Seah Renyi Benjamin, Lim Winston Shang Rong, Lo Ngai Nung, Yew Andy Khye Soo, Chong Hwei Chi, Yeo Seng Jin
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
J Arthroplasty. 2017 Mar;32(3):807-810. doi: 10.1016/j.arth.2016.09.035. Epub 2016 Oct 4.
Total knee arthroplasty (TKA) is an effective procedure for end-stage osteoarthritis of the knee. Some patients experience persistent unexplained pain post-TKA despite normal investigations. The purpose of this study is to identify which of these patients are likely to improve without any surgical intervention. We hypothesize that patients with unexplained persistent pain and a poor 6-month Oxford knee score (OKS) post-TKA can improve at 2 years.
Prospectively collected data for all primary unilateral TKA performed from June 2004 to January 2012 were analyzed to identify which patients with unexplained pain at 6 months will improve at 2 years. Patients were included if they had persistent pain and an OKS <27 at 6 months; normal radiological and clinical investigations; no infection identified; surgery performed for primary osteoarthritis. Two hundred sixty patients with OKS <27 at 6 months were analyzed. These patients were subdivided into 2 groups (group 1: 6-month OKS 20-26, group 2: 6-month OKS less than 20).
One hundred ninety-one out of 208 (92%) patients in group 1 experienced improvement in pain and outcome at 2 years. Most of the group 1 patients attained a minimal clinically important difference in OKS of at least 5 (P < .001) at 2 years. Group 1 patients also reported better Knee Society Functional Score and Short Form Survey 36 mean scores at 2 years.
In patients with unexplained pain, an OKS of at least 20 at 6 months predicts good functional outcome at 2 years.
全膝关节置换术（TKA）是治疗终末期膝骨关节炎的有效方法。一些患者在TKA术后尽管检查结果正常，但仍经历持续无法解释的疼痛。本研究的目的是确定哪些患者在不进行任何手术干预的情况下可能会改善。我们假设TKA术后有无法解释的持续性疼痛且6个月牛津膝关节评分（OKS）较差的患者在2年时会有所改善。
对2004年6月至2012年1月进行的所有初次单侧TKA的前瞻性收集数据进行分析，以确定哪些6个月时有无法解释疼痛的患者在2年时会改善。纳入标准为6个月时有持续性疼痛且OKS<27；放射学和临床检查正常；未发现感染；因原发性骨关节炎进行手术。对6个月时OKS<27的260例患者进行分析。这些患者被分为两组（第1组：6个月OKS为20 - 26，第2组：6个月OKS小于20）。
第1组208例患者中有191例（92%）在2年时疼痛和结局有所改善。第1组的大多数患者在两年时OKS至少有5分的最小临床重要差异（P <.001）。第1组患者在2年时还报告了更好的膝关节协会功能评分和简短形式调查36平均评分。
在有无法解释疼痛的患者中，6个月时OKS至少为20分可预测2年时良好的功能结局。
