Mark-Christensen Troels, Kehlet Henrik
Department of Rehabilitation, Centre of Health, Bornholms Regionskommune, Rønne, Denmark.
Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Musculoskeletal Care. 2019 Dec;17(4):300-312. doi: 10.1002/msc.1409. Epub 2019 Sep 6.
A significant proportion of patients experience functional limitations following total hip and knee arthroplasty (THA and TKA). The purpose of this study was to investigate prospectively the patient-reported and objectively assessed functional recovery following THA and TKA.
Patients were recruited at a regional Danish hospital, using a prospective, observational hypothesis-generating cohort design. Primary outcome measures were performance-based function (30-s chair-stand test) and self-reported physical function measured by the Hip Disability and Osteoarthritis Outcome Score (HOOS) for those who had undergone THA, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for those who had undergone TKA. In addition, patient expectations, the "forgotten joint" scale and pain catastrophizing were measured. Outcome measures were collected at baseline (preoperatively) and at follow-up (4 months postoperatively).
A total of 95 patients (59 who had undergone THA and 36 who had undergone TKA) were recruited. Performance-based function improved only slightly, with a mean difference of 2.9 (95% confidence interval [CI] 1.9, 4.0) for THAs and 1.6 (95% CI 0.4, 2.8) for TKAs. Self-reported physical function improved significantly, with a mean difference of 37.9 (95% CI 31.5, 44.3) for THAs and 28.6 (95% CI 22.7, 34.4) for TKAs. However, dividing the cohort into "improved" and "non-improved" groups based on changes in performance-based function, no clinically relevant predictors for poor performance-based outcome could be found.
Self-reported outcome measures improved significantly following THA and TKA, whereas performance-based function improved only slightly by the 4-month follow-up. The subgroup that did not improve in performance-based function still reported significant improvements in self-reported outcome measures, demonstrating the difficulty in predicting optimal rehabilitation strategies after THA and TKA.
相当一部分患者在全髋关节置换术（THA）和全膝关节置换术（TKA）后出现功能受限。本研究的目的是前瞻性地调查患者报告的以及客观评估的THA和TKA后的功能恢复情况。
在丹麦一家地区医院招募患者，采用前瞻性观察性队列设计以生成假设。主要结局指标是基于表现的功能（30秒坐立试验），对于接受THA的患者，通过髋关节残疾和骨关节炎结局评分（HOOS）测量自我报告的身体功能；对于接受TKA的患者，通过膝关节损伤和骨关节炎结局评分（KOOS）测量自我报告的身体功能。此外，还测量了患者期望、“被遗忘关节”量表和疼痛灾难化程度。在基线（术前）和随访（术后4个月）时收集结局指标。
共招募了95例患者（59例接受THA，36例接受TKA）。基于表现的功能仅略有改善，THA的平均差异为2.9（95%置信区间[CI]1.9，4.0），TKA的平均差异为1.6（95%CI 0.4，2.8）。自我报告的身体功能显著改善，THA的平均差异为37.9（95%CI 31.5，44.3），TKA的平均差异为28.6（95%CI 22.7，34.4）。然而，根据基于表现的功能变化将队列分为“改善”和“未改善”组，未发现与基于表现的不良结局相关的临床预测因素。
THA和TKA后自我报告的结局指标显著改善，而基于表现的功能在4个月随访时仅略有改善。基于表现的功能未改善的亚组在自我报告的结局指标方面仍报告有显著改善，这表明预测THA和TKA后的最佳康复策略存在困难。
