Perez Brian A, Slover James, Edusei Emmanuel, Horan Annamarie, Anoushiravani Afshin, Kamath Atul F, Nelson Charles L
Department of Orthopedics, University of Pennsylvania, Philadelphia, PA 19104, United States.
Department of Orthopedic Surgery, New York University Langone Health, New York, NY 10016, United States.
World J Orthop. 2020 May 18;11(5):265-277. doi: 10.5312/wjo.v11.i5.265.
Total joint arthroplasty is one of the most common surgeries performed in the United States with total knee arthroplasty (TKA) being one of the most successful surgeries for restoring function and diminishing pain. Even with the demonstrated success of TKA and a higher prevalence of arthritis and arthritis related disability among minorities, racial and gender disparity remains a constant issue in providing care for the adult reconstruction patient.
To assess the role of demographics and expectations on differences in perioperative patient reported outcomes (PRO) following TKA.
One hundred and thirty-three patients scheduled for primary unilateral TKA secondary to moderate to severe osteoarthritis were enrolled in this two-institution prospective study. Validated PRO questionnaires were collected at four time points. Statistical analysis was conducted to determine the impact of gender, ethnic background and expectation surveys responses to assess PRO at these time points.
Females were associated with worse preoperative Knee Injury and Osteoarthritis Outcome Scores (KOOS) for symptoms, pain, and activities of daily living. African Americans were associated with worse KOOS for pain, activities of daily living, and quality of life. Despite worse preoperative scores, no difference was noted in these categories between the groups postoperatively. Additionally, all pre-operative psychometric scales were equivalent across groups except Geriatric Depression scale, which was significantly different between groups within the Race and Age Group ( < 0.05). Conversely, Pain Catastrophizing Scale, was significantly different for all subscales and total score within Age Group ( < 0.05), and the Magnification, Helplessness subscales as well as the Total score were significantly different between groups for Race and Relationship Status ( < 0.01).
We conclude that female and African American patients have lower preoperative KOOS scores compared to white male patients. No postoperative differences in outcomes between these groups.
全关节置换术是美国最常见的手术之一，全膝关节置换术（TKA）是恢复功能和减轻疼痛最成功的手术之一。尽管TKA已被证明取得成功，且少数族裔中关节炎及与关节炎相关的残疾患病率更高，但在为成人重建患者提供护理方面，种族和性别差异仍是一个长期存在的问题。
评估人口统计学和期望对TKA术后围手术期患者报告结局（PRO）差异的作用。
本两项机构前瞻性研究纳入了133例因中度至重度骨关节炎计划接受初次单侧TKA的患者。在四个时间点收集经过验证的PRO问卷。进行统计分析以确定性别、种族背景和期望调查回复对这些时间点评估PRO的影响。
女性在症状、疼痛和日常生活活动方面的术前膝关节损伤和骨关节炎结局评分（KOOS）较差。非裔美国人在疼痛、日常生活活动和生活质量方面的KOOS较差。尽管术前评分较差，但术后两组在这些类别中未发现差异。此外，除老年抑郁量表外，所有术前心理测量量表在各组间均相当，老年抑郁量表在种族和年龄组内各组间有显著差异（<0.05）。相反，疼痛灾难化量表在年龄组内所有子量表和总分均有显著差异（<0.05），在种族和关系状态方面，放大、无助子量表以及总分在各组间有显著差异（<0.01）。
我们得出结论，与白人男性患者相比，女性和非裔美国患者术前KOOS评分较低。这些组之间术后结局无差异。
