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全膝关节和单髁膝关节置换术后活动的预测因素。

Predictors for activity following total and unicompartmental knee arthroplasty.

机构信息

Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA.

Department of Visceral Surgery, University Hospital Bern, Freiburgerstrasse, 3010, Bern, Switzerland.

出版信息

Arch Orthop Trauma Surg. 2023 Nov;143(11):6815-6820. doi: 10.1007/s00402-023-04973-0. Epub 2023 Jul 24.

Abstract

BACKGROUND

Functional demands of patients undergoing knee arthroplasty are increasing. However, it remains unclear which patient-specific factors have an impact on postoperative activity and whether there is a difference between total and unicompartmental knee arthroplasties (TKA/UKA).

MATERIALS AND METHODS

This retrospective study analyzed 1907 knees with TKA (n = 1746) or UKA (n = 161), implanted for primary osteoarthritis. Pain and activity (lower extremity activity scale, LEAS) were assessed 2 years after surgery. High activity was defined as LEAS ≥ 14. Cohorts were compared using Kruskal-Wallis or Pearson-Chi-square test. A generalized least squares model was used to predict LEAS scores between cohorts adjusted for age, sex, BMI, Charlson Comorbidity Index, ASA score, and preoperative LEAS.

RESULT

There was no difference in pain 2 years after surgery between UKA and TKA (p = 0.952). Preoperative LEAS was similar for UKA and TKA (p = 0.994), and both groups showed significant (p < 0.001 respectively) and similar improvements after surgery (p = 0.068). LEAS 2 years after surgery was 11.1 (SD 3.2) for TKA and 11.9 (SD 3.5) for the UKA group (p = 0.004). After adjusting for preoperative LEAS, age, sex, BMI, CCI and ASA, the difference was not significant (p = 0.225). Male sex, lower BMI, higher preoperative LEAS, and younger age were associated with higher postoperative LEAS (p < 0.001, respectively).

CONCLUSION

Patients can achieve a high level of activity following both TKA and UKA. While the postoperative activity level did not depend on the type of the procedure, younger age, male sex, lower BMI, and a higher preoperative activity level were associated with a higher postoperative activity level.

摘要

背景

接受膝关节置换术的患者的功能需求正在增加。然而,目前尚不清楚哪些患者特定因素会影响术后活动,以及全膝关节置换术(TKA)和单髁膝关节置换术(UKA)之间是否存在差异。

材料和方法

本回顾性研究分析了 1907 例接受 TKA(n=1746)或 UKA(n=161)治疗的原发性骨关节炎患者。术后 2 年评估疼痛和活动度(下肢活动量表,LEAS)。高活动度定义为 LEAS≥14。使用 Kruskal-Wallis 或 Pearson-Chi-square 检验比较队列。使用广义最小二乘模型预测调整年龄、性别、BMI、Charlson 合并症指数、ASA 评分和术前 LEAS 后各队列之间的 LEAS 评分。

结果

UKA 和 TKA 术后 2 年疼痛无差异(p=0.952)。UKA 和 TKA 的术前 LEAS 相似(p=0.994),两组术后均有显著改善(p<0.001,p=0.068)。TKA 术后 2 年的 LEAS 为 11.1(SD 3.2),UKA 组为 11.9(SD 3.5)(p=0.004)。调整术前 LEAS、年龄、性别、BMI、CCI 和 ASA 后,差异无统计学意义(p=0.225)。男性、较低的 BMI、较高的术前 LEAS 和较年轻的年龄与较高的术后 LEAS 相关(p<0.001,分别)。

结论

TKA 和 UKA 术后患者均可达到较高的活动水平。虽然术后活动水平与手术类型无关,但年龄较小、男性、BMI 较低、术前活动水平较高与术后活动水平较高相关。

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