Vissers Lieke C M, van Hove Ruud P, van der Zwaard Babette C
Department of Orthopedic Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, the Netherlands; Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
Department of Orthopedic Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's-Hertogenbosch, the Netherlands.
Knee. 2020 Jun;27(3):683-689. doi: 10.1016/j.knee.2020.04.006. Epub 2020 Apr 30.
Approximately 20% of patients do not perceive functional improvement after a primary total knee arthroplasty (TKA). This study aims to assess which patient-related and clinical determinants at baseline and six months postoperative can predict lack of self-reported functional improvement at 12 months after primary TKA.
In a retrospective cohort study of 569 patients who received a primary TKA between 2015 and 2018, self-reported functional improvement, measured as ≥7 points increase in Oxford Knee Score (OKS) from baseline to 12 months postoperative, was assessed. Patient characteristics and patient-reported variables at baseline and six months postoperative were entered in a logistic regression model with manual backward elimination.
Incidence of functional improvement in this study was 73%. Preoperative variables were no strong predictors of the outcome. An increase in pain between baseline and six months postoperative was a risk factor for not functionally improving (odds ratio (OR) 1.13 (95% confidence interval (CI) 1.03-1.23)). An improvement in knee pain and function was a protective factor for lacking functional improvement (OR 0.78 (95% CI 0.74-0.82)). The prediction model explained 44% of variance and showed good calibration and discrimination. Sensitivity and specificity were 82% and 76%, respectively.
Using pre- and postoperative variables, a prediction model for self-reported functional improvement one year after TKA was developed. This prediction tool was easy to use at six months postoperative and allowed identification of patients at high risk for not functionally improving one year after TKA. This could facilitate early interventions directed at functional improvement after TKA.
约20%的患者在初次全膝关节置换术（TKA）后未感觉到功能改善。本研究旨在评估基线及术后6个月时哪些患者相关因素和临床决定因素可预测初次TKA术后12个月时自我报告的功能未改善情况。
在一项对2015年至2018年间接受初次TKA的569例患者的回顾性队列研究中，评估了自我报告的功能改善情况，以牛津膝关节评分（OKS）从基线到术后12个月增加≥7分为衡量标准。将基线及术后6个月时的患者特征和患者报告变量纳入逻辑回归模型，并进行手动向后消除法分析。
本研究中功能改善的发生率为73%。术前变量并非结果的强预测因素。基线至术后6个月疼痛增加是功能未改善的危险因素（比值比（OR）为1.13（95%置信区间（CI）为1.03 - 1.23））。膝关节疼痛和功能的改善是功能未改善的保护因素（OR为0.78（95%CI为0.74 - 0.82））。该预测模型解释了44%的方差，显示出良好的校准和区分能力。敏感性和特异性分别为82%和76%。
利用术前和术后变量，建立了TKA术后1年自我报告功能改善的预测模型。该预测工具在术后6个月易于使用，能够识别TKA术后1年功能未改善的高危患者。这有助于针对TKA术后功能改善进行早期干预。
