Which Patients Are Most Likely to Benefit From Total Joint Arthroplasty?
Which Patients Are Most Likely to Benefit From Total Joint Arthroplasty?
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DOI：
10.1002/art.37901
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发表时间：
2013-05-01
影响因子：
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通讯作者：
Sale, Joanna E. M.
中科院分区：
文献类型：
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作者：
Hawker, Gillian A.;Badley, Elizabeth M.;Sale, Joanna E. M.
目的评价全关节置换术(TJA)术后患者预后良好的预测因素。方法收集1996-1998年间55岁的髋膝关节炎(骨关节炎或炎症性关节炎)患者作为研究对象，每年使用西安大略大学和麦克马斯特大学的骨关节炎指数(WOMAC)评估其人口学特征、关节问题、健康状况和整体髋膝关节炎的严重程度。调查数据与行政数据库相联系，以确定主要的TJA。良好结果被定义为WOMAC总分的改善大于或等于最小重要差异(MID；平均变化的0.5SD)。用Logistic回归和Akaike的信息准则来确定预测因子的最佳数量和该大小的最佳模型。采用对数泊松回归分析预后良好的相对危险度(RR)。结果202例患者中，平均年龄71.0岁；女性占79.7%；髋关节/膝关节问题1例，占82.7%；膝关节置换占65.8%。WOMAC总分平均改善10.2分(SD 18.05，中位数9分)。在这些患者中，53.5%的患者预后良好。四个预测因子是最优的。最好的4变量模型包括TJA前的WOMAC、共病、麻烦的髋膝数目和关节炎类型(C统计0.80)。较差(较高)的TJA前WOMAC总分(每增加10分调整RR1.32；P<；0.0001)、麻烦较少的髋关节/膝盖(每关节调整RR0.82；P=0.002)、OA(类风湿性关节炎的调整RRvs.OA0.33；P=0.009)和较少的合并症(调整后RR0.88；P=0.01)，好结果的可能性更大。结论：在具有多个麻烦关节和共病的高患病率的骨性关节炎队列中，只有一半的患者获得了良好的TJA结果，定义为疼痛和残疾的改善。有必要对TJA的好处和风险进行更全面的评估。
Objective To evaluate patient predictors of good outcome following total joint arthroplasty (TJA). Methods A population cohort with hip/knee arthritis (osteoarthritis [OA] or inflammatory arthritis) ages 55 years was recruited between 1996 and 1998 (baseline) and assessed annually for demographics, troublesome joints, health status, and overall hip/knee arthritis severity using the Western Ontario and McMaster Universities OA Index (WOMAC). Survey data were linked with administrative databases to identify primary TJAs. Good outcome was defined as an improvement in WOMAC summary score greater than or equal to the minimal important difference (MID; 0.5 SD of the mean change). Logistic regression and Akaike's information criterion were used to determine the optimal number of predictors and the best model of that size. Log Poisson regression was used to determine the relative risk (RR) for a good outcome. Results Primary TJA was performed in 202 patients (mean age 71.0 years; 79.7% female; 82.7% with >1 troublesome hip/knee; 65.8% knee replacements). Mean improvement in WOMAC summary score was 10.2 points (SD 18.05; MID 9 points). Of these patients, 53.5% experienced a good outcome. Four predictors were optimal. The best 4-variable model included pre-TJA WOMAC, comorbidity, number of troublesome hips/knees, and arthritis type (C statistic 0.80). The probability of a good outcome was greater with worse (higher) pre-TJA WOMAC summary scores (adjusted RR 1.32 per 10-point increase; P < 0.0001), fewer troublesome hips/knees (adjusted RR 0.82 per joint; P = 0.002), OA (adjusted RR for rheumatoid arthritis versus OA 0.33; P = 0.009), and fewer comorbidities (adjusted RR per condition 0.88; P = 0.01). Conclusion In an OA cohort with a high prevalence of multiple troublesome joints and comorbidity, only half achieved a good TJA outcome, defined as improved pain and disability. A more comprehensive assessment of the benefits and risks of TJA is warranted.