Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Bone Joint J. 2020 Jul;102-B(7):845-851. doi: 10.1302/0301-620X.102B7.BJJ-2019-1562.R2.
While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years' follow-up.
Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS.
There was no difference in the mean KSKS, KSFS, OKS, and SF-36 PCS at two years or ten years after TKA. Equal proportions of patients in each group attained the minimal clinically important difference for each score. Psychologically distressed patients had a comparable rate of satisfaction (91.8% (47/51) vs 97.1% (69/71); p = 0.193) and fulfilment of expectations (89.8% vs 97.1%; p = 0.094). The proportion of distressed patients declined from 41.8% preoperatively to 29.8% at final follow-up (p = 0.021), and their mean SF-36 MCS improved by 10.4 points (p < 0.001).
Patients with poor mental health undergoing TKA may experience long-term improvements in function and quality of life that are comparable to those experienced by their non-distressed counterparts. These patients also achieved a similar rate of satisfaction and expectation fulfilment. Undergoing TKA was associated with improvements in mental health in distressed patients, although this effect may be due to residual confounding. Cite this article: 2020;102-B(7):845-851.
虽然心理困扰的患者在全膝关节置换术后（TKA）的短期结果较差，但他们的长期功能尚不清楚。我们旨在 1）评估术前心理健康状况对长期功能结果、生活质量和患者满意度的影响；2）分析在没有精神健康障碍病史的患者队列中，TKA 后心理健康的变化，随访时间至少为十年。
回顾了 2006 年接受初次单侧 TKA 的 122 例患者的前瞻性收集数据。使用膝关节学会膝关节评分（KSKS）和功能评分（KSFS）、牛津膝关节评分（OKS）以及源自 36 项简短健康调查问卷（SF-36）的精神（MCS）和身体成分综合评分（PCS），在术前和术后 2 年和 10 年对患者进行评估。患者根据精神健康状况（MCS<50，n=51）和非精神健康状况（MCS≥50，n=71）分为两组。采用多元回归控制年龄、性别、BMI、Charlson 合并症指数（CCI）和基线评分。比较 MCS 低和高的患者的期望满足率和满意度。
TKA 后 2 年和 10 年，KSKS、KSFS、OKS 和 SF-36 PCS 的平均水平无差异。每个组中获得每个评分的最小临床重要差异的患者比例相同。在每个组中，有心理困扰的患者的满意度（91.8%（47/51）与 97.1%（69/71）；p=0.193）和期望满足率（89.8%与 97.1%；p=0.094）相同。术前有心理困扰的患者比例从 41.8%下降到最后随访时的 29.8%（p=0.021），他们的平均 SF-36 MCS 提高了 10.4 分（p<0.001）。
接受 TKA 的精神健康状况不佳的患者可能会经历长期的功能和生活质量改善，这与非精神健康状况不佳的患者相似。这些患者的满意度和期望满足率也相似。接受 TKA 与有心理困扰的患者的心理健康改善有关，尽管这种影响可能是由于残余混杂因素所致。
