Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Center, 6-10-1 Shiraniwadai, Ikoma-City, Nara, 630-0136, Japan.
Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka-City, Osaka, 545-8585, Japan.
Eur J Orthop Surg Traumatol. 2024 Dec;34(8):4009-4017. doi: 10.1007/s00590-024-04097-0. Epub 2024 Sep 20.
Total knee arthroplasty (TKA) has consistently demonstrated lower patient satisfaction compared to total hip arthroplasty (THA). However, prior investigations failed to account for the patients' demographic characteristics. This study aimed to conduct a comparative analysis of patient-reported outcomes between TKA and THA while adjusting for patient background.
A total of 326 primary TKAs and 259 THAs conducted at a single center were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores preoperatively and at 3 months, 1 year, and 2 years postoperatively. Notably, TKA patients exhibited advanced age and higher body mass index (BMI) than their THA counterparts. To mitigate the impact of these differences, we employed propensity score-matched data, adjusting for background characteristics such as age, gender, BMI, and diagnosis.
THA consistently demonstrated significantly superior WOMAC total, pain, and stiffness scores compared to TKA at 3 months, 1 year, and 2 years postoperatively. Nevertheless, no statistically significant disparity in WOMAC physical function scores was observed between the two groups at 3 months and 1 year postoperatively in the matched data (3 months, p = 0.131; 1 year, p = 0.269).
In contrast to earlier findings, our analysis of propensity score-matched data revealed no significant differences in WOMAC physical function scores between the TKA and THA groups at 3 months and 1 year postoperatively. The distinctive background factors observed in patients undergoing TKA and THA, notably advanced age and higher BMI, coupled with the delayed improvement timeline in TKA's WOMAC scores compared to that of THA, have the potential to impact patient-reported outcomes. Consequently, clinicians should be mindful of the potential impact of patient background on variations in patient-reported outcome measures following total joint arthroplasty.
与全髋关节置换术（THA）相比，全膝关节置换术（TKA）的患者满意度一直较低。然而，先前的研究未能考虑患者的人口统计学特征。本研究旨在对 TKA 和 THA 患者报告的结果进行比较分析，同时调整患者背景。
在一家单中心，对 326 例初次 TKA 和 259 例 THA 患者进行了评估，使用 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）评分在术前以及术后 3 个月、1 年和 2 年进行评估。值得注意的是，TKA 患者的年龄比 THA 患者大，体重指数（BMI）也更高。为了减轻这些差异的影响，我们使用了倾向评分匹配数据，根据年龄、性别、BMI 和诊断等背景特征进行了调整。
THA 在术后 3 个月、1 年和 2 年时，WOMAC 总评分、疼痛评分和僵硬评分始终显著优于 TKA。然而，在匹配数据中，两组在术后 3 个月和 1 年时的 WOMAC 躯体功能评分没有统计学上的显著差异（3 个月时，p=0.131；1 年时，p=0.269）。
与早期研究结果相反，我们对倾向评分匹配数据的分析显示，在术后 3 个月和 1 年时，TKA 和 THA 两组的 WOMAC 躯体功能评分没有显著差异。TKA 和 THA 患者的背景因素存在显著差异，特别是年龄较大和 BMI 较高，再加上 TKA 的 WOMAC 评分改善时间比 THA 晚，这些因素可能会影响患者报告的结果。因此，临床医生应该注意患者背景对全关节置换术后患者报告结局测量结果变化的潜在影响。
