Singh Vivek, Zak Stephen, Robin Joseph X, Kugelman David N, Hepinstall Matthew S, Long William J, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
Eur J Orthop Surg Traumatol. 2022 Apr;32(3):541-549. doi: 10.1007/s00590-021-03010-3. Epub 2021 May 26.
Back pain may both decrease patient satisfaction after TKA and confound outcome assessment in satisfied patients. Our primary objective was to determine whether preoperative back pain is associated with differences in postoperative patient-reported outcome measures (PROMs).
We retrospectively reviewed 234 primary TKA patients who completed PROMs preoperatively and 12 weeks postoperatively, which included a back pain questionnaire, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and the Forgotten Joint Score-12 (FJS-12). Cohorts were defined based on the severity of preoperative back pain (none, mild, moderate and severe) and compared. Demographics were compared using ANOVA and Chi-square analysis. Univariate ANCOVA analysis was utilized to compare PROMs while accounting for significant demographic differences.
Both preoperative KOOS JR scores (none: 47.90, mild: 47.61, moderate: 44.61 and severe: 38.70; p = 0.013) and 12-week postoperative KOOS JR scores (none: 61.24, mild: 64.94, moderate: 57.48 and severe: 57.01; p = 0.012) had a statistically significant inverse relationship with regard to the intensity of preoperative back pain. Although FJS-12 scores at the 12-week postoperative period trended lower with increasing levels of preoperative back pain (p = 0.362), it did not reach statistical significance. Patients who reported severe back pain preoperatively achieved the largest delta improvement from baseline compared to those with lesser pain intensity (p = 0.003). Patients who had a 2-grade improvement in their back pain achieved significantly higher KOOS JR scores 12 weeks postoperatively compared to patients with either 1-grade or no improvement (63.53 vs. 55.98; p = 0.042). Both preoperative (47.99 vs. 41.11; p = 0.003) and 12-week postoperative (64.06 vs. 55.73; p < 0.001) KOOS JR scores were statistically higher for those who reported mild or no back pain pre-and postoperatively than those who reported moderate or severe back pain pre-and postoperatively.
Knee pain and back pain both exert negative effects on outcome instruments designed to measure pain and function. Although mean improvement from pre- to postoperative KOOS JR scores for patients with severe pre-existing back pain was higher than their counterparts, this statistical difference is likely not clinically significant. This implies that all patients may experience similar benefits from TKA despite the presence or absence of back pain. Attempts to measure TKA outcomes using PROMs should seek to control for lumbago and other sources of body pain. Level of Evidence IIIRetrospective Cohort Study.
背痛可能会降低全膝关节置换术（TKA）后患者的满意度，并混淆对满意患者的结果评估。我们的主要目的是确定术前背痛是否与术后患者报告的结局指标（PROMs）的差异相关。
我们回顾性分析了234例接受初次TKA的患者，这些患者在术前和术后12周完成了PROMs评估，包括背痛问卷、关节置换的膝关节损伤和骨关节炎结局评分（KOOS JR）以及遗忘关节评分-12（FJS-12）。根据术前背痛的严重程度（无、轻度、中度和重度）对患者进行分组并比较。使用方差分析和卡方分析比较人口统计学特征。采用单变量协方差分析在考虑显著人口统计学差异的情况下比较PROMs。
术前KOOS JR评分（无：47.90，轻度：47.61，中度：44.61，重度：38.70；p = 0.013）和术后12周KOOS JR评分（无：61.24，轻度：64.94，中度：57.48，重度：57.01；p = 0.012）与术前背痛强度均存在统计学显著的负相关。虽然术后12周FJS-12评分随着术前背痛程度的增加呈下降趋势（p = 0.362），但未达到统计学显著性。与疼痛强度较轻的患者相比，术前报告严重背痛的患者从基线到术后的改善幅度最大（p = 0.003）。背痛改善2级的患者术后12周的KOOS JR评分显著高于改善1级或未改善的患者（63.53对55.98；p = 0.042）。术前（47.99对41.11；p = 0.003）和术后12周（64.06对55.73；p < 0.001），术前和术后报告轻度或无背痛的患者的KOOS JR评分在统计学上高于术前和术后报告中度或重度背痛的患者。
膝关节疼痛和背痛均对旨在测量疼痛和功能的结局指标产生负面影响。虽然术前存在严重背痛的患者从术前到术后KOOS JR评分的平均改善高于其他患者，但这种统计学差异可能没有临床意义。这意味着无论是否存在背痛，所有患者可能从TKA中获得相似的益处。使用PROMs测量TKA结果时应设法控制腰痛和身体其他部位的疼痛来源。证据等级III回顾性队列研究。
