Hoelen Thomáy-Claire Ayala, Schotanus Martijn, van Kuijk Sander, Bastiaenen Caroline, Boonen Bert, Most Jasper
Dept Orthopedic Surgery, CAPHRI, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Dept Orthopedics and Traumatology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6161 BG, Sittard, the Netherlands.
J Orthop. 2023 Mar 22;39:11-17. doi: 10.1016/j.jor.2023.03.011. eCollection 2023 May.
To determine whether there was a relation between socioeconomic status (SES) and patient symptoms before and one year after total knee arthroplasty (TKA), and/or total hip arthroplasty (THA) and whether a change in symptoms was clinically relevant.
A secondary analysis of a prospective cohort study was conducted on SES and osteoarthritis symptoms of patients (≥45 years old) who received a primary TKA or THA between 2016 and 2018. The relation between SES and respectively pre- and postoperative and change in patient-reported outcome measures including the Oxford Knee Score (OKS), Oxford Hip Score (OHS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), the visual analog scale (VAS) for pain and the EuroQol 5-Dimensions (EQ-5D) were assessed using linear mixed-effects regression models adjusted for age and sex. The following potential confounding variables were considered in the regression models: body mass index (BMI), American Society of Anesthesiologists (ASA)- classification, Charnley-classification, smoking status, and alcohol consumption.
Patients with lower SES were mostly female, had a higher BMI and ASA-classification compared to patients with a higher SES. Patients with lower SES reported lower OKS (β = 3.78, P = 0.001). Patients undergoing THA reported lower scores for the OHS (β = 4.78, P = 0.001), WOMAC (β = 11.7, P = 0.001), and less pain (VAS, β = -0.91, P = 0.001). No statistically significant differences between SES groups were seen in the quality of life and health status as measured with the EQ-5D.
Patients with a lower socioeconomic status reported worse symptoms and showed less clinically relevant improvement at one-year follow-up.
确定社会经济地位（SES）与全膝关节置换术（TKA）和/或全髋关节置换术（THA）术前及术后一年患者症状之间是否存在关联，以及症状变化是否具有临床相关性。
对2016年至2018年间接受初次TKA或THA的患者（≥45岁）的SES和骨关节炎症状进行了一项前瞻性队列研究的二次分析。使用针对年龄和性别进行调整的线性混合效应回归模型，评估SES与患者报告的结局指标（包括牛津膝关节评分（OKS）、牛津髋关节评分（OHS）、西安大略和麦克马斯特大学关节炎指数（WOMAC）、疼痛视觉模拟量表（VAS）和欧洲五维健康量表（EQ-5D））术前、术后及变化之间的关系。回归模型中考虑了以下潜在混杂变量：体重指数（BMI）、美国麻醉医师协会（ASA）分级、Charnley分级、吸烟状况和饮酒情况。
与SES较高的患者相比，SES较低的患者大多为女性，BMI和ASA分级更高。SES较低的患者报告的OKS较低（β = 3.78，P = 0.001）。接受THA的患者报告的OHS较低（β = 4.78，P = 0.001）、WOMAC较低（β = 11.7，P = 0.001），疼痛较轻（VAS，β = -0.91，P = 0.001）。用EQ-5D衡量的生活质量和健康状况在SES组之间未观察到统计学上的显著差异。
社会经济地位较低的患者报告的症状较差，且在一年随访时临床相关改善较少。
