Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
Stomatology Department, Dingtao District People's Hospital, Heze, China.
Orthop Surg. 2022 Feb;14(2):207-214. doi: 10.1111/os.12807. Epub 2021 Dec 13.
To assess if the educational level of patients in Southwestern China will affect the functional recovery after total knee arthroplasty (TKA).
This retrospective study included a total of 334 patients (48 males, 286 females, with an average age of 68 years, range from 51 to 84 years) who had undergone primary unilateral TKA from March 2017 to April 2018. Patients were screened for enrollment and classified into four groups (illiterate group, the primary school group, high school group, and university group) according to their educational attainment. All patients were monitored for at least 2 years after TKA. The primary outcome was determined using the Hospital for Special Surgery knee (HSS) score at the time of follow-up. The secondary outcomes were determined using the 12-Item Short Form Health Survey (SF-12) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, the satisfaction level, and complications of the surgery.
Three hundred and thirty-four patients were divided into four groups based on their highest educational level: 83 patients in the illiteracy group, 84 in the primary school group, 91 in the high school group, and 76 in the university group. They were followed up for at least 2 years. For the primary outcome, patients with high school and university education had noteworthy better HSS scores on the surgical-side knee than those in the primary school and illiterate groups (illiteracy group 86.71 ± 5.94 vs primary school group 85.36 ± 5.88 vs high school group 89.48 ± 3.66 vs university group 88.95 ± 3.55; P < 0.05). For secondary outcomes, the mental component summary (MCS) in the university group was significantly lower than the other three groups (P < 0.05). The results of WOMAC scores were consistent with the results of the HSS score: patients in the university group and the high school group had better results when compared with the other two groups (P < 0.05). There were no statistical differences in the comparison of additional indicators and complications among the four groups, but more patients (12 peoples, 15.8%) in the university group were dissatisfied with knee function after TKA.
In Southwest China, patients with high school education or above can achieve better joint function after TKA but do not get better postoperative satisfaction, which may be related to the patients' higher surgical expectations for social and mental needs.
评估中国西南部患者的受教育程度是否会影响全膝关节置换术（TKA）后的功能恢复。
本回顾性研究共纳入 334 例（男 48 例，女 286 例，平均年龄 68 岁，51~84 岁）初次单侧 TKA 患者。根据受教育程度将患者分为 4 组（文盲组、小学组、中学组和大学组）。所有患者在 TKA 后至少随访 2 年。主要结局指标为随访时的美国特种外科医院膝关节评分（HSS）。次要结局指标包括 12 项简明健康调查问卷（SF-12）和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分、手术满意度和手术并发症。
根据最高受教育程度，334 例患者分为 4 组：文盲组 83 例，小学组 84 例，中学组 91 例，大学组 76 例。所有患者均至少随访 2 年。主要结局指标显示，接受中学和大学教育的患者在手术侧膝关节的 HSS 评分明显高于小学和文盲组（文盲组 86.71±5.94 比小学组 85.36±5.88 比中学组 89.48±3.66 比大学组 88.95±3.55；P<0.05）。次要结局指标中，大学组的心理成分综合评分（MCS）明显低于其他 3 组（P<0.05）。WOMAC 评分结果与 HSS 评分结果一致：与其他两组相比，大学组和中学组的结果更好（P<0.05）。4 组间其他指标及并发症比较差异无统计学意义，但大学组（12 人，15.8%）对 TKA 后膝关节功能不满意的患者更多。
在中国西南部，接受中学及以上教育的患者 TKA 后关节功能恢复更好，但术后满意度无提高，这可能与患者对社会和精神需求的手术期望较高有关。
