Kronikgune Institute for Health Services Research, Barakaldo, Spain.
Osakidetza Basque Health Service, Research Unit, Basurto University Hospital, Bilbao, Spain.
BMC Musculoskelet Disord. 2023 Apr 25;24(1):327. doi: 10.1186/s12891-023-06399-6.
To analyze evolution and factors related with greater gains in Health Related Quality of Life (HRQOL) and with a greater probability of exceed their corresponding minimal clinically important differences (MCID) in patients with Osteoarthritis of the knee, undergoing total knee arthroplasty (TKA) at long-term.
Data were obtained from two previously recruited multicenter cohorts of patients who underwent TKA in the Basque Country. Patients were follow-up at 6 months and 10 years after surgery. Patients completed specific and generic HRQOL questionnaires plus sociodemographic, and clinical data at 10 years. Associations were analysed using linear and logistic regression models.
A total of 471 patients responded at 10-year follow-up. The multivariable analysis showed that low preoperative HRQOL scores, higher age, higher BMI, some comorbidities and readmissions at 6 months were associated with less gains in HRQOL. Apart from aforementioned, to have a peripheral vascular disease (odd ratio 0.49 (95% CI, 0.24-0.99)), complications (odd ratio 0.31 (95% CI, 0.11-0.91)), and readmissions within 6 months of discharge (odd ratio 2.12 (95% CI, 1.18-3.80)) were associated with a lower probability of exceeding the MCID. The effect sizes (ESs) of changes from baseline to 6 months (range, 1.20-1.96) and to 10 years (range, 1.54-1.99) were large in all dimensions, nevertheless the ESs from 6 months to 10 years were not appreciable for pain (ES = 0.03) or stiffness (ES = 0.09), and small for function (ES = 0.30).
Low preoperative HRQOL scores, to be elderly, severe obesity, the presence of some comorbidities -depression and rheumatology disease-, having readmissions or complications and not having rehabilitation of discharge, are good predictors of long-term lower gains in HRQOL. Some other non-registered parameters of the follow-up may also influence those outcomes.
KEY INDEXING TERMS (MESH TERMS): Health-Related Quality of Life, Knee Arthroplasty, Total, Osteoarthritis.
分析膝关节骨关节炎患者行全膝关节置换术（TKA）后长期健康相关生活质量（HRQOL）的变化，并探讨与更大程度获益及更大概率超过相应最小临床重要差异（MCID）相关的因素。
数据来自巴斯克地区两个之前招募的多中心 TKA 患者队列。患者在术后 6 个月和 10 年进行随访。患者在 10 年时完成特定和通用的 HRQOL 问卷以及社会人口学和临床数据。使用线性和逻辑回归模型分析相关性。
共 471 名患者在 10 年随访时做出回应。多变量分析显示，术前 HRQOL 评分较低、年龄较大、BMI 较高、合并某些疾病和术后 6 个月内再入院与 HRQOL 获益较少相关。除此之外，患有外周血管疾病（比值比 0.49（95%可信区间，0.24-0.99））、并发症（比值比 0.31（95%可信区间，0.11-0.91））和出院后 6 个月内再入院（比值比 2.12（95%可信区间，1.18-3.80））与更大概率未超过 MCID 相关。从基线到 6 个月（范围，1.20-1.96）和 10 年（范围，1.54-1.99）的变化效应量（ES）在所有维度上均较大，但 6 个月到 10 年的 ES 在疼痛（ES=0.03）或僵硬（ES=0.09）方面不明显，而在功能方面（ES=0.30）则较小。
术前 HRQOL 评分较低、年龄较大、严重肥胖、合并某些疾病（抑郁和风湿病）、再入院或并发症以及未进行出院后的康复治疗是长期 HRQOL 获益较低的良好预测因素。随访中其他一些未记录的参数也可能影响这些结果。
关键词（MeSH 主题词）：生活质量，膝关节，人工，骨关节炎。
