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全髋关节和膝关节置换术后早期患者报告的客观功能结局:一项前瞻性队列研究。

Early patient-reported outcomes objective function after total hip and knee arthroplasty: a prospective cohort study.

作者信息

Luna I E, Kehlet H, Peterson B, Wede H R, Hoevsgaard S J, Aasvang E K

机构信息

Gentofte-Herlev Hospital, Copenhagen, Denmark.

The Lundbeck Centre for fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.

出版信息

Bone Joint J. 2017 Sep;99-B(9):1167-1175. doi: 10.1302/0301-620X.99B9.BJJ-2016-1343.R1.

Abstract

AIMS

The purpose of this study was to assess early physical function after total hip or knee arthroplasty (THA/TKA), and the correlation between patient-reported outcome measures, physical performance and actual physical activity (measured by actigraphy).

PATIENTS AND METHODS

A total of 80 patients aged 55 to 80 years undergoing THA or TKA for osteoarthritis were included in this prospective cohort study. The main outcome measure was change in patient reported hip or knee injury and osteoarthritis outcome score (HOOS/KOOS) from pre-operatively until post-operative day 13 (THA) or 20 (TKA). Secondary measures were correlations to objectively assessed change in physical performance (paced-walk, chair-stand, stair-climb tests) at day 14 (THA) or 21 (TKA) and actual physical activity (actigraphy) measured at day 12 and 13 (THA) or 19 and 20 (TKA).

RESULTS

Patients reported improved physical function (HOOS or KOOS) pre-operatively until day 13 (THA) or 20 (TKA) with a mean difference of 7 (95% confidence interval (CI) 1 to 13, p = 0.033) and 6 (95% CI 1 to 12, p = 0.033) percentage points, respectively. By contrast, objectively assessed physical function and activity declined, with no correlations between subjective and objective assessments for either THA or TKA patients (r ≤ 0.16, p ≥ 0.314).

CONCLUSIONS

Early improvement in patient-reported physical function after THA/TKA does not correlate with objectively assessed function, and patient reported outcomes should not be used as the only measure of recovery. Cite this article: 2017;99-B:1167-75.

摘要

目的

本研究旨在评估全髋关节置换术或全膝关节置换术(THA/TKA)后的早期身体功能,以及患者报告的结局指标、身体表现与实际身体活动(通过活动记录仪测量)之间的相关性。

患者与方法

本前瞻性队列研究纳入了80例年龄在55至80岁之间、因骨关节炎接受THA或TKA手术的患者。主要结局指标是患者报告的髋关节或膝关节损伤及骨关节炎结局评分(HOOS/KOOS)从术前到术后第13天(THA)或第20天(TKA)的变化。次要指标是与第14天(THA)或第21天(TKA)客观评估的身体表现变化(定时步行、从椅子上站起、爬楼梯测试)以及第12天和第13天(THA)或第19天和第20天(TKA)测量的实际身体活动(活动记录仪)之间的相关性。

结果

患者报告术前至第13天(THA)或第20天(TKA)身体功能有所改善,平均差异分别为7个百分点(95%置信区间(CI)1至13,p = 0.033)和6个百分点(95%CI 1至12,p = 0.033)。相比之下,客观评估的身体功能和活动下降,THA或TKA患者的主观和客观评估之间均无相关性(r≤0.16,p≥0.314)。

结论

THA/TKA术后患者报告的身体功能早期改善与客观评估的功能不相关,患者报告的结局不应作为恢复的唯一衡量标准。引用本文:2017;99-B:1167-75。

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