of dissatisfaction on univariate analysis included: KL grade 1/2 OA (59% dissatisfied), poor pre-operative OKS, complications, poor improvements in PCS and OKS and indication (primary OA 19% dissatisfied, previous meniscectomy 41%, multiply operated 42%, other surgery 29%, BMI > 40 kg/m 31%, post-traumatic OA 45%, and inflammatory arthropathy 5%). Poor pre-operative OKS, poor improvement in OKS and post-operative stiffness independently predicted dissatisfaction on multivariate analysis.
Patients receiving TKA younger than 55 years old should be informed about the increased risks of dissatisfaction. Offering TKA in KL 1/2 is questionable, with a dissatisfaction rate of 59%. Cite this article: Bone Joint J 2016;98-B:1625-34.
全膝关节置换术（TKA）后，55岁以下患者的翻修风险较高，但关于非翻修结局的报道数据较少。本研究旨在确定这些患者不满意的预测因素。
我们对2008年至2013年间的177例TKA（157例连续患者，99例女性，平均年龄50岁；17至54岁）进行了前瞻性评估。记录年龄、性别、植入物、适应证、体重指数（BMI）、社会剥夺情况、活动范围、骨关节炎（OA）的凯尔格伦-劳伦斯（KL）分级以及既往膝关节手术情况。获取术前和术后牛津膝关节评分（OKS）以及简短健康调查问卷12项身体（PCS）和精神成分评分。在术后一年测量活动范围、并发症和满意度。
总体而言，44例55岁以下接受TKA的患者（44例TKA，占24.9%）对其膝关节情况不确定或不满意。单因素分析中，不满意的显著预测因素包括：KL 1/2级OA（59%不满意）、术前OKS差、并发症、PCS和OKS改善不佳以及适应证（原发性OA 19%不满意，既往半月板切除术41%，多次手术42%，其他手术29%，BMI>40 kg/m² 31%，创伤后OA 45%，炎性关节病5%）。多因素分析中，术前OKS差、OKS改善不佳和术后僵硬独立预测不满意。
应告知接受TKA的55岁以下患者不满意风险增加。对于KL 1/2级患者进行TKA是否合适值得质疑，其不满意率为59%。引用本文：《骨与关节杂志》2016年；98-B：1625 - 34。
