分期双侧全膝关节置换术的 MCID 获得：两个关节是否一样？
MCID achievement in staged bilateral total knee arthroplasty: Are both joints created equal?
机构信息
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Knee. 2024 Oct;50:1-8. doi: 10.1016/j.knee.2024.07.013. Epub 2024 Jul 31.
BACKGROUND
A notable portion of unilateral total knee arthroplasty (TKA) patients undergo arthroplasty of the contralateral knee. The aims of this study were to describe the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in staged bilateral TKAs (BTKAs) and identify factors associated with these outcomes.
METHODS
Patients with staged BTKA were retrospectively reviewed. Demographics, surgery details, and Patient-Reported Outcome Measurement Information System Physical Function Short Form 10a (PROMIS PF10a) were collected. MCID-I and MCID-W were defined for PROMIS PF10a. Patients were stratified into nine groups based on the MCID achievement of the first and second TKA: (A) MCID-I, MCID- I, (B) MCID-I, Neutral, (C) MCID-I, MCID-W, (D) Neutral, MCID-I, (E) Neutral, Neutral, (F) Neutral, MCID-W, (G) MCID- W, MCID-I, (H) MCID-W, Neutral, (I) MCID-W, MCID-W. Neutral patients did not achieve either MCID-I or MCID-W.
RESULTS
The final cohort consisted of 59 staged BTKA patients. In patients who achieved MCID-I in the first TKA, 39.1% achieved MCID-I again in the second TKA (A), 39.1% were neutral (B), and 21.7% achieved MCID-W (C) in the second TKA. However, 77.8% of those who achieved MCID-W in the first joint (n = 9) went on to achieve MCID-I (G) in the second TKA. Those who achieved MCID-I after both TKAs (A) had a longer staged interval than those who achieved first MCID-I, then MCID-W (C) (15 months vs 8 months, P = 0.0113).
CONCLUSION
In staged BTKA, MCID achievement of the first TKA may not be associated with the outcome of the second TKA.
背景
相当一部分单侧全膝关节置换术（TKA）患者会接受对侧膝关节的关节置换术。本研究旨在描述分期双侧全膝关节置换术（BTKA）的改善（MCID-I）和恶化（MCID-W）的最小临床重要差异，并确定与这些结果相关的因素。
方法
回顾性分析分期 BTKA 的患者。收集了人口统计学、手术细节以及患者报告的结局测量信息系统（PROMIS）物理功能 10a 简表（PROMIS PF10a）。为 PROMIS PF10a 定义了 MCID-I 和 MCID-W。根据第一次和第二次 TKA 的 MCID 实现情况，患者分为 9 组：（A）MCID-I，MCID-I；（B）MCID-I，中性；（C）MCID-I，MCID-W；（D）中性，MCID-I；（E）中性，中性；（F）中性，MCID-W；（G）MCID-W，MCID-I；（H）MCID-W，中性；（I）MCID-W，MCID-W。中性患者既未达到 MCID-I 也未达到 MCID-W。
结果
最终队列包括 59 例分期 BTKA 患者。在第一次 TKA 中达到 MCID-I 的患者中，39.1%在第二次 TKA 中再次达到 MCID-I（A），39.1%为中性（B），21.7%在第二次 TKA 中达到 MCID-W（C）。然而，在第一次关节达到 MCID-W 的 9 例患者中，77.8%在第二次 TKA 中达到 MCID-I（G）。在两次 TKA 中均达到 MCID-I（A）的患者，分期间隔时间长于第一次达到 MCID-I，然后达到 MCID-W（C）的患者（15 个月 vs 8 个月，P=0.0113）。
结论
在分期 BTKA 中，第一次 TKA 的 MCID 实现情况可能与第二次 TKA 的结果无关。
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