Ries M D, Philbin E F, Groff G D, Sheesley K A, Richman J A, Lynch F
The Mary Imogene Bassett Hospital, Cooperstown, New York 13326-1394, USA.
J Bone Joint Surg Am. 1996 Nov;78(11):1696-701. doi: 10.2106/00004623-199611000-00009.
Patients who have osteoarthrosis involving weight-bearing joints typically have a gradual decline in physical activity, which is often associated with cardiovascular deconditioning. After joint replacement, many patients resume routine walking and recreational activities, which may improve aerobic capacity. The purpose of the present study was to determine the effect of total knee arthroplasty on cardiovascular fitness. Nineteen patients who had had total knee arthroplasty (the arthroplasty group) performed an exercise test for cardiovascular fitness preoperatively. Sixteen of these patients were tested again at one year postoperatively and thirteen, at two years postoperatively. Sixteen patients in whom osteoarthrosis of the knee was being treated medically (the control group) were tested at the time of enrollment in the study and one year later. Nine of these patients also were tested two years after enrollment. All of the patients completed the Arthritis Impact-Measurement Scales (AIMS) at each examination. Fitness was assessed by the performance of a progressive maximum exercise test with use of a bicycle ergometer and a metabolic cart. All patients achieved the anaerobic threshold. One year postoperatively, the patients in the arthroplasty group demonstrated an increase, which approached significance, in maximum oxygen consumption (measured in milliliters of oxygen per minute) (p = 0.07), maximum oxygen consumption corrected for body weight (p = 0.08), and percentage of predicted maximum uptake of oxygen (p = 0.06). Two years after the total knee arthroplasty, the patients had a significant improvement with regard to all three parameters (p = 0.008, 0.005, and 0.005, respectively). The patients in the control group demonstrated a significant decrease in duration of exercise and in maximum workload at one year (p = 0.003 and 0.005, respectively) and at two years (p = 0.008 for both parameters). Physical activity had increased in the arthroplasty group but not in the control group, as demonstrated by the results of the Arthritis Impact-Measurement Scales. These findings demonstrate a trend toward improvement in cardiovascular fitness one year after total knee arthroplasty and a significant improvement two years postoperatively for patients who had been able to resume routine functional activities because of the arthroplasty. These improvements compared favorably with the static pattern or the decline in the measures of fitness that were observed in the control group. Our results should be considered preliminary because of the relatively small number of patients who were studied.
患有涉及负重关节骨关节炎的患者通常身体活动会逐渐减少，这往往与心血管功能失调有关。关节置换术后，许多患者恢复了日常步行和娱乐活动，这可能会提高有氧能力。本研究的目的是确定全膝关节置换术对心血管健康的影响。19例接受全膝关节置换术的患者（置换术组）在术前进行了心血管健康运动测试。其中16例患者在术后1年再次接受测试，13例在术后2年接受测试。16例接受膝关节骨关节炎药物治疗的患者（对照组）在研究入组时和1年后接受测试。其中9例患者在入组2年后也接受了测试。所有患者在每次检查时均完成关节炎影响测量量表（AIMS）。通过使用自行车测力计和代谢车进行渐进式最大运动测试来评估健康状况。所有患者均达到无氧阈值。术后1年，置换术组患者的最大耗氧量（以每分钟毫升氧量计）（p = 0.07）、校正体重后的最大耗氧量（p = 0.08）和预测最大摄氧量百分比（p = 0.06）均有增加，接近显著水平。全膝关节置换术后2年，患者在所有三个参数方面均有显著改善（分别为p = 0.008、0.005和0.005）。对照组患者在1年时（分别为p = 0.003和0.005）和2年时（两个参数均为p = 0.008）的运动持续时间和最大工作量均显著下降。关节炎影响测量量表的结果表明，置换术组的身体活动增加，而对照组则没有。这些发现表明，全膝关节置换术后1年心血管健康有改善趋势，对于因置换术能够恢复日常功能活动的患者，术后2年有显著改善。与对照组观察到的健康指标的静态模式或下降相比，这些改善情况良好。由于研究的患者数量相对较少，我们的结果应被视为初步结果。
