Edwards Hannah B, Smith Michèle, Herrett Emily, MacGregor Alexander, Blom Ashley, Ben-Shlomo Yoav
University of Bristol, Bristol, United Kingdom.
NIHR Collaboration for Leadership in Applied Health Research and Care West, Bristol, United Kingdom.
JB JS Open Access. 2018 Apr 24;3(2):e0042. doi: 10.2106/JBJS.OA.17.00042. eCollection 2018 Jun 28.
Total knee replacement (TKR) is a common procedure for the treatment of osteoarthritis that provides a substantial reduction of knee pain and improved function in most patients. We investigated whether sociodemographic factors could explain variations in the benefit resulting from TKR.
Data were collected from 3 sources: the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man; National Health Service (NHS) England Patient Reported Outcome Measures; and Hospital Episode Statistics. These 3 sources were linked for analysis. Pain and function of the knee were measured with use of the Oxford Knee Score (OKS). The risk factors of interest were age group, sex, deprivation, and social support. The outcomes of interest were sociodemographic differences in preoperative scores, 6-month postoperative scores, and change in scores.
Ninety-one thousand nine hundred and thirty-six adults underwent primary TKR for the treatment of osteoarthritis in an NHS England unit from 2009 to 2012. Sixty-six thousand seven hundred and sixty-nine of those patients had complete knee score data and were included in the analyses for the present study. The preoperative knee scores were worst in female patients, younger patients, and patients from deprived areas. At 6 months postoperatively, the mean knee score had improved by 15.2 points. There were small sociodemographic differences in the benefit of surgery, with greater area deprivation (-0.71 per quintile of increase in deprivation; 95% confidence interval [CI], -0.76 to -0.66; p < 0.001) and younger age group (-3.51 for ≤50 years compared with 66 to 75 years; 95% CI, -4.00 to -3.02; p < 0.001) associated with less benefit. Cumulatively, sociodemographic factors explained <1% of the total variability in improvement.
Sociodemographic factors have a small influence on the benefit resulting from TKR. However, as they are associated with the clinical threshold at which the procedure is performed, they do affect the eventual outcomes of TKR.
Prognostic Level IV. See Instructions for Authors for a complete description of evidence.
全膝关节置换术（TKR）是治疗骨关节炎的常见手术，可使大多数患者的膝关节疼痛大幅减轻，功能得到改善。我们调查了社会人口统计学因素是否能够解释TKR带来的益处差异。
数据收集自3个来源：英格兰、威尔士、北爱尔兰和马恩岛国家关节注册中心；英格兰国民保健服务（NHS）患者报告结局测量；以及医院病历统计数据。将这3个来源的数据进行关联分析。使用牛津膝关节评分（OKS）来测量膝关节的疼痛和功能。感兴趣的风险因素包括年龄组、性别、贫困程度和社会支持。感兴趣的结局是术前评分、术后6个月评分以及评分变化方面的社会人口统计学差异。
2009年至2012年期间，在英格兰国民保健服务机构的一个单位中，91936名成年人接受了原发性TKR治疗骨关节炎。其中66769名患者有完整的膝关节评分数据，并被纳入本研究分析。术前膝关节评分在女性患者、年轻患者以及来自贫困地区的患者中最差。术后6个月时，膝关节平均评分提高了15.2分。手术益处方面存在微小的社会人口统计学差异，贫困程度增加（每增加一个五分位数为 -0.71；95%置信区间[CI]，-0.76至 -0.66；p < 0.001）以及年龄较小的年龄组（≤50岁与66至75岁相比为 -3.51；95% CI，-4.00至 -3.02；p < 0.001）与益处较少相关。累积来看，社会人口统计学因素解释的改善总变异性不到1%。
社会人口统计学因素对TKR带来的益处影响较小。然而，由于它们与进行该手术的临床阈值相关，所以确实会影响TKR的最终结局。
预后IV级。有关证据的完整描述，请参阅作者指南。
