Liao Chun-De, Chen Hung-Chou, Huang Shih-Wei, Liou Tsan-Hon
Master Program in Long-Term Care, Taipei Medical University, College of Nursing, Taipei.
Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei.
Ther Adv Musculoskelet Dis. 2021 Mar 12;13:1759720X21998508. doi: 10.1177/1759720X21998508. eCollection 2021.
Knee osteoarthritis (KOA) is associated with an increased risk of sarcopenia, and aging-related muscle deterioration continues after total knee replacement (TKR). Low skeletal muscle mass index may influence postoperative rehabilitation outcomes. Through this study, we aimed to investigate the impact of preoperative sarcopenia on clinical outcomes after postoperative rehabilitation in older Asian adults.
A total of 190 older adults (39 men, 151 women) were enrolled from two previous trials and were classified as having no sarcopenia, class I sarcopenia, or class II sarcopenia according to definitions provided by the Asian Working Group for Sarcopenia (AWGS) and the European Working Group on Sarcopenia in Older People (EWGSOP). All patients were retrospectively analyzed before (T) and after (T) TKR rehabilitation and 10 months after surgery (T). The outcome measures included the timed up-and-go test (TUGT), gait speed (GS), timed chair rise (TCR), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical difficulty (WOMAC-PF). With patient characteristics and T scores as covariates, an analysis of variance was performed to identify intergroup differences in changes of all outcome measures at T and T.
According to the definitions of both the AWGS and EWGSOP, patients with class I and class II sarcopenia exhibited minor changes in TUGT, GS, TCR, and WOMAC-PF at T and T (all < 0.05), compared with those without sarcopenia. For patients classified as having sarcopenia based on AWGS and EWGSOP definitions, no significant intergroup differences in WOMAC pain score was observed at T or T (all > 0.05).
Sarcopenia independently had negative impacts on the treatment effects of rehabilitation on physical mobility but not on pain outcome after TKR in older adults with KOA.
膝关节骨关节炎（KOA）与肌肉减少症风险增加相关，且全膝关节置换术（TKR）后与衰老相关的肌肉退化仍会持续。低骨骼肌质量指数可能会影响术后康复效果。通过本研究，我们旨在调查术前肌肉减少症对亚洲老年成年人术后康复临床结局的影响。
从之前的两项试验中纳入了190名老年人（39名男性，151名女性），并根据亚洲肌肉减少症工作组（AWGS）和欧洲老年人肌肉减少症工作组（EWGSOP）提供的定义，将其分为无肌肉减少症、I级肌肉减少症或II级肌肉减少症。对所有患者在TKR康复前（T）、康复后（T）以及术后10个月（T）进行回顾性分析。结局指标包括计时起立行走测试（TUGT）、步速（GS）、定时从椅子上起身测试（TCR）以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛和身体功能困难评分（WOMAC-PF）。以患者特征和T评分作为协变量，进行方差分析以确定T和T时所有结局指标变化的组间差异。
根据AWGS和EWGSOP的定义，与无肌肉减少症的患者相比，I级和II级肌肉减少症患者在T和T时的TUGT、GS、TCR和WOMAC-PF变化较小（均<0.05）。对于根据AWGS和EWGSOP定义被归类为患有肌肉减少症的患者，在T或T时未观察到WOMAC疼痛评分的显著组间差异（均>0.05）。
在患有KOA的老年成年人中，肌肉减少症独立地对康复对身体活动能力的治疗效果有负面影响，但对TKR后的疼痛结局没有影响。
