Loth F L, Liebensteiner M C, Giesinger J M, Giesinger K, Bliem H R, Holzner B
Institute of Psychology, University of Innsbruck, A-6020, Innsbruck, Austria.
Department for Orthopaedic Surgery, Medical University Innsbruck, A-6020, Innsbruck, Austria.
BMC Musculoskelet Disord. 2018 Jan 8;19(1):5. doi: 10.1186/s12891-017-1923-4.
Joint awareness was recently introduced as a new concept for outcome assessment after total knee arthroplasty (TKA). Findings from qualitative and psychometric studies suggest that joint awareness is a distinct concept especially relevant to patients with good surgical outcome and patients at late follow-up time points. The aim of this study was to improve the understanding of the concept of joint awareness by identifying situations in which patients are aware of their artificial knee joint and to investigate what bodily sensations and psychological factors raise a patient's awareness of her/his knee. In addition, we evaluated the relative importance of patient-reported outcome parameters that are commonly assessed in orthopaedics.
Qualitative interviews were conducted with patients being at least 12 months after TKA. The interviews focused on when, where and for what reasons patients were aware of their artificial knee joint. To evaluate the relative importance of 'joint awareness' after TKA among nine commonly assessed outcome parameters (e.g. pain or stiffness), we collected importance ratings ('0' indicating no importance at all and '10' indicating high importance).
We conducted interviews with 40 TKA patients (mean age 69.0 years; 65.0% female). Joint awareness was found to be frequently triggered by kneeling on the floor (30%), climbing stairs (25%), and starting up after resting (25%). Patients reported joint awareness to be related to activities of daily living (68%), specific movements (60%), or meteoropathy (18%). Sensations causing joint awareness included pain (45%) or stiffness (15%). Psychological factors raising a patient's awareness of his/her knee comprised for example feelings of insecurity (15%), and fears related to revision surgeries, inflammations or recurring pain (8%). Patients' importance ratings of outcome parameters were generally high and did not allow differentiating clearly among them.
We have identified a wide range of situations, activities, movements and psychological factors contributing to patients' awareness of their artificial knee joints. This improves the understanding of the concept of joint awareness and of a patient's perception of his/her artificial knee joint. The diversity of sensations and factors raising patient's awareness of their joint encourages taking a broader perspective on outcome after TKA.
关节感知最近作为全膝关节置换术（TKA）后结果评估的一个新概念被引入。定性和心理测量学研究结果表明，关节感知是一个独特的概念，尤其与手术效果良好的患者以及随访后期的患者相关。本研究的目的是通过识别患者意识到其人工膝关节的情况来增进对关节感知概念的理解，并调查哪些身体感觉和心理因素会提高患者对其膝关节的感知。此外，我们评估了骨科中常用的患者报告结局参数的相对重要性。
对TKA术后至少12个月的患者进行定性访谈。访谈重点关注患者何时、何地以及为何意识到其人工膝关节。为了评估TKA后“关节感知”在九个常用结局参数（如疼痛或僵硬）中的相对重要性，我们收集了重要性评分（“0”表示完全不重要，“10”表示高度重要）。
我们对40例TKA患者（平均年龄69.0岁；65.0%为女性）进行了访谈。发现关节感知经常由跪在地上（30%）、爬楼梯（25%）和休息后起身（25%）引发。患者报告关节感知与日常生活活动（68%）、特定动作（60%）或气象病（18%）有关。引起关节感知的感觉包括疼痛（45%）或僵硬（15%）。提高患者对其膝关节感知的心理因素包括例如不安全感（15%）以及与翻修手术、炎症或复发性疼痛相关的恐惧（8%）。患者对结局参数的重要性评分普遍较高，无法在它们之间进行明确区分。
我们已经确定了多种导致患者意识到其人工膝关节的情况、活动、动作和心理因素。这增进了对关节感知概念以及患者对其人工膝关节感知的理解。引起患者关节感知的感觉和因素的多样性鼓励在TKA术后结果方面采取更广泛的视角。
