Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.
Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
Bone Joint J. 2023 Mar 15;105-B(4):365-372. doi: 10.1302/0301-620X.105B4.BJJ-2022-0659.R1.
This study investigates whether primary knee arthroplasty (KA) restores health-related quality of life (HRQoL) to levels expected in the general population. This retrospective case-control study compared HRQoL data from two sources: patients undergoing primary KA in a university-teaching hospital (2013 to 2019), and the Health Survey for England (HSE; 2010 to 2012). Patient-level data from the HSE were used to represent the general population. Propensity score matching was used to balance covariates and facilitate group comparisons. A propensity score was estimated using logistic regression based upon the covariates sex, age, and BMI. Two matched cohorts with 3,029 patients each were obtained for the adjusted analyses (median age 70.3 (interquartile range (IQR) 64 to 77); number of female patients 3,233 (53.4%); median BMI 29.7 kg/m (IQR 26.5 to 33.7)). HRQoL was measured using the three-level version of the EuroQol five-dimension questionnaire (EQ-5D-3L), and summarized using the Index and EuroQol visual analogue scale (EQ-VAS) scores. Patients awaiting KA had significantly lower EQ-5D-3L Index scores than the general population (median 0.620 (IQR 0.16 to 0.69) vs median 0.796 (IQR 0.69 to 1.00); p < 0.001). By one year postoperatively, the median EQ-5D-3L Index score improved significantly in the KA cohort (mean change 0.32 (SD 0.33); p < 0.001), and demonstrated no clinically relevant differences when compared to the general population (median 0.796 (IQR 0.69 to 1.00) vs median 0.796 (IQR 0.69 to 1.00)). Compared to the general population cohort, the postoperative EQ-VAS was significantly higher in the KA cohort (p < 0.001). Subgroup comparisons demonstrated that older age groups had statistically better EQ-VAS scores than matched peers in the general population. Patients awaiting KA for osteoarthritis had significantly poorer HRQoL than the general population. However, within one year of surgery, primary KA restored HRQoL to levels expected for the patient's age-, BMI-, and sex-matched peers.
本研究旨在探讨初次膝关节置换术（KA）是否能恢复与一般人群预期相符的健康相关生活质量（HRQoL）。本回顾性病例对照研究比较了两个来源的 HRQoL 数据：在一所大学教学医院接受初次 KA 的患者（2013 年至 2019 年）和英格兰健康调查（HSE；2010 年至 2012 年）。HSE 的患者水平数据用于代表一般人群。采用倾向评分匹配来平衡协变量并促进组间比较。基于性别、年龄和 BMI 等协变量，使用逻辑回归估计倾向评分。对 3029 例患者进行了调整分析，得到了两个匹配队列（中位年龄 70.3（四分位距 64 至 77）；女性患者 3233 例（53.4%）；中位 BMI 29.7kg/m（四分位距 26.5 至 33.7））。HRQoL 使用 EuroQol 五维问卷（EQ-5D-3L）的三级版本进行测量，并使用指数和 EuroQol 视觉模拟量表（EQ-VAS）评分进行总结。接受 KA 治疗的患者的 EQ-5D-3L 指数评分明显低于一般人群（中位数 0.620（四分位距 0.16 至 0.69）vs 中位数 0.796（四分位距 0.69 至 1.00）；p < 0.001）。术后一年时，KA 组的 EQ-5D-3L 指数评分显著改善（平均变化 0.32（SD 0.33）；p < 0.001），与一般人群相比无临床相关差异（中位数 0.796（四分位距 0.69 至 1.00）vs 中位数 0.796（四分位距 0.69 至 1.00））。与一般人群队列相比，KA 队列的术后 EQ-VAS 明显更高（p < 0.001）。亚组比较表明，年龄较大的组的 EQ-VAS 评分明显优于一般人群中的同龄匹配者。等待 OA 接受 KA 治疗的患者的 HRQoL 明显低于一般人群。然而，在手术一年之内，初次 KA 恢复了与患者年龄、BMI 和性别相匹配的同龄人的 HRQoL。
