Kim Man Soo, Koh In Jun, Choi Keun Young, Ju Gang Ik, In Yong
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021,Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2022 Apr;30(4):1257-1265. doi: 10.1007/s00167-021-06561-4. Epub 2021 Apr 10.
The goal of this retrospective observational study is to determine whether patients with and without central sensitization (CS) undergoing total knee arthroplasty (TKA) have similar preoperative expectations. It was hypothesized that the degree of preoperative expectations is higher in patients with CS than in those without.
The data of 324 patients who underwent primary unilateral TKA for knee osteoarthritis were reviewed and CS was measured using the Central Sensitization Inventory (CSI), which is a validated self-reported questionnaire consisting of a total of 25 questions. CS was defined as a CSI score of 40 or more. Patient expectations were investigated using the Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES) comprising five categories including pain relief, baseline activity, high flexion activity, social activity, and psychological well-being. The expectations of patients, the Western Ontario and McMaster Universities arthritis index (WOMAC) and American Society of Anesthesiologists (ASA) classification scores were compared between the CS and non-CS groups.
The top three patient expectations in both groups were pain relief, psychological well-being, and walking ability. The total score for the expectations was 55.0 ± 8.3 in the CS group and 52.3 ± 10.4 in the non-CS group, indicating that the expectations of the CS group were higher than the non-CS group before TKA (p < 0.05). When the items on the HSS-KRES scale and the five categories were compared, the CS group had significantly higher expectations for pain relief and psychological well-being than did the non-CS group (all p < 0.05).
The expectations of patients with CS before TKA were higher than those without CS. Given the limited improvement in patient-reported outcome measures of patients with CS undergoing TKA, they should be counseled to be realistic especially with their preoperative expectations of pain relief and psychological well-being.
III.
本回顾性观察性研究的目的是确定接受全膝关节置换术（TKA）的有和没有中枢敏化（CS）的患者术前期望是否相似。研究假设是，有CS的患者术前期望程度高于没有CS的患者。
回顾了324例行原发性单侧膝关节骨关节炎TKA患者的数据，并使用中枢敏化量表（CSI）测量CS，该量表是一份经过验证的自我报告问卷，共25个问题。CS定义为CSI评分40分及以上。使用特种外科医院膝关节置换期望调查（HSS-KRES）对患者期望进行调查，该调查包括疼痛缓解、基线活动、高屈曲活动、社交活动和心理健康五个类别。比较CS组和非CS组患者的期望、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及美国麻醉医师协会（ASA）分级评分。
两组患者期望的前三位均为疼痛缓解、心理健康和行走能力。CS组期望总分是55.0±8.3，非CS组是52.3±10.4，表明TKA术前CS组的期望高于非CS组（p<0.05）。当比较HSS-KRES量表项目和五个类别时，CS组对疼痛缓解和心理健康的期望显著高于非CS组（所有p<0.05）。
TKA术前有CS的患者期望高于没有CS的患者。鉴于接受TKA的有CS患者的患者报告结局指标改善有限，应建议他们保持现实，尤其是对疼痛缓解和心理健康的术前期望。
III级
