Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK.
Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Bone Joint J. 2020 Jan;102-B(1):125-131. doi: 10.1302/0301-620X.102B1.BJJ-2019-0328.R1.
The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences patient satisfaction with their TKA.
A retrospective cohort of 3,178 primary TKA patients were identified from an arthroplasty database. Patient characteristics, comorbidities, and WOMAC scores were collected preoperatively and one year postoperatively for the index knee. In addition, WOMAC pain scores were also collected for the contralateral knee. Overall patient satisfaction was assessed at one year. Preoperative contralateral knee pain was defined according to the WOMAC score: minimal (> 78 points), mild (59 to 78), moderate (44 to 58), and severe (< 44). Multivariate regression analysis was used to adjust for confounding.
According to severity there were 1,425 patients (44.8%) with minimal, 710 (22.3%) with mild, 518 (16.3%) with moderate, and 525 (16.5%) with severe pain in the contralateral knee. Patients in the severe group had a greater clinically significant improvement in their functional WOMAC score (9.8 points; p < 0.001). Only patients in the moderate (22.9 points) and severe (37.8 points) groups had a clinically significant improvement in their contralateral knee pain (p < 0.001), but they were significantly less likely to be satisfied with their TKA (moderate: odds ratio (OR) 0.64, 95% confidence interval (CI) 0.4 to 0.92, p = 0.022; severe: OR 0.57, 95% CI 0.39 to 0.82, p = 0.002).
Contralateral knee pain did not impair improvement in the WOMAC score after TKA, and patients with the most severe contralateral knee pain had a clinically significantly greater improvement in their functional outcome. More than half the patients presenting for TKA had mild-to-severe contralateral knee pain, most of whom had a clinically meaningful improvement but were significantly less likely to be satisfied with their TKA. Cite this article: . 2020;102-B(1):125-131.
本研究的主要目的是根据西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分评估对侧膝关节疼痛对全膝关节置换术（TKA）结果是否具有临床显著影响。次要目的是：描述对侧膝关节疼痛的患病率；确定 TKA 后其是否在临床上有所改善；并评估对侧膝关节疼痛是否会独立影响患者对 TKA 的满意度。
从关节置换数据库中确定了 3178 例初次 TKA 患者的回顾性队列。收集索引膝关节术前和术后一年的患者特征、合并症和 WOMAC 评分。此外，还收集了对侧膝关节的 WOMAC 疼痛评分。一年时评估总体患者满意度。根据 WOMAC 评分定义术前对侧膝关节疼痛：轻度（>78 分）、中度（59-78 分）、中度（44-58 分）和重度（<44 分）。使用多元回归分析调整混杂因素。
根据严重程度，1425 例（44.8%）患者对侧膝关节疼痛轻度、710 例（22.3%）中度、518 例（16.3%）中度和 525 例（16.5%）重度。严重组患者的功能性 WOMAC 评分有更大的临床显著改善（9.8 分；p<0.001）。只有中度（22.9 分）和重度（37.8 分）组的患者对侧膝关节疼痛有临床显著改善（p<0.001），但他们对 TKA 的满意度明显降低（中度：比值比（OR）0.64，95%置信区间（CI）0.4-0.92，p=0.022；重度：OR 0.57，95%CI 0.39-0.82，p=0.002）。
对侧膝关节疼痛不会影响 TKA 后 WOMAC 评分的改善，且对侧膝关节疼痛最严重的患者其功能结局有更显著的临床改善。超过一半接受 TKA 的患者存在轻至重度对侧膝关节疼痛，其中大多数患者的临床改善有意义，但对 TKA 的满意度明显降低。引用本文：。2020；102-B（1）：125-131。
