Indications for total hip and total knee arthroplasties - Results of orthopaedic surveys
Indications for total hip and total knee arthroplasties - Results of orthopaedic surveys
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DOI：
10.1016/s0883-5403(96)80159-8
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发表时间：
1996-01-01
影响因子：
3.5
通讯作者：
Charlson, ME
中科院分区：
文献类型：
--
作者：
Mancuso, CA;Ranawat, CS;Charlson, ME
全髋关节置换术（THA）和全膝关节置换术（THA）的适应症缺乏共识被认为是导致全髋关节置换术和全膝关节置换术在美国发病率差异的原因之一。本研究的目的是调查特定地理区域（纽约市）的骨科医生关于骨关节炎患者是否适合进行全髋关节置换术或全髋关节置换术的情况，并比较两家学术医疗中心（美国特殊外科医院和加拿大麦吉尔大学）骨科医生的全髋关节置换术适应症。向骨科医生发送邮件调查，询问适应症、影响结果的因素以及可能改变手术决定的因素。1992年在纽约市进行全髋关节置换术和全髋关节置换术的骨科医生中约有45%完成了调查。尽管不同的外科医生有很大的差异，但大多数外科医生每天至少需要剧烈的疼痛，每周几天的休息疼痛，每周几天（THA）或每天（TKA）的转移性疼痛，并在x线照片上破坏大部分关节间隙。年龄小、合并症、技术困难和缺乏动力改变了反对手术的决定，而独立和重返工作的愿望影响了手术的决定。大多数外科医生认为，患有严重疼痛、骨关节炎或类风湿关节炎的患者有很高的可能性获得良好的结果，而那些有合并症和某些技术因素的患者只有中等的可能性获得良好的结果。在美国和加拿大对THA的调查中，超过90%的外科医生做出了回应，加拿大外科医生倾向于要求更频繁的疼痛和使用辅助装置来行走。尽管对几个适应症有大多数意见，但外科医生对THA和TKA的适应症没有明确的共识。可能的解释是，孤立的适应症不如综合和权衡几个适应症那么重要，而且患者继续进行THA或TKA的愿望是决定手术的重要驱动力。
A lack of consensus regarding the indications for total hip arthroplasty (THA) and total knee arthroplasty (THA) has been cited as one reason for the variations in the rates of THA and TKA across the United States. The purposes of this study were to survey orthopaedists in a specific geographic area (New York City) regarding the candidacy of patients with osteoarthritis for THA or TKA and to compare indications for THA between orthopaedists at two academic medical centers, The Hospital for Special Surgery in the United Slates and McGill University in Canada. Orthopaedists were sent mail surveys asking about indications, factors affecting outcomes, and factors that might modify decisions for surgery. Approximately 45% of orthopaedists who performed THA and TKA in New York City in 1992 completed the surveys. Although there were wide variations among surgeons, most surgeons required at least severe pain daily, rest pain several days per week, transfer pain either several days per week (THA) or daily (TKA), and destruction of most of the joint space on radiograph. Younger age, comorbidity, technical difficulties, and lack of motivation modified the decision against surgery whereas the desire to be independent and return to work swayed the decision for surgery. Most surgeons rated that patients with severe pain, osteoarthritis, or rheumatoid arthritis would have a high likelihood of an excellent outcome, whereas those with comorbidity and certain technical factors would have only a moderate likelihood of an excellent outcome. In the U.S.-Canadian survey of THA, in which more than 90% of surgeons responded, Canadian surgeons tended to require more frequent pain and use of assistive devices for walking. Although there was a majority of opinion for several indications, there was no clear consensus among surgeons regarding the indications for THA and TKA. Possible explanations for this are that isolated indications are not as important as integrating and weighing several indications and that I-he patient's desire to proceed with THA or TKA is an important driving force in the decision to operate.