Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, United Kingdom.
Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
J Arthroplasty. 2019 May;34(5):939-946. doi: 10.1016/j.arth.2019.01.040. Epub 2019 Jan 24.
The incidence of revision total knee arthroplasty (TKA) is projected to increase 6-fold worldwide by 2030. As the number of younger, physically active revision TKA patients increases in future, understanding factors influencing postoperative function will be increasingly important to help counsel patients. The primary aim of this study was to examine factors influencing return to physical activity following revision TKA.
Patients who had undergone tibiofemoral revision between 2003 and 2013 at a single UK teaching hospital were retrospectively identified from a prospectively collected arthroplasty database. Preoperative activity level (University of California, Los Angeles [UCLA] score), patient demographics, indication, implant used, and Oxford Knee Scores (OKSs) were recorded in the database. At a mean follow-up of 3.9 years (standard deviation, 2.2), UCLA score, OKS, EuroQol-5 Dimension Score (EQ-5D), satisfaction, complications, and WORQ scores (Work, Osteoarthritis and Joint-Replacement Questionnaire) were sampled via postal questionnaire. Patient experience of complications and related surgery was also identified from healthcare records. Univariate and multivariate analyses were performed.
Responses were received from 112 revision TKAs (112 patients; mean age, 71 years). Mean UCLA activity scores improved from preoperative levels (P < .001): activity levels improved in 47% of patients with 58% engaging in moderate or more intensive activities (UCLA score ≥5). Postoperative activity level was independently predicted by male gender (P = .042) and preoperative UCLA score (P < .001). Increasing social deprivation was associated with inferior UCLA (P = .005), EQ-5D (P < .005), and OKS (P = .006) scores. Indication, implant type, and patient body mass index did not affect functional outcome or satisfaction (P > .05). Patients <65 years old were more likely to be dissatisfied (P = .009), and patients aged ≤55 years were more likely to report difficulties with WORQ criteria (P < .05).
Although 90% of patients maintain activity levels following revision TKA, less than half increase levels and this is predicted by male sex and pre-revision activity level.
预计到 2030 年，全球翻修全膝关节置换术（TKA）的发病率将增加 6 倍。随着未来越来越多的年轻、活跃的翻修 TKA 患者的出现，了解影响术后功能的因素将变得越来越重要，这有助于为患者提供咨询。本研究的主要目的是研究翻修 TKA 后恢复体力活动的影响因素。
从英国一家教学医院前瞻性收集的关节置换数据库中回顾性确定了 2003 年至 2013 年期间接受胫股翻修的患者。数据库中记录了术前活动水平（加利福尼亚大学洛杉矶分校[UCLA]评分）、患者人口统计学、适应证、植入物的使用情况和牛津膝关节评分（OKS）。在平均 3.9 年（标准差 2.2）的随访中，通过邮寄问卷调查了 UCLA 评分、OKS、欧洲五维健康量表（EQ-5D）评分、满意度、并发症和 WORQ 评分（工作、骨关节炎和关节置换问卷）。还从医疗记录中确定了患者对并发症和相关手术的体验。进行了单变量和多变量分析。
收到了 112 例翻修 TKA（112 例患者；平均年龄 71 岁）的回复。术前 UCLA 活动评分（P<.001）：术后活动水平提高了 47%，其中 58%的患者参与了中等或更高强度的活动（UCLA 评分≥5）。术后活动水平独立预测因素为男性（P=.042）和术前 UCLA 评分（P<.001）。社会贫困程度增加与 UCLA（P=.005）、EQ-5D（P<.005）和 OKS（P=.006）评分降低相关。适应证、植入物类型和患者体重指数均未影响功能结果或满意度（P>.05）。<65 岁的患者更有可能不满意（P=.009），≤55 岁的患者更有可能报告 WORQ 标准存在困难（P<.05）。
尽管 90%的翻修 TKA 患者保持活动水平，但只有不到一半的患者增加了活动水平，这可由男性和术前活动水平预测。
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