Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years
Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years
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DOI：
10.1007/s10067-019-04811-y
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发表时间：
2019-11-13
影响因子：
3.4
通讯作者：
Reginster, Jean-Yves
中科院分区：
文献类型：
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作者：
Neuprez, Audrey;Neuprez, Arnaud Henri;Reginster, Jean-Yves
目的：研究并确定下肢骨关节炎（OA）患者在关节置换手术后存活5年对疼痛、功能和生活质量影响的决定因素。
方法：来自一所大学医院的626例骨关节炎患者，按手术部位分为两组，在髋关节（n = 346）或膝关节（n = 280）置换后进行了为期5年的前瞻性随访。在手术前及术后每年使用经过验证的西安大略和麦克马斯特大学关节炎指数（WOMAC）特异性量表以及评估生活质量的通用量表（SF - 36和EQ）。我们将WOMAC临床相关改善大于或等于最小重要差异（MID）定义为良好结局。回归分析显示了术前、围手术期和术后指标与5年后WOMAC评分变化（百分比变化）之间的关系。我们还检验了良好结局的预测因素。
结果：髋关节和膝关节置换术（HA和KA）后第一年观察到的对生活质量的有益影响可维持长达5年。我们研究中超过3/4的患者有良好结局（HA组为86.04%，KA组为79.91%）。两组中，良好结局和WOMAC 5年变化都可由术前（即放射学严重程度、合并症、残疾和教育水平）、围手术期（即住院时间和出院地点）和术后（即并发症）变量预测。
结论：对于对药物治疗无反应的髋关节或膝关节OA患者，关节置换术是一种非常有价值的治疗策略。这些结果是朝着收集可靠、科学合理的数据迈出的一步，这将有助于完成OA领域的卫生经济学分析。
Objectives To study and identify the determinants of the impact on pain, function, and quality of life of a prosthetic replacement surgery after 5 years of survival in patients with osteoarthritis (OA) of the lower limb. Method In total, 626 osteoarthritic patients from a University Hospital, divided in 2 groups (according to surgical site), were prospectively followed for 5 years after hip (n = 346) or knee (n = 280) replacement. Validated specific Western Ontario and McMaster Universities Arthritis Index (WOMAC) and generic (SF-36 and EQ) instruments assessing quality of life were used prior to surgery and yearly, thereafter. We defined a good outcome as a clinically relevant improvement in WOMAC greater than or equal to the minimally important difference (MID). Regressions showed the relationships among preoperative, perioperative, and postoperative measures and the evolution of WOMAC scores after 5 years (percent change). We also examined any predictors of good outcomes. Results The beneficial effect on quality of life observed during the first year after hip and knee arthroplasty (HA and KA) was maintained for up to 5 years. More than 3/4 of the patients in our study experienced a good outcome (86.04% in HA group and 79.91% in KA group). Both the good outcome and the 5-year change in WOMAC are predicted by preoperative (i.e., radiological severity, comorbidities, disability, and level of education), perioperative (i.e., length of hospital stay and place of discharge), and postoperative (i.e., complications) variables in the two groups. Conclusions Joint arthroplasty is a highly valuable therapeutic strategy for hip or knee OA patients who do not respond to pharmacological management. These results represent a step towards the collection of robust, scientifically sound data that will facilitate the completion of health economic analyses in the field of OA.