膝关节损伤与骨关节炎疗效评分系统用于关节置换术的评分在两年后仍持续改善。

Knee Injury and Osteoarthritis Outcome Score for Joint Replacement Scores Continue to Improve Beyond Two Years.

作者信息

Nwankwo Tobenna N, Strait Alexander V, Parks Nancy L, Fricka Kevin B, Hamilton William G, Sershon Robert A

机构信息

Anderson Orthopaedic Research Institute, Alexandria, Virginia.

Anderson Orthopaedic Research Institute, Alexandria, Virginia; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, Virginia.

出版信息

J Arthroplasty. 2025 May 30. doi: 10.1016/j.arth.2025.05.086.

DOI:10.1016/j.arth.2025.05.086

PMID:40449765

Abstract

BACKGROUND

The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) metric is used to evaluate improvements in stiffness, pain, and function following primary knee arthroplasty. The purpose of this study was to determine when KOOS, JR scores peaked following unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) at our institution.

METHODS

Cross-sectional KOOS, JR responses from 1,818 UKAs and 4,342 TKAs performed between January 2011 and March 2024 were analyzed. A total of 11,057 surveys were collected preoperatively and at 4 weeks, 4 months, and at 1, 2, 5, and 10 years postoperatively. Outcomes included mean KOOS, JR scores at each interval, timing of peak scores, and attainment of clinical thresholds, including minimal clinically important difference, minimal detectable change, patient acceptable symptom state, and substantial clinical benefit.

RESULTS

Statistically significant improvements in KOOS, JR scores were observed through 5-year follow-up for TKA and 2-year follow-up for UKA (P < 0.05). The patient's acceptable symptom state (PASS, ≥ 63.7) was reached earlier after UKA (4 weeks) than after TKA (4 months). Substantial clinical benefits (SCB, +20 points) were achieved by 4 months for TKA (mean score, 71.8 ± 12.8) and at 1 year for UKA (78.9 ± 14.8). Pain with twisting/pivoting, stair use, and morning stiffness showed the greatest improvements from preoperative to peak scores, with favorable outcomes rising 72.2, 72.0, and 63.4% for TKA and 72.2, 69.3, and 60.8% for UKA, respectively. However, these parameters were among the slowest to recover. Morning stiffness reached only 57.4 and 63.2% of its maximum improvement for TKA and UKA, respectively, at 4 months, compared to over 80% for most other survey questions.

CONCLUSIONS

Although recovery is most rapid in the early postoperative period, clinically important improvements in pain and function continue to occur up to 5 years after TKA and 2 years after UKA.

摘要

背景

膝关节置换术的膝关节损伤和骨关节炎疗效评分（KOOS，JR）指标用于评估初次膝关节置换术后僵硬、疼痛和功能的改善情况。本研究的目的是确定在我们机构进行单髁膝关节置换术（UKA）和全膝关节置换术（TKA）后，KOOS，JR评分何时达到峰值。

方法

分析了2011年1月至2024年3月期间进行的1818例UKA和4342例TKA的横断面KOOS，JR反应。共收集了11057份术前及术后4周、4个月、1年、2年、5年和10年的调查问卷。结果包括每个时间间隔的平均KOOS，JR评分、评分峰值出现的时间以及临床阈值的达成情况，包括最小临床重要差异、最小可检测变化、患者可接受症状状态和实质性临床获益。

结果

TKA随访5年、UKA随访2年时，KOOS，JR评分有统计学意义的改善（P < 0.05）。UKA术后（4周）比TKA术后（4个月）更早达到患者可接受症状状态（PASS，≥ 63.7）。TKA术后4个月（平均评分，71.8 ± 12.8）和UKA术后1年（78.9 ± 14.8）实现了实质性临床获益（SCB，+20分）。从术前到评分峰值，扭转/旋转、上下楼梯时的疼痛和晨僵改善最为明显，TKA的良好结果分别上升72.2%、72.0%和63.4%，UKA分别为72.2%、69.3%和60.8%。然而，这些参数是恢复最慢的。与大多数其他调查问卷问题超过80%的情况相比，TKA和UKA的晨僵在4个月时分别仅达到其最大改善的57.4%和63.2%。