Williams Jonathan, Rucinski Kylee, Stucky Renee, Stannard James P, Crecelius Cory R, Stoker Aaron M, Nuelle Clayton W, Cook James L
Thompson Laboratory for Regenerative Orthopaedics, MU Joint Preservation Center, Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.
J Knee Surg. 2025 Jan;38(1):28-34. doi: 10.1055/s-0044-1790252. Epub 2024 Sep 5.
Emerging evidence suggests that patients' behavioral health may influence outcomes after osteochondral allograft transplantation (OCAT). A comprehensive behavioral health program (BHP) including preoperative screening and education, and postoperative counseling and support, led by a health behavior psychologist was implemented for patients considering OCAT. We hypothesized that patients undergoing knee OCAT and enrolled in the BHP would have a significantly higher 2-year graft survival rate than those not enrolled. Prospectively collected data for patients undergoing knee OCAT enrolled in the lifelong outcomes registry were analyzed. Based on the timing of implementation of a comprehensive BHP to provide preoperative screening and education followed by postoperative counseling and support, BHP and no-BHP cohorts were compared. Treatment failure was defined as the need for either OCAT revision surgery or knee arthroplasty. The Kaplan-Meier method using log-rank tests compared cumulative survival rates. Multivariable Cox regression analysis was used to determine the effects of confounding variables on the influence of BHP enrollment on graft survival. A total of 301 patients were analyzed (no-BHP = 220 and BHP = 81). At 2-year follow-up, a significantly lower cumulative graft survival rate was observed for patients not enrolled in the BHP (68.2 vs. 91.4%; = 0.00347). Adjusting for sex, age, body mass index, tobacco use, tibiofemoral bipolar OCAT type surgery, and nonadherence, patients not enrolled in the BHP were 2.8 times more likely to experience OCAT treatment failure by 2 years after primary OCAT compared with patients in the BHP (95% confidence interval, 1.02-4.98; = 0.01). A comprehensive BHP contributes to significant improvements in 2-year graft survival rates following OCAT in the knee. Preoperative mental and behavioral health screening and support for shared decision-making regarding treatment options, in conjunction with patient and caregiver education and assistance through integrated health care team engagement, are beneficial to patients pursuing complex joint preservation surgeries. Level of evidence is 2, prospective cohort study.
新出现的证据表明，患者的行为健康可能会影响异体骨软骨移植（OCAT）后的治疗结果。对于考虑接受OCAT的患者，实施了一项由健康行为心理学家主导的综合行为健康计划（BHP），该计划包括术前筛查和教育，以及术后咨询和支持。我们假设，接受膝关节OCAT并参加BHP的患者，其2年移植存活率将显著高于未参加者。对前瞻性收集的纳入终身结局登记处的接受膝关节OCAT患者的数据进行了分析。根据实施综合BHP以提供术前筛查和教育，随后进行术后咨询和支持的时间，对BHP组和非BHP组进行了比较。治疗失败定义为需要进行OCAT翻修手术或膝关节置换术。使用对数秩检验的Kaplan-Meier方法比较累积存活率。多变量Cox回归分析用于确定混杂变量对参加BHP对移植存活影响的作用。共分析了301例患者（非BHP组=220例，BHP组=81例）。在2年随访时，未参加BHP的患者累积移植存活率显著较低（68.2%对91.4%；P=0.00347）。在对性别、年龄、体重指数、吸烟情况、胫股双极OCAT类型手术和不依从性进行调整后，与BHP组患者相比，未参加BHP的患者在初次OCAT后2年发生OCAT治疗失败的可能性高2.8倍（95%置信区间，1.02-4.98；P=0.01）。综合BHP有助于显著提高膝关节OCAT后2年的移植存活率。术前进行心理和行为健康筛查以及支持关于治疗选择的共同决策，同时通过综合医疗团队的参与对患者和护理人员进行教育和提供帮助，对寻求复杂关节保留手术的患者有益。证据级别为2级，前瞻性队列研究。
