Brown Marcel G, Ogunsola Ayobami S, Gwilt Matthew S, Brady Davis, Granados Leslie, Shields John S, Ma Xue
Atrium Health Wake Forest Baptist, Department of Orthopaedic Surgery and Rehabilitation, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
Wake Forest University School of Medicine, Winston-Salem, USA.
Arch Orthop Trauma Surg. 2025 Apr 19;145(1):255. doi: 10.1007/s00402-025-05867-z.
Total Knee Arthroplasty (TKA) is the primary definitive treatment for knee osteoarthritis (OA) and has been essential in helping patients reduce knee pain and regain mobility. There is a need to assess whether various factors such as surgical complications from primary TKA, pre and postoperative range of motion (ROM), Charlson Comorbidity Index (CCI), comorbidities other than CCI, and demographics representative of an outpatient TKA population affect patient-reported outcome measures (PROMs).
Retrospective chart review was performed on 444 patients who underwent TKA at an outpatient surgical facility. Demographics, qualitative, and quantitative measurements were collected at baseline, 4-6 months, and 1-year postoperatively. Patients were stratified by CCI into low (< 2), moderate (2-4), and high (> 4) risk categories. A generalized linear model was used to assess the relationship between time, complications, risk categories, and Knee injury and Osteoarthritis Outcome Score Joint Replacement (KOOS, JR).
Majority of patients were women (58.9%), non-Hispanic white (81.9%), categorized as moderate risk CCI (78.8%), with 22.5% experiencing complications post-TKA. KOOS, JR scores improved over time, with an increase of 18.1 points at 4-6 months and 26.1 points at 1-year post-TKA (p < 0.0001). Surgical complications were linked to a decrease of 3.5 points in KOOS, JR scores, whereas patients with high pre-TKA KOOS, JR scores had an increase of 6.4 points after surgery. Patients who identified as African American experienced an average of 4.7 points lower on KOOS, JR than non-Hispanic whites (p = 0.0211). High-risk patients (CCI > 4) on average, had higher KOOS, JR scores 12 months after TKA. African Americans and those with surgical complications reported Lower KOOS, JR scores.
TKA improved KOOS, JR scores through one year with the greatest improvement in PROM being in higher-risk patients, those without surgical complications. Patients with surgical complications and/or African American race had a lower average KOOS, JR score.
全膝关节置换术（TKA）是膝关节骨关节炎（OA）的主要确定性治疗方法，对于帮助患者减轻膝关节疼痛和恢复活动能力至关重要。有必要评估诸如初次TKA的手术并发症、术前和术后活动范围（ROM）、查尔森合并症指数（CCI）、除CCI之外的合并症以及代表门诊TKA人群的人口统计学特征等各种因素是否会影响患者报告的结局指标（PROMs）。
对在一家门诊手术机构接受TKA的444例患者进行回顾性病历审查。在基线、术后4 - 6个月和1年收集人口统计学、定性和定量测量数据。患者根据CCI分为低风险（<2）、中度风险（2 - 4）和高风险（>4）类别。使用广义线性模型评估时间、并发症、风险类别与膝关节损伤和骨关节炎结局评分关节置换（KOOS，JR）之间的关系。
大多数患者为女性（58.9%），非西班牙裔白人（81.9%），归类为中度风险CCI（78.8%），22.5%的患者在TKA术后出现并发症。KOOS，JR评分随时间改善，TKA术后4 - 6个月增加18.1分，1年时增加26.1分（p < 0.0001）。手术并发症与KOOS，JR评分降低3.5分相关，而术前KOOS，JR评分高的患者术后增加6.4分。自我认定为非裔美国人的患者在KOOS，JR上的得分平均比非西班牙裔白人低4.7分（p = 0.0211）。高风险患者（CCI > 4）在TKA术后12个月时平均有更高的KOOS，JR评分。非裔美国人和有手术并发症的患者报告的KOOS，JR评分较低。
TKA在一年内改善了KOOS，JR评分，PROM改善最大的是高风险患者以及无手术并发症的患者。有手术并发症的患者和/或非裔美国种族的患者平均KOOS，JR评分较低。
