Yap Y Y W, Edwards K L, Soutakbar H, Fernandes G S, Scammell B E
School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
Centre for Sport Exercise and Osteoarthritis Research Versus Arthritis, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
Osteoarthr Cartil Open. 2021 Feb 22;3(2):100143. doi: 10.1016/j.ocarto.2021.100143. eCollection 2021 Jun.
Total knee replacement (TKR) procedure is commonly carried out in patients with advanced osteoarthritis to reduce pain and increase mobility, with on average 84% rated satisfactory outcome, but some (some suggest 44%) continue to experience debilitating pain. The study aimed to investigate factors affecting pain and function outcomes (using Oxford Knee Score, OKS) one year after TKR, with normative comparison to a reference population.
We recruited TKR patients from one hospital (Nottinghamshire, UK); collected pre- and post-operative OKS; graded radiographs for severity of osteoarthritis (K-L grade) in a sub-group. We also collected OKS by postal survey from the local area, calculated age and sex specific normative scores and z-scores of post-operative OKS (Z-OKS). The associations between K-L grade, pre-operative OKS, age, sex, against change in OKS and Z-OKS were analysed.
There were 536 TKR cases, 91 in radiographic sub-group and 360 people in reference cohort. Post-operative Z-OKS was associated with K-L grade (β = 0.368; p<0.001). Change in OKS was associated with K-L grade (β = 0.247; p = 0.003); pre-operative OKS (β = -0.449; p<0.001); age (β = 0.276; p = 0.001); and female sex protective (β = -0.213; p = 0.008). On average TKR patients returned to 74% of their normative age and sex adjusted OKS, with younger women achieving worst outcomes. More severe radiographic osteoarthritis predicted greater improvement and better post-operative outcome when compared to normative population.
This study identified factors and provided normative OKS data intended to guide clinicians in counselling patients regarding likely surgical outcomes. This could help manage patients' expectations, aid decision making and increase post-surgery satisfaction rate.
全膝关节置换术（TKR）常用于晚期骨关节炎患者，以减轻疼痛并提高活动能力，平均84%的患者对手术结果表示满意，但仍有部分患者（有人认为比例为44%）持续遭受疼痛折磨。本研究旨在调查全膝关节置换术后一年影响疼痛和功能结果（采用牛津膝关节评分，OKS）的因素，并与参考人群进行规范比较。
我们从一家医院（英国诺丁汉郡）招募了全膝关节置换术患者；收集术前和术后的牛津膝关节评分；对一个亚组的骨关节炎严重程度（K-L分级）进行X线片分级。我们还通过邮寄调查收集了当地人群的牛津膝关节评分，计算了年龄和性别特异性的规范评分以及术后牛津膝关节评分的z评分（Z-OKS）。分析了K-L分级、术前牛津膝关节评分、年龄、性别与牛津膝关节评分及Z-OKS变化之间的关联。
共有536例全膝关节置换术病例，91例在X线片子组，360人在参考队列。术后Z-OKS与K-L分级相关（β = 0.368；p<0.001）。牛津膝关节评分的变化与K-L分级相关（β = 0.247；p = 0.003）；术前牛津膝关节评分（β = -0.449；p<0.001）；年龄（β = 0.276；p = 0.001）；女性具有保护作用（β = -0.213；p = 0.008）。全膝关节置换术患者平均恢复到其年龄和性别调整后的牛津膝关节评分的74%，年轻女性的结果最差。与参考人群相比，更严重的X线片骨关节炎预示着更大的改善和更好的术后结果。
本研究确定了相关因素，并提供了规范的牛津膝关节评分数据，旨在指导临床医生向患者咨询可能的手术结果。这有助于管理患者的期望，辅助决策并提高术后满意度。
