Department of Surgery, CIUSSS-de-L'Est-de-L'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
Department of Surgery, CIUSSS-de-L'Est-de-L'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Department of Surgery, Université de Montréal, Montreal, Quebec, Canada.
J Arthroplasty. 2019 Jan;34(1):65-70. doi: 10.1016/j.arth.2018.09.086. Epub 2018 Oct 3.
Assessing patients' functional outcomes following total hip arthroplasty with traditional scoring systems is limited by their ceiling effects. The Forgotten Joint Score (FJS) has been suggested as a more discriminating option. The actual score in the FJS which constitutes a "forgotten joint," however, has not been defined. The emerging concept of joint perception led to the development of the Patient's Joint Perception question (PJP) to assess the patient's opinion of their prosthetic joint.
Two hundred fifty-seven total hip arthroplasties were assessed at a mean of 68 months of follow-up (range 57-79). Outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), FJS, and PJP. Correlation of the scores as well as the ceiling effects were analyzed.
The mean FJS was 88.5 (range 27.1-100). PJP was correlated with the FJS and WOMAC (Spearman's rho -0.510 and 0.465, respectively). Fifty-two percent of the patients felt their hip as a natural joint (FJS: 95% confidence interval [CI] 93.3-96.0), 24.1% as an artificial joint with no restriction (FJS: 95% CI 83.1-90.5), and 23.3% as an artificial joint with minor restrictions (FJS: 95% CI 73.8-82.2). Only 0.8% had major restrictions and none reported a non-functional joint. The ceiling effect was high with both the WOMAC and FJS, with 27.2% and 31.9%. In addition, 28.6% of the patients had a WOMAC >10 and 23.4% an FJS <90 while reporting having a natural hip. Furthermore, 21.5% with a perfect WOMAC or 21.9% with a perfect FJS reported having an artificial joint with or without limitation.
A forgotten hip perception corresponds to an FJS >93. In 20%-30% of the cases, the WOMAC and FJS failed to identify the forgotten joint, or reached the maximum score when the patients did not feel their hip was natural. The PJP is a simple and reliable tool that enables identification of patients who feel replaced hip is natural.
使用传统评分系统评估全髋关节置换术后患者的功能结果存在局限性，因为它们存在天花板效应。遗忘关节评分（FJS）被认为是一种更具鉴别力的选择。然而，FJS 中构成“遗忘关节”的实际分数尚未确定。关节感知的新概念导致了患者关节感知问题（PJP）的发展，用于评估患者对假体关节的看法。
对 257 例全髋关节置换术患者进行评估，平均随访 68 个月（57-79 个月）。结果包括西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）、FJS 和 PJP。分析了评分的相关性和天花板效应。
平均 FJS 为 88.5（范围 27.1-100）。PJP 与 FJS 和 WOMAC 相关（Spearman rho 分别为-0.510 和 0.465）。52%的患者认为他们的髋关节是自然关节（FJS：95%置信区间[CI]93.3-96.0），24.1%认为是无限制的人工关节（FJS：95%CI 83.1-90.5），23.3%认为是人工关节有轻微限制（FJS：95%CI 73.8-82.2）。只有 0.8%的患者有严重限制，没有患者报告关节无功能。WOMAC 和 FJS 的天花板效应均很高，分别为 27.2%和 31.9%。此外，28.6%的患者 WOMAC>10，23.4%的患者 FJS<90，但报告他们的髋关节是自然的。此外，21.5%的患者 WOMAC 完美或 21.9%的患者 FJS 完美，报告他们的人工关节有或没有限制。
遗忘髋关节感知对应 FJS>93。在 20%-30%的情况下，WOMAC 和 FJS 无法识别遗忘关节，或者当患者不认为他们的髋关节是自然的时候，它们达到了最高分。PJP 是一种简单可靠的工具，可以识别出感觉置换髋关节是自然的患者。
