Functional Outcomes After Total Knee Arthroplasty Correlate With Spine Disability
Functional Outcomes After Total Knee Arthroplasty Correlate With Spine Disability
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DOI：
10.1016/j.arth.2016.06.015
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发表时间：
2016-09-01
影响因子：
3.5
通讯作者：
Reedy, Mary E.
中科院分区：
文献类型：
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作者：
Schroer, William C.;Diesfeld, Paul J.;Reedy, Mary E.
背景：尽管全膝关节置换术 (TKA) 后大多数患者的疼痛得到缓解，但约 20% 的患者仍然存在功能不良，并且常常与患者不满意有关。腰椎问题是功能障碍的主要原因。本研究旨在确定较低的膝关节功能评分与脊柱残疾史之间的关联。方法：收集了 2010 年 7 月至 2012 年 7 月期间 1156 个连续 TKA 的前瞻性人口统计、健康状况和膝关节特异性数据。从 691 个膝关节中获得了脊柱调查问卷和 Oswestry 残疾指数 (ODI) 评分。结果：在 691 名患者中，371 名 TKA 患者每天出现背痛或背痛有限活动。与无背部问题的患者相比，术前 (36.9/34.8；P = .0006) 和术后 (20.2/17.0；P < .0001) 的牛津膝评分显着较差，但没有改善 (16.7/17.8；P = .10)。无论脊柱病史如何，膝关节协会 (KS) 疼痛评分相似。与无背部问题的患者相比，有背部问题的患者术前 (42.3/47.0；P = .0005)、术后 (69.0/79.8；P < .0001) 和改善 (25.8/32.9；P < .0001) 的 KS 功能评分较低。较低的 KS 功能与女性性别、年龄、健康状况、术前功能和 ODI 相关。 ODI 与牛津膝关节评分 (R = 0.57) 和 KS 功能评分 (R = 0.54) 相关。结论：有背部问题病史的患者膝关节功能评分明显较差，且与 ODI 评分直接相关。 KS功能评分表明，有背部问题的TKA患者在TKA前后功能较差，改善较少。 TKA 结果不佳和不满意可能反映出膝关节功能不佳、脊柱残疾或两者兼而有之。对共存脊柱残疾的认识应指导患者对 TKA 结果的期望和评估。 (C) 2016 年，爱思唯尔公司出版
Background: Despite pain resolution in most patients after total knee arthroplasty (TKA), poor function persists in approximately 20% of patients and frequently is associated with patient dissatisfaction. Lumbar spine problems are a leading cause of functional disability. This study sought to determine the association between lower knee function scores and history of spine disability.Methods: Prospective demographic, health, and knee-specific data were collected for 1156 consecutive TKAs from July 2010 to July 2012. A spine questionnaire and Oswestry Disability Index (ODI) score were obtained from 691 knees.Results: Of 691 patients, 371 (54%) with TKA had daily back pain or back pain that limited activity. Oxford Knee Score was significantly worse in patients with vs without back problems preoperatively (36.9/34.8; P = .0006) and postoperatively (20.2/17.0; P < .0001), but not for improvement (16.7/17.8; P = .10). Knee Society (KS) pain scores were similar regardless of spine history. KS function scores were lower in patients with vs without back problems preoperatively (42.3/47.0; P = .0005), postoperatively (69.0/79.8; P < .0001), and for improvement (25.8/32.9; P < .0001). Lower KS function was associated with female gender, age, health, preoperative function, and ODI. ODI was associated with Oxford Knee Score (R = 0.57) and KS function score (R = 0.54).Conclusion: Knee function scores were significantly worse in patients with a history of back problems and directly associated with ODI score. KS function scores indicated that TKA patients with back problems had worse function before and after TKA with less improvement. Poor TKA outcomes and dissatisfaction may reflect poor knee function, spine disability, or both. Awareness of coexisting spine disability should guide patient expectations and evaluation of TKA outcomes. (C) 2016 Published by Elsevier Inc.