Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, 94025, USA.
Stanford University, 450 Broadway Street, M/C 6342 Pavilion C, 4th Floor, Room 402, Redwood City, CA, 94305, USA.
BMC Musculoskelet Disord. 2024 Jun 17;25(1):473. doi: 10.1186/s12891-024-07580-1.
Both length of hospital stay and discharge to a skilled nursing facility are key drivers of total knee arthroplasty (TKA)-associated spending. Identifying patients who require increased postoperative care may improve expectation setting, discharge planning, and cost reduction. Balance deficits affect patients undergoing TKA and are critical to recovery. We aimed to assess whether a device that measures preoperative balance predicts patients' rehabilitation needs and outcomes after TKA.
40 patients indicated for primary TKA were prospectively enrolled and followed for 12 months. Demographics, KOOS-JR, and PROMIS data were collected at baseline, 3-months, and 12-months. Single-leg balance and sway velocity were assessed preoperatively with a force plate (Sparta Science, Menlo Park, CA). The primary outcome was patients' discharge facility (home versus skilled nursing facility). Secondary outcomes included length of hospital stay, KOOS-JR scores, and PROMIS scores.
The mean preoperative sway velocity for the operative leg was 5.7 ± 2.7 cm/s, which did not differ from that of the non-operative leg (5.7 ± 2.6 cm/s, p = 1.00). Five patients (13%) were discharged to a skilled nursing facility and the mean length of hospital stay was 2.8 ± 1.5 days. Sway velocity was not associated with discharge to a skilled nursing facility (odds ratio, OR = 0.82, 95% CI = 0.27-2.11, p = 0.690) or longer length of hospital stay (b = -0.03, SE = 0.10, p = 0.738). An increased sway velocity was associated with change in PROMIS items from baseline to 3 months for global07 ("How would you rate your pain on average?" b = 1.17, SE = 0.46, p = 0.015) and pain21 ("What is your level of pain right now?" b = 0.39, SE = 0.17, p = 0.025) at 3-months.
Preoperative balance deficits were associated with postoperative improvements in pain and function after TKA, but a balance focused biometric that measured single-leg sway preoperatively did not predict discharge to a skilled nursing facility or length of hospital stay after TKA making their routine measurement cost-ineffective.
住院时间和出院到熟练护理机构都是全膝关节置换术（TKA）相关支出的主要驱动因素。确定需要增加术后护理的患者可以改善预期设定、出院计划和降低成本。平衡缺陷会影响接受 TKA 的患者，并且对康复至关重要。我们旨在评估一种测量术前平衡的设备是否可以预测 TKA 后患者的康复需求和结果。
前瞻性纳入 40 名接受初次 TKA 的患者，并随访 12 个月。在基线、3 个月和 12 个月时收集人口统计学、KOOS-JR 和 PROMIS 数据。使用力板（Sparta Science，Menlo Park，CA）术前评估单腿平衡和摆动速度。主要结局是患者的出院机构（家庭与熟练护理机构）。次要结局包括住院时间、KOOS-JR 评分和 PROMIS 评分。
手术腿的术前平均摆动速度为 5.7 ± 2.7 cm/s，与非手术腿（5.7 ± 2.6 cm/s，p = 1.00）无差异。5 名患者（13%）出院到熟练护理机构，平均住院时间为 2.8 ± 1.5 天。摆动速度与出院到熟练护理机构无关（优势比，OR = 0.82，95%CI = 0.27-2.11，p = 0.690）或住院时间更长（b = -0.03，SE = 0.10，p = 0.738）。摆动速度增加与从基线到 3 个月时 PROMIS 项目的变化相关，包括全球 07 项（“您平均疼痛程度如何？”b = 1.17，SE = 0.46，p = 0.015）和疼痛 21 项（“您现在的疼痛程度如何？”b = 0.39，SE = 0.17，p = 0.025）。
术前平衡缺陷与 TKA 后疼痛和功能的术后改善相关，但术前测量单腿摆动的以平衡为重点的生物计量学指标并未预测 TKA 后的熟练护理机构出院或住院时间，因此其常规测量不具有成本效益。
