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Contralateral knee pain reduces the rate of patient satisfaction but does not clinically impair the change in WOMAC score after total knee arthroplasty.

对侧膝关节疼痛降低了患者满意率,但在临床上不损害全膝关节置换术后WOMAC评分的变化。

  • 影响因子:0
  • DOI:10.1302/0301-620X.102B1.BJJ-2019-0328.R1
  • 作者列表:"Clement ND","Weir DJ","Holland J","Deehan DJ
  • 发表时间:2020-01-01
Abstract

AIMS:The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences patient satisfaction with their TKA. METHODS:A retrospective cohort of 3,178 primary TKA patients were identified from an arthroplasty database. Patient characteristics, comorbidities, and WOMAC scores were collected preoperatively and one year postoperatively for the index knee. In addition, WOMAC pain scores were also collected for the contralateral knee. Overall patient satisfaction was assessed at one year. Preoperative contralateral knee pain was defined according to the WOMAC score: minimal (> 78 points), mild (59 to 78), moderate (44 to 58), and severe (< 44). Multivariate regression analysis was used to adjust for confounding. RESULTS:According to severity there were 1,425 patients (44.8%) with minimal, 710 (22.3%) with mild, 518 (16.3%) with moderate, and 525 (16.5%) with severe pain in the contralateral knee. Patients in the severe group had a greater clinically significant improvement in their functional WOMAC score (9.8 points; p < 0.001). Only patients in the moderate (22.9 points) and severe (37.8 points) groups had a clinically significant improvement in their contralateral knee pain (p < 0.001), but they were significantly less likely to be satisfied with their TKA (moderate: odds ratio (OR) 0.64, 95% confidence interval (CI) 0.4 to 0.92, p = 0.022; severe: OR 0.57, 95% CI 0.39 to 0.82, p = 0.002). CONCLUSION:Contralateral knee pain did not impair improvement in the WOMAC score after TKA, and patients with the most severe contralateral knee pain had a clinically significantly greater improvement in their functional outcome. More than half the patients presenting for TKA had mild-to-severe contralateral knee pain, most of whom had a clinically meaningful improvement but were significantly less likely to be satisfied with their TKA. Cite this article: Bone Joint J. 2020;102-B(1):125-131.

摘要

目的: 本研究的主要目的是评估对侧膝关节疼痛是否对全膝关节置换术 (TKA) 的结果有临床意义的影响。根据西安大略和麦克马斯特大学骨关节炎指数 (WOMAC) 评分。次要目的是: 描述对侧膝关节疼痛的患病率; 确定TKA后临床是否改善; 并评估对侧膝关节疼痛是否独立影响患者对其TKA的满意度。 方法: 从关节成形术数据库中确定了 3,178 例原发性TKA患者的回顾性队列。收集术前和术后 1 年的指数膝关节的患者特征、合并症和WOMAC评分。此外,还收集了对侧膝关节的WOMAC疼痛评分。在一年时评估患者的总体满意度。术前对侧膝关节疼痛根据WOMAC评分定义: 最小 (> 78 分) 、轻度 (59 ~ 78 分) 、中度 (44 ~ 58 分) 和重度 (< 44 分)。采用多元回归分析调整混杂因素。 结果: 根据严重程度,1,425 例患者 (44.8%) 轻微,710 例 (22.3%) 轻度,518 例 (16.3%) 中度,525 例 (16.5%) 对侧膝关节剧烈疼痛。重症组患者的功能性WOMAC评分有更大的临床显著改善 (9.8 分; p <0.001)。只有中度 (22.9 分) 和重度 (37.8 分) 组的患者对侧膝关节疼痛有临床显著改善 (p <0.001),但他们对TKA的满意度明显降低 (中度: 比值比 (OR) 0.64,95% 置信区间 (CI))0.4 ~ 0.92,p = 0.022; 重度: OR 0.57,95% CI 0.39 ~ 0.82,p = 0.002)。 结论: 对侧膝关节疼痛不影响TKA后WOMAC评分的改善,对侧膝关节疼痛最严重的患者在临床上其功能结局有更大的改善。超过一半的TKA患者有轻度至重度对侧膝关节疼痛,其中大多数患者有临床意义的改善,但对其TKA的满意度明显降低。引用本文: 骨关节J.2020;1 02-B(1):1 25-1 3 1.

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发表时间:2020-01-01
DOI:10.1002/acr.23824
作者列表:["Chen SK","Liao KP","Liu J","Kim SC"]

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DOI:10.1002/acr.23827
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