Early postoperative predictors of satisfaction following total knee arthroplasty
Early postoperative predictors of satisfaction following total knee arthroplasty
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DOI：
10.1016/j.knee.2013.05.011
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发表时间：
2013-12-01
期刊：
影响因子：
1.9
通讯作者：
Beverland, D. E.
中科院分区：
文献类型：
--
作者：
Williams, D. P.;O'Brien, S.;Beverland, D. E.
背景资料：尽管使用传统结局指标报告了极佳的全膝关节置换术（TKA）结果，但术后报告的不满意率高达30%。虽然一些术前因素已被确定为满意度的可能预测因子，但仍有相互矛盾的证据。因此，在术后早期评估的不满识别可能是一个替代consideration.Methods：我们研究了12个月的满意度之间的关系，并在一个队列的486 TKA患者的术后早期结果。分析了术前和术后3个月和12个月的结局指标（牛津膝关节评分、疼痛评分、SF 12和膝关节活动度），并比较了TKA术后12个月时满意和不满意的患者。计算平均评分和术后评分变化。术后结果与满意度的相关性进行了检查，并使用多变量logistic回归模型来确定潜在的预测unsatisfactors.Results：总体满意度为77.0%。两组之间未观察到术前差异。除3个月SF 12-身体部分（p = 0.052）外，在所有结局指标中，不满意与术后状态恶化相关（p <0.001）。不满意的患者在术后3个月至12个月之间的结局评分显示出最小的进一步改善甚至恶化（p < 0.02）。3个月OKS（OR = 1.15，p < 0.001）和膝关节屈曲（OR = 1.03，p = 0.009）是随后12个月满意度的重要预测因素。结论：TKA术后的不满意与术后3个月的不良结局相关，术后12个月的进一步改善最小。因此，应考虑TKA后的早期术后评估，包括临床评估，以识别存在不满意风险的患者。(C)2013爱思唯尔有限公司版权所有。
Background: Despite the excellent total knee arthroplasty (TKA) results reported using traditional outcome measures, dissatisfaction rates of up to 30% are reported following surgery. Although several preoperative factors have been identified as possible predictors of satisfaction, there is conflicting evidence. Identification of dissatisfaction in the early postoperative assessment may therefore be an alternative consideration.Methods: We examined the relationship between 12-month satisfaction, and early post-operative outcomes in a cohort of 486 TKA patients. Preoperative, and postoperative outcome measures at 3- and 12-months (Oxford knee score, pain score, SF12, and knee motion), were analysed and compared between patients who were satisfied and dissatisfied at 12-months following TKA. Mean scores, and postoperative change in scores were calculated. Postoperative outcomes were examined for correlation with satisfaction, and multivariate logistic regression models used to identify potential predictors of dissatisfaction.Results: Overall satisfaction was 77.0%. No preoperative differences were observed between groups. Dissatisfaction was associated with worse postoperative status across all outcome measures (p < 0.001), except the 3-month SF12-physical component (p = 0.052). Dissatisfied patients demonstrated minimal further improvement or even worsening of outcome scores between 3- and 12-months postoperatively (p < 0.02). Both the 3-month OKS (OR = 1.15, p < 0.001), and knee flexion (OR = 1.03, p = 0.009) were significant predictors of subsequent 12-month satisfaction.Conclusions: Dissatisfaction following TKA is associated with worse outcomes as early as 3 months following surgery, with minimal further improvement subsequently achieved at 12-months. Early postoperative assessment following TKA should therefore be considered, including clinical assessment, to identify those patients at risk of dissatisfaction. (C) 2013 Elsevier B.V. All rights reserved.