Department of Physical Medicine and Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
MSk Lab, Imperial College London, Floor 7, Laboratory Block, Charing Cross Campus, London, UK.
Knee Surg Sports Traumatol Arthrosc. 2018 Nov;26(11):3272-3279. doi: 10.1007/s00167-018-4856-z. Epub 2018 Feb 8.
The focus in the evaluation of total knee arthroplasty has shifted from objective measures of implant position and knee function, to patient-reported outcome measures (PROMs). The relation between these two measures was investigated and the possibility of prediction of the patient satisfaction level was evaluated by defining thresholds for improvement of (1) range of motion (ROM), (2) 6-min walk test (6MWT), (3) sit-to-stand test (STS) and (4) quadriceps force after TKA?
Fifty-seven patients were prospectively tested at preoperative and 6 months postoperative intervals. The ROM, 6MWT, STS-test and quadriceps force were evaluated. Two clusters were created based on the postoperative KOOS, OKS and the satisfaction subscore of the new KSS, cluster 1 consisted of patients with good to excellent PROMs, cluster 2 of patients with poorer PROMs. Patients in each cluster were more similar to each other than to those in the other cluster. Receiver operating characteristic (ROC)-curve analysis was used to identify thresholds for the functional outcomes that established cluster allocation. Multiple logistic regression was used to define a model to predict cluster allocation.
Patients with high postoperative PROMs (cluster 1 allocation) showed higher postoperative functional outcomes (p < 0.05). Thresholds for the improvement of ROM (≥ 5°, OR 6.3, 95% CI 1.23-31.84), 6MWT (≥ 50 m, OR 8.2, 95% CI 1.61-42.18) STS (≥ 1.05 s, OR 3, 95% CI 0.56-16.07) and normalized Q4 force (≥ 1.5 N/BMI, OR 2.5, 95% CI 0.49-12.89) were found to be predictors of cluster allocation. A model to predict the cluster allocation contained gender, ROM improvement and 6MWT improvement (sensitivity 91.1%, specificity 75%).
Thresholds for improvement of functional parameters can predict the patient satisfaction cluster. Patients, who are male, improve on the 6-min walk test with 50 m or more and have an increased range of motion of 5° or more, compared to the preoperative situation, are 6-8 times more likely of being satisfied after TKA. These tests are easy to use in clinical practice and can predict the level of patient satisfaction after TKA.
Level II, prognostic study.
全膝关节置换术的评估重点已从植入物位置和膝关节功能的客观测量指标转移到患者报告的结果测量指标（PROMs）。本研究旨在探讨这两种测量方法之间的关系，并通过定义以下四个方面的改善阈值来评估预测患者满意度水平的可能性：（1）关节活动度（ROM），（2）6 分钟步行试验（6MWT），（3）坐站试验（STS）和（4）TKA 后股四头肌力量。
57 例患者前瞻性地在术前和术后 6 个月进行测试。评估了 ROM、6MWT、STS 测试和股四头肌力量。根据术后 KOOS、OKS 和新 KSS 的满意度子评分，创建了两个聚类，聚类 1 包括 PROMs 良好到优秀的患者，聚类 2 包括 PROMs 较差的患者。每个聚类内的患者彼此之间比与另一聚类内的患者更相似。使用接收者操作特征（ROC）曲线分析确定用于确定聚类分配的功能结果的阈值。使用多元逻辑回归定义预测聚类分配的模型。
术后 PROMs 较高的患者（聚类 1 分配）表现出更高的术后功能结果（p<0.05）。ROM（≥5°，OR 6.3，95%CI 1.23-31.84）、6MWT（≥50 m，OR 8.2，95%CI 1.61-42.18）、STS（≥1.05 s，OR 3，95%CI 0.56-16.07）和归一化 Q4 力量（≥1.5 N/BMI，OR 2.5，95%CI 0.49-12.89）改善的阈值被发现是聚类分配的预测因子。一个用于预测聚类分配的模型包含性别、ROM 改善和 6MWT 改善（敏感性 91.1%，特异性 75%）。
功能参数改善的阈值可以预测患者满意度的聚类。与术前相比，男性患者 6MWT 增加 50m 或更多，ROM 增加 5°或更多，更有可能在 TKA 后感到满意，其可能性是未增加的 6-8 倍。这些测试在临床实践中易于使用，可以预测 TKA 后患者的满意度水平。
二级，预后研究。
