Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
Department of Clinical Biomechanics, School of Medicine, Keio University, Tokyo, Japan.
J Arthroplasty. 2018 Jul;33(7):2125-2130. doi: 10.1016/j.arth.2018.02.015. Epub 2018 Feb 13.
Joint line modification in kinematically aligned total knee arthroplasty (KA-TKA) is attracting attention in expectation of optimizing patient satisfaction after TKA. This study aimed to examine the effects of joint line modification on Pain Catastrophizing Scale (PCS), painDETECT score, and new Knee Society Score (KSS) 2011, all of which are robustly related to patient satisfaction.
The study enrolled 45 knees of 45 patients undergoing KA-TKA and a matched group of 45 knees of 45 patients undergoing mechanically aligned (MA) TKA as controls. At a mean of 31.6 months after TKA, new KSS 2011, PCS, and painDETECT score were assessed and compared between KA- and MA-TKA. Data from all 90 patients were pooled into one group for secondary multiple regression analysis to identify postoperative variables affecting patient satisfaction.
Assessment with new KSS 2011 showed no significant differences between the 2 TKAs preoperatively, but functional activity score was significantly higher with KA-TKA than with MA-TKA postoperatively (P = .047). Among the 4 categories of functional activity score, advanced activity score was significantly higher with KA-TKA than with MA-TKA (P = .003). Of the 5 advanced activities, the score for climbing ladder/step stool was significantly greater with KA-TKA (P = .004). KA-TKA failed to influence patient satisfaction score. Multiple regression analysis revealed that standard activity score and PCS affected patient satisfaction positively and negatively, respectively.
Joint line modification in KA-TKA improved functional activity but not patient satisfaction. PCS was a key element negatively affecting patient satisfaction.
在运动学对线的全膝关节置换术（KA-TKA）中，关节线的修正受到关注，期望优化 TKA 后的患者满意度。本研究旨在研究关节线修正对疼痛灾难化量表（PCS）、疼痛 DETECT 评分和新膝关节协会评分（KSS）2011 的影响，这些评分都与患者满意度密切相关。
本研究纳入了 45 例接受 KA-TKA 的患者的 45 个膝关节和 45 例接受机械对线（MA）TKA 的患者的 45 个膝关节作为对照组。在 TKA 后平均 31.6 个月，评估并比较了 KA-TKA 和 MA-TKA 的新 KSS 2011、PCS 和疼痛 DETECT 评分。将所有 90 例患者的数据汇总到一组，进行二次多元回归分析，以确定影响患者满意度的术后变量。
新 KSS 2011 评估显示，两种 TKA 在术前无显著差异，但术后 KA-TKA 的功能活动评分明显高于 MA-TKA（P=0.047）。在功能活动评分的 4 个类别中，KA-TKA 的高级活动评分明显高于 MA-TKA（P=0.003）。在 5 项高级活动中，KA-TKA 攀爬梯子/台阶的评分明显更高（P=0.004）。KA-TKA 并未影响患者满意度评分。多元回归分析显示，标准活动评分和 PCS 分别对患者满意度产生正向和负向影响。
KA-TKA 中的关节线修正改善了功能活动，但没有改善患者满意度。PCS 是一个关键因素，对患者满意度产生负面影响。
