Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
Division of Orthopaedic Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
J Arthroplasty. 2021 May;36(5):1502-1510.e5. doi: 10.1016/j.arth.2020.11.020. Epub 2020 Nov 18.
While total joint replacement (TJR) is the most effective treatment for end-stage osteoarthritis (OA), one-third of patients do not experience clinically important improvement in pain or function following the surgery. Thus, it is important to identify factors for nonresponders and develop strategies to improve TJR outcomes.
Study participants were patients who underwent TJR (hip/knee) due to OA and completed the WOMAC before and on average 4 years after surgery. Nonresponders (pain nonresponders, function nonresponders, pain and function nonresponders) were determined using the WOMAC change score from baseline to follow-up under two previously reported criteria. Eighty-eight self-reported factors collected by a general health questionnaire were examined for associations with nonresponders.
A total of 601 patients (30.8% hip and 69.2% knee replacement) were included; 18% of them were found to be either pain or function nonresponders. Nine factors were identified in the univariable analyses to be associated with nonresponders, and 5 of them (clinical depression, multisite musculoskeletal pain [MSMP], younger age, golfer's elbow, and driving more than 4 hours on average per working day) remained significant in the multivariable analyses in at least one of six categories. Clinical depression, having MSMP, and younger age were the major factors to be independently associated with nonresponders across five categories. In addition, two factors (age at menopause and age at hysterectomy) were significantly associated with female nonresponders.
Our data suggested potential roles of pain perception, widespread pain sensitization, patient expectations, and early menopause in females in TJR outcomes, warranting further investigation.
全关节置换术（TJR）是治疗终末期骨关节炎（OA）的最有效方法，但三分之一的患者在手术后疼痛或功能没有得到临床上的显著改善。因此，确定无应答者的因素并制定改善 TJR 结果的策略非常重要。
研究参与者为因 OA 接受 TJR（髋关节/膝关节）的患者，并在手术前和平均 4 年后使用 WOMAC 进行评估。使用两种先前报道的标准，根据 WOMAC 基线至随访的变化评分确定无应答者（疼痛无应答者、功能无应答者、疼痛和功能无应答者）。检查由一般健康问卷收集的 88 个自我报告因素与无应答者的相关性。
共纳入 601 名患者（30.8%髋关节和 69.2%膝关节置换），其中 18%为疼痛或功能无应答者。单变量分析确定了 9 个与无应答者相关的因素，其中 5 个因素（临床抑郁、多部位肌肉骨骼疼痛[MSMP]、年龄较小、高尔夫球肘和平均每天工作超过 4 小时）在至少一个 6 个类别中的多变量分析中仍然具有统计学意义。在五个类别中，临床抑郁、患有 MSMP 和年龄较小是与无应答者独立相关的主要因素。此外，两个因素（绝经年龄和子宫切除术年龄）与女性无应答者显著相关。
我们的数据表明，疼痛感知、广泛的疼痛敏化、患者期望和女性早期绝经可能在 TJR 结果中发挥作用，值得进一步研究。
