Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Department of Orthopedic Surgery, Mayo Clinic, Minneapolis, MN, USA.
Knee Surg Sports Traumatol Arthrosc. 2020 Sep;28(9):2962-2969. doi: 10.1007/s00167-019-05704-y. Epub 2019 Nov 21.
The purpose of this study was to identify effects of psychosocial and demographic factors on patellofemoral arthroplasty (PFA) outcomes.
Patients who underwent PFA by a single surgeon between 2002 and 2013 (min. 2 year follow-up) were included. Knee Society scores (KSS), UCLA, and Tegner Scores were prospectively collected in a designated arthroplasty registry. Patient records were retrospectively reviewed and univariate and multivariate statistical analyses were performed to assess the effect of psychosocial factors and demographic variables including patient sex, BMI, smoking and medication use, psychiatric history, and employment status on improvement between pre- and post-operative scores.
Seventy-four knees in 55 patients (88% female) with a mean age of 51.8 (SD 8.8) and mean follow-up of 46.5 (SD 26.9) months were included. Patients showed significant improvement in all functional outcomes (p < 0.001). Mean improvement in KSS-F scores and median improvement in Tegner scores was greater in males compared to females (37.8 vs 16.1, p = 0.007; 3.0 vs 2.0, p = 0.07, respectively). Smokers showed less improvement in KSS-P compared to non-smokers (17.2 vs 30.0, p = 0.028). Retired or employed patients had a greater mean improvement in KSS-F and median improvement in Tegner Scores compared to those were unemployed or on work disability (p = 0.022, p = 0.01). Patients who reported using opioids and/or anti-depressants pre-operatively showed less improvement in UCLA scores (p = 0.006). Obese patients showed less improvement in both KSS-F and Tegner score compared to non-obese patients (p = 0.009, p = 0.004).
Psychosocial factors influence the degree of improvement following PFA. Although patients showed overall improvement compared to their baseline scores, obese patients, smokers, unemployed/work disabled, and pre-operative use of opioids and/or anti-depressants were risk factors for decreased improvement… The consideration of psychosocial variables are clinically important when assessing a patient's candidacy for PFA and improve pre-operative patient selection and counselling.
Level IV.
本研究旨在确定社会心理和人口统计学因素对髌股关节置换术（PFA）结果的影响。
纳入了 2002 年至 2013 年间由同一位外科医生进行 PFA 的患者（至少随访 2 年）。在指定的关节置换登记处前瞻性收集膝关节学会评分（KSS）、UCLA 和 Tegner 评分。回顾性查阅患者病历，并进行单变量和多变量统计分析，以评估社会心理因素和人口统计学变量（包括患者性别、BMI、吸烟和药物使用、精神病史和就业状况）对术前和术后评分改善的影响。
纳入了 55 名患者（88%为女性）的 74 个膝关节，平均年龄为 51.8（SD 8.8）岁，平均随访时间为 46.5（SD 26.9）个月。所有功能结果均有显著改善（p<0.001）。与女性相比，男性 KSS-F 评分的平均改善和 Tegner 评分的中位数改善更大（37.8 比 16.1，p=0.007；3.0 比 2.0，p=0.07）。与不吸烟者相比，吸烟者的 KSS-P 改善较小（17.2 比 30.0，p=0.028）。与失业或残疾相比，退休或就业的患者在 KSS-F 中有更大的平均改善，在 Tegner 评分中有更大的中位数改善（p=0.022，p=0.01）。术前报告使用阿片类药物和/或抗抑郁药的患者 UCLA 评分改善较小（p=0.006）。与非肥胖患者相比，肥胖患者的 KSS-F 和 Tegner 评分改善较小（p=0.009，p=0.004）。
社会心理因素影响 PFA 后的改善程度。尽管患者与基线评分相比总体有所改善，但肥胖患者、吸烟者、失业/残疾患者以及术前使用阿片类药物和/或抗抑郁药是改善程度降低的危险因素……在评估患者 PFA 的候选资格时，考虑社会心理变量具有重要的临床意义，并可改善术前患者选择和咨询。
IV 级。
