Aggarwal Ashwin, Naylor Justine M, Adie Sam, Liu Victor K, Harris Ian A
Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, Faculty of Medicine, UNSW Sydney, Liverpool, New South Wales, Australia.
Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; St George Hospital, New South Wales, Australia.
J Arthroplasty. 2022 Apr;37(4):714-720.e4. doi: 10.1016/j.arth.2021.12.036. Epub 2022 Jan 3.
Although total hip arthroplasty (THA) has been established as a cost-effective intervention, some patients experience ongoing pain and dissatisfaction. There is interest in predicting postoperative outcomes based on preoperative data, but the relative contribution of different preoperative factors is unclear. The study's aim was to develop multivariable prediction models for the assessment of patient-reported outcomes.
Registry data on 1412 patients undergoing THA for osteoarthritis at two hospitals between 2013 and 2018 was used. Potential predictors included age, sex, body mass index, spoken language, education level, previous THA, American Society of Anaesthesiologists (ASA) score, lower back pain, depression/anxiety, other lower limb arthritis, number of other comorbidities, the preoperative expectation of pain and function, EuroQol Visual Analogue Scale (EQ-VAS) and preoperative OHS. Radiographic scores were also used: joint space narrowing (JSN), osteophytes, sclerosis, and an overall grade based on the Kellgren-Lawrence (KL) classification. Outcomes assessed were the patient-rated improvement, satisfaction, and OHS at six months.
JSN or overall KL scores were the most important predictors (P < .001) for all outcomes, with better radiographic scores associated with worse outcomes. Other predictors associated with poorer outcomes were lower back pain and lower expectation (predicting poor improvement), lower education and higher ASA (predicting lower satisfaction) and younger age, female sex, non-English speakers, lower preoperative EQ-VAS, lower education, back pain, and anxiety/depression (predicting lower OHS).
Preoperative radiological scores are an important predictor of patient-reported outcomes at six months postoperatively. Understanding the relative strengths and significance of different factors in predicting outcomes will help the clinician and patient decision-making for THA.
尽管全髋关节置换术（THA）已被确立为一种具有成本效益的干预措施，但一些患者仍持续感到疼痛且不满意。人们有兴趣根据术前数据预测术后结果，但不同术前因素的相对贡献尚不清楚。本研究的目的是开发多变量预测模型以评估患者报告的结果。
使用了2013年至2018年间在两家医院接受THA治疗骨关节炎的1412例患者的登记数据。潜在预测因素包括年龄、性别、体重指数、语言、教育水平、既往THA、美国麻醉医师协会（ASA）评分、下背痛、抑郁/焦虑、其他下肢关节炎、其他合并症数量、术前对疼痛和功能的期望、欧洲五维健康量表视觉模拟评分（EQ-VAS）和术前牛津髋关节评分（OHS）。还使用了放射学评分：关节间隙狭窄（JSN）、骨赘、硬化以及基于凯尔格伦-劳伦斯（KL）分类的总体分级。评估的结果包括患者在六个月时自评的改善情况、满意度和OHS。
JSN或总体KL评分是所有结果的最重要预测因素（P <.001），放射学评分越好，结果越差。与较差结果相关的其他预测因素包括下背痛和较低的期望（预测改善不佳）、较低的教育水平和较高的ASA评分（预测较低的满意度）以及较年轻的年龄、女性、非英语使用者、较低的术前EQ-VAS、较低的教育水平、背痛以及焦虑/抑郁（预测较低的OHS）。
术前放射学评分是患者术后六个月报告结果的重要预测因素。了解不同因素在预测结果中的相对强度和意义将有助于临床医生和患者在THA方面的决策。
