患者对全膝关节置换术的术前期望和一年后对治疗结果的满意度：一项前瞻性队列研究。

Patients' Preoperative Expectations of Total Knee Arthroplasty and Satisfaction With Outcomes at One Year: A Prospective Cohort Study.

机构信息

University of Toronto, Toronto, Ontario, Canada.

University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.

出版信息

Arthritis Rheumatol. 2021 Feb;73(2):223-231. doi: 10.1002/art.41510. Epub 2020 Dec 26.

DOI:10.1002/art.41510

PMID:32892511

Abstract

OBJECTIVE

To assess the relationship between patients' expectations for total knee arthroplasty (TKA) and satisfaction with surgical outcome.

METHODS

This prospective cohort study recruited patients with knee osteoarthritis (OA) ages ≥30 years who were referred for TKA at 2 hip/knee surgery centers in Alberta, Canada. Those who received primary, unilateral TKA completed questionnaires pre-TKA to assess TKA expectations (17-item Hospital for Special Surgery [HSS] TKA Expectations questionnaire) and contextual factors (age, sex, Western Ontario and McMaster Universities Osteoarthritis Index pain score, Knee Injury and Osteoarthritis Outcome Score physical function short form [KOOS-PS], 8-item Patient Health Questionnaire depression scale, body mass index [BMI], comorbidities, and prior joint replacement), and 1-year post-TKA to assess overall satisfaction with TKA results. Using multivariate logistic regression, we examined the relationship between TKA expectations (HSS TKA outcomes considered to be very important) and postoperative satisfaction (very satisfied versus somewhat satisfied versus dissatisfied). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.

RESULTS

At 1 year, 1,266 patients with TKA (92.1%) reported their TKA satisfaction (mean ± SD age 67.2 ± 8.8 years, 60.9% women, and mean BMI 32.6 kg/m ); 74.7% of patients were very satisfied, 17.1% were somewhat satisfied, and 8.2% were dissatisfied. Controlling for other factors, an expectation of TKA to improve patients' ability to kneel was associated with lower odds of satisfaction (adjusted OR 0.725 [95% CI 0.54-0.98]). An expectation of TKA to improve psychological well-being was associated with lower odds of satisfaction for individuals in the lowest tertile of pre-TKA KOOS-PS scores (adjusted OR 0.49 [95% CI 0.28-0.84]), but higher odds for those in the highest tertile (adjusted OR 2.37 [95% CI 1.33-4.21]).

CONCLUSION

In patients with TKA, preoperative expectations regarding kneeling and psychological well-being were significantly associated with the level of TKA satisfaction at 1 year. Ensuring that patients' expectations are achievable may enhance appropriate provision of TKA.

摘要

目的

评估患者对全膝关节置换术（TKA）的期望与对手术结果满意度之间的关系。

方法

本前瞻性队列研究招募了年龄≥30 岁的膝关节骨关节炎（OA）患者，这些患者在加拿大艾伯塔省的 2 家髋关节/膝关节外科中心接受 TKA。那些接受初次单侧 TKA 的患者在 TKA 前完成了调查问卷，以评估 TKA 期望（17 项特种外科医院 [HSS] TKA 期望问卷）和背景因素（年龄、性别、安大略西部和麦克马斯特大学骨关节炎指数疼痛评分、膝关节损伤和骨关节炎结局评分物理功能简短形式 [KOOS-PS]、8 项患者健康问卷抑郁量表、体重指数 [BMI]、合并症和既往关节置换），并在 TKA 后 1 年评估对 TKA 结果的总体满意度。我们使用多变量逻辑回归，研究了 TKA 期望（HSS TKA 结果被认为非常重要）与术后满意度（非常满意与有些满意与不满意）之间的关系。计算了调整后的优势比（OR）和 95%置信区间（95%CI）。

结果

在 1 年时，1266 名接受 TKA 的患者（92.1%）报告了他们的 TKA 满意度（平均±标准差年龄 67.2±8.8 岁，60.9%为女性，平均 BMI 为 32.6kg/m）；74.7%的患者非常满意，17.1%的患者有些满意，8.2%的患者不满意。在控制其他因素后，期望 TKA 能够改善患者的跪姿能力与满意度降低的可能性相关（调整后的 OR 0.725 [95%CI 0.54-0.98]）。期望 TKA 能改善心理健康的患者在 TKA 前 KOOS-PS 评分最低三分位的患者中，满意度降低的可能性较小（调整后的 OR 0.49 [95%CI 0.28-0.84]），但在最高三分位的患者中，满意度提高的可能性较大（调整后的 OR 2.37 [95%CI 1.33-4.21]）。