King Lauren K, Waugh Esther J, Jones C Allyson, Bohm Eric, Dunbar Michael, Woodhouse Linda, Noseworthy Thomas, Marshall Deborah A, Hawker Gillian A
Medicine, University of Toronto, Toronto, Ontario, Canada.
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
BMJ Open. 2021 Jun 18;11(6):e047061. doi: 10.1136/bmjopen-2020-047061.
To assess the relationship between comorbidities and amount of improvement in pain and physical function in recipients of total knee arthroplasty (TKA) for knee osteoarthritis (OA).
Prospective cohort study.
Two provincial central intake hip and knee centres in Alberta, Canada.
1051 participants (278 in 6-minute walk test (6MWT) subset), ≥30 years of age with primary knee OA referred for consultation regarding elective primary TKA; assessed 1 month prior and 12 months after TKA.
Pre-post TKA change in knee OA pain (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), physical function (Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Short-Form) and 6MWT walking distance; and the reporting of an acceptable symptom state (Patient Acceptable Symptom State (PASS)) at 12 months after TKA.
Mean participant age was 67 years (SD 8.8), 59% were female and 85% reported at least one comorbidity. Individuals with a higher number of comorbidities had worse pre-TKA and post-TKA scores for pain, physical function and 6MWT distance. At 12-month follow-up, mean changes in pain, function and 6MWT distance, and proportion reporting a PASS, were similar for those with and without comorbidities. In multivariable regression analysis, adjusted for potential confounders and clustering by surgeon, no specific comorbidities nor total number of comorbidities were associated with less improvement in pain, physical function or 6MWT distance at 12 months after TKA. Patients with diabetes (OR 0.64, 95% CI 0.44 to 0.94) and a higher number of lower extremity troublesome joints (OR 0.85, 95% CI 0.76 to 0.96) had lower odds of reporting a PASS.
For individuals with knee OA, comorbid conditions do not limit improvement in pain, physical function or walking ability after TKA, and most conditions do not impact achieving an acceptable symptom state.
评估膝骨关节炎（OA）患者接受全膝关节置换术（TKA）后合并症与疼痛及身体功能改善程度之间的关系。
前瞻性队列研究。
加拿大艾伯塔省的两个省级中央髋膝关节收治中心。
1051名参与者（6分钟步行试验（6MWT）亚组中有278名），年龄≥30岁，因择期初次TKA前来咨询的原发性膝OA患者；在TKA术前1个月和术后12个月进行评估。
TKA前后膝OA疼痛（西安大略和麦克马斯特大学骨关节炎指数（WOMAC））、身体功能（膝关节损伤和骨关节炎结局评分（KOOS）身体功能简表）及6MWT步行距离的变化；以及TKA术后12个月时可接受症状状态（患者可接受症状状态（PASS））的报告情况。
参与者的平均年龄为67岁（标准差8.8），59%为女性，85%报告至少有一种合并症。合并症数量较多的个体在TKA术前和术后的疼痛、身体功能及6MWT距离评分较差。在12个月随访时，有合并症和无合并症患者在疼痛、功能及6MWT距离方面的平均变化，以及报告PASS的比例相似。在多变量回归分析中，经潜在混杂因素调整并按外科医生进行聚类分析后，在TKA术后12个月时，没有特定合并症或合并症总数与疼痛、身体功能或6MWT距离改善较少相关。糖尿病患者（比值比0.64，95%置信区间0.44至0.94）和下肢麻烦关节数量较多的患者（比值比0.85，95%置信区间0.76至0.96）报告PASS的几率较低。
对于膝OA患者，合并症并不限制TKA术后疼痛、身体功能或步行能力的改善，且大多数情况不会影响达到可接受的症状状态。
