单髁膝关节置换术与全膝关节置换术后疼痛、阿片类药物使用和功能的差异。
Differences in Pain, Opioid Use, and Function Following Unicompartmental Knee Arthroplasty compared to Total Knee Arthroplasty.
机构信息
Department of Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, New York, NY.
出版信息
J Arthroplasty. 2020 Sep;35(9):2435-2438. doi: 10.1016/j.arth.2020.04.072. Epub 2020 Apr 27.
BACKGROUND
We sought to determine if immediate postsurgical pain, opioid use, and clinical function differed between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA).
METHODS
A single-institution database was utilized to identify patients who underwent elective total joint arthroplasty between 2016 and 2019.
RESULTS
In total, 6616 patients were identified: 98.20% TKA (6497) and 1.80% (119) UKA. UKA patients were younger, had lower body mass index, and more often male than the TKA cohort. Aggregate opioid consumption (75.94 morphine milligram equivalents vs 136.5 morphine milligram equivalents; P < .001) along with the first 24-hour and 48-hour usage was significantly less for UKA as compared to TKA. Similarly, pain scores (1.98 vs 2.58; P < .001) were lower for UKA while Activity Measure for Post-Acute Care mobilization scores were higher (21.02 vs 18.76; P < .001). UKA patients were able to be discharged home on the day of surgery 37% of the time as compared to 2.45% of TKA patients (P < .0001). Notably, when comparing UKA and TKA patients who were discharged home on the day of surgery, no differences regarding pain scores, opioid utilization, or mobilization were observed.
CONCLUSION
UKA patients are younger, have lower body mass index and American Society of Anesthesiologists scores, and more often male than TKA patients. UKA patients had significantly shorter length of stay than TKA patients and were discharged home more often than TKA patients, on both the day of surgery and following hospital admission. Most notably, UKA patients reported lower pain scores and were found to require 45% lower opioid medication in the immediate postsurgical period than TKA patients. Surprisingly, UKA and TKA patients discharged on the day of surgery did not differ in terms of pain scores, opioid utilization, or mobilization, suggesting that our rapid rehabilitation UKA protocols can be successfully translated to outpatient TKAs with similar outcomes.
LEVEL III EVIDENCE
Retrospective Cohort Study.
背景
我们旨在确定单髁膝关节置换术（UKA）和全膝关节置换术（TKA）在术后即刻疼痛、阿片类药物使用和临床功能方面是否存在差异。
方法
利用单机构数据库确定了 2016 年至 2019 年间行择期全关节置换术的患者。
结果
共确定了 6616 例患者：98.20%为 TKA（6497 例），1.80%为 UKA（119 例）。UKA 患者较 TKA 患者年轻、体重指数较低且男性更多。与 TKA 相比，UKA 的阿片类药物总消耗量（75.94 吗啡毫克当量与 136.5 吗啡毫克当量；P<0.001）以及前 24 小时和 48 小时的使用率显著较低。同样，UKA 的疼痛评分（1.98 与 2.58；P<0.001）较低，而术后急性护理活动能力测量的活动评分（21.02 与 18.76；P<0.001）较高。UKA 患者中有 37%可在手术当天出院，而 TKA 患者只有 2.45%（P<0.0001）。值得注意的是，当比较手术当天出院的 UKA 和 TKA 患者时，在疼痛评分、阿片类药物使用或活动方面均未观察到差异。
结论
与 TKA 患者相比，UKA 患者更年轻、体重指数和美国麻醉医师协会评分较低且男性更多。UKA 患者的住院时间明显短于 TKA 患者，且更常于手术当天和住院后出院。值得注意的是，UKA 患者术后即刻的疼痛评分较低，且需要的阿片类药物比 TKA 患者少 45%。令人惊讶的是，手术当天出院的 UKA 和 TKA 患者在疼痛评分、阿片类药物使用或活动方面没有差异，这表明我们的快速康复 UKA 方案可以成功转化为门诊 TKA，且具有相似的结果。
证据等级
III 级回顾性队列研究。
Zotero 插件