School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.
Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK.
Bone Joint J. 2021 Jun;103-B(6):1096-1102. doi: 10.1302/0301-620X.103B6.BJJ-2020-1821.R1.
Although total knee arthroplasty (TKA) is a highly successful procedure, about 20% of patients remain dissatisfied postoperatively. This proportion is derived from dichotomous models of the assessment of surgical success or failure, which may not reflect the spectrum of outcomes. The aim of this study was to explore differing responses to surgery, and assess whether there are distinct groups of patients with differing patterns of outcome.
This was a secondary analysis of a UK multicentre TKA longitudinal cohort study. We used a group-based trajectory modelling analysis of Oxford Knee Score (OKS) in the first year following surgery with longitudinal data involving five different timepoints and multiple predictor variables. Associations between the derived trajectory groups and categorical baseline variables were assessed, and predictors of trajectory group membership were identified using Poisson regression and multinomial logistic regression, as appropriate. The final model was adjusted for sociodemographic factors (age, sex) and baseline OKS.
Data from 731 patients were available for analysis. Three distinct trajectories of outcome were identified: "poor" 14.0%, "modest" 39.1%, and "good" 46.9%. The predicted probability of membership for patients assigned to each trajectory group was high (0.89 to 0.93). Preoperative mental, physical health, and psychosocial factors determined which trajectory is likely to be followed. Poor responders were characterized by a comparatively small number of factors, preoperative expectations of pain and limitations, coping strategies, and a lower baseline physical health status, while the good responders were characterized by a combination of clinical, psychosocial, mental health, and quality of life factors.
We identified three distinct response trajectories in patients undergoing TKA. Controlling for baseline score, age, and sex, psychosocial factors such as expectations of pain and limited function and poor coping strategies differentiated the trajectory groups, suggesting a role for preoperative psychosocial support in optimizing the clinical outcome. Cite this article: 2021;103-B(6):1096-1102.
全膝关节置换术（TKA）是一种非常成功的手术，但仍有约 20%的患者术后不满意。这一比例源自于对手术成功或失败的二分模型评估，而这种评估可能并不能反映结果的全貌。本研究旨在探讨不同的手术反应，并评估是否存在具有不同结局模式的不同患者群体。
这是一项英国多中心 TKA 纵向队列研究的二次分析。我们使用基于群组的轨迹建模分析，对术后第一年的牛津膝关节评分（OKS）进行分析，该分析涉及五个不同时间点和多个预测变量的纵向数据。评估了得出的轨迹组与分类基线变量之间的关联，并使用泊松回归和多项逻辑回归，根据需要，确定了轨迹组归属的预测因素。最终模型调整了社会人口因素（年龄、性别）和基线 OKS。
共有 731 名患者的数据可用于分析。确定了三种不同的结局轨迹：“较差”占 14.0%，“中等”占 39.1%，“良好”占 46.9%。分配给每个轨迹组的患者的预测成员概率较高（0.89 至 0.93）。术前的心理、身体健康和心理社会因素决定了可能遵循的轨迹。反应较差的患者具有相对较少的因素，包括术前对疼痛和限制的预期、应对策略以及较低的基线身体健康状况，而反应良好的患者具有一系列临床、心理社会、心理健康和生活质量因素。
我们在接受 TKA 的患者中确定了三种不同的反应轨迹。在控制基线评分、年龄和性别后，疼痛和功能受限的预期、应对策略较差等心理社会因素可区分轨迹组，这表明术前心理社会支持在优化临床结局方面发挥作用。
