患者接受全膝关节置换术的适宜性和良好预后的预测概率。

Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome.

机构信息

Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.

出版信息

RMD Open. 2023 Apr;9(2). doi: 10.1136/rmdopen-2022-002808.

DOI:10.1136/rmdopen-2022-002808

PMID:37068914

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10111922/

Abstract

OBJECTIVES

One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients' preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome.

METHODS

In patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes-yes/no) and expectations (outcomes deemed 'very important'). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios.

RESULTS

Of 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66-0.74). The predicted probability of a good outcome ranged from 44.4% (33.9-55.5) to 92.4% (88.4-95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations.

CONCLUSIONS

Although external validation is required, our findings suggest that incorporation of patients' TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome.

摘要

目的

五分之一的全膝关节置换术（TKA）患者的治疗效果并不理想。在 TKA 评估中纳入患者的偏好可能会改善治疗结果。我们旨在确定术前 TKA 需求、准备/意愿和对 TKA 良好结果的期望的术前测量指标的判别能力。

方法

在患有膝关节骨关节炎（OA）并接受初次 TKA 的患者中，我们在术前评估了 TKA 的需求（西部安大略省麦克马斯特大学骨关节炎指数（WOMAC）疼痛评分和膝关节损伤和骨关节炎结局评分（KOOS）功能、关节炎应对）、健康状况、准备情况（患者可接受的症状状态、抑郁症状）、意愿（明确的是/是/否）和期望（认为“非常重要”的结果）。良好的结果定义为症状改善（符合风湿病和骨关节炎结果研究协会国际（OMERACT-OARSI）应答标准）和 TKA 后 1 年对结果的满意度。使用逻辑回归，我们评估了独立的结果预测因素、模型判别力（接受者操作特征曲线下面积，AUC）以及不同需求、准备/意愿和期望情况下良好结果的预测概率。

结果

在 1053 名 TKA 患者中（平均年龄 66.9 岁（SD 8.8）；58.6%女性），78.1%的患者取得了良好的结果。仅使用 TKA 需求（WOMAC 疼痛子量表、KOOS 物理功能简表），模型判别力较好（AUC 0.67，95%CI 0.63-0.71）。纳入准备/意愿、抑郁症状以及对跪姿、爬楼梯、幸福感和进行娱乐活动的期望改善了判别力（p=0.01；经乐观校正后的 AUC 为 0.70，0.66-0.74）。良好结果的预测概率范围为 44.4%（33.9-55.5）至 92.4%（88.4-95.1），取决于 TKA 需求、准备/意愿、抑郁症状和手术期望的水平。