Variability in long-term pain and function trajectories after total knee replacement: A cohort study

被引:27
作者
Wylde, Vikki [1 ,2 ,3 ]
Penfold, Chris [1 ,2 ,3 ]
Rose, Alice [1 ]
Blom, Ashley W. [1 ,2 ,3 ]
机构
[1] Univ Bristol, Bristol Med Sch, Musculoskeletal Res Unit, Translat Hlth Sci, Bristol BS10 5NB, Avon, England
[2] Univ Hosp Bristol NHS Fdn Trust, Bristol Biomed Res Ctr, Natl Inst Hlth Res, Bristol, Avon, England
[3] Univ Bristol, Bristol, Avon, England
关键词
Total knee replacement; Pain; Function; Trajectories; PROMS; QUALITY-OF-LIFE; TOTAL HIP; OUTCOMES; ARTHROPLASTY; RECOVERY; RESPONSIVENESS; WOMAC;
D O I
10.1016/j.otsr.2019.08.014
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Introduction: Previous research suggests that patient-reported outcomes plateau by one year after total knee replacement (TKR). Analysis of trajectories to date has predominately been based on changes in median/mean scores over the first post-operative year, rather than variability in trajectory patterns over the longer-term. The aim was to evaluate variability in long-term pain and function trajectories after TKR. Hypothesis: There will be variability in long-term pain and function trajectories after TKR. Patients and methods: In all, 266 patients undergoing a Triathlon TKR because of osteoarthritis were recruited from one orthopaedic centre. Participants completed the WOMAC Pain and Function scales preoperatively and then at 3 months, 1 year, 2 years, 3 years, 5 years and 7 years post-operative. Longitudinal analyses evaluated patterns of clinically meaningful change. Results: Most patients had an improvement in pain and function during the first year post-operative; improvement was greatest in the first 3 months. By 1 -year post-operative, 8% of patients had no change or a worsening of pain and 21% for function. Thereafter, approximately 15% of patients improved and 15% worsened between each assessment time. For those patients who had no change in symptoms from pre -operative to 1 -year post-operative, one third had further improvement between 1 and 2 years postoperative. Discussion: This study identified clinically meaningful variability in long-term outcomes after TKR, which could be discussed with patients to ensure they have realistic expectations of their outcome. Further research is needed to evaluate determinants of this variability and whether patients who will do poorly can be identified early in their recovery pathway. (C) 2019 Elsevier Masson SAS. All rights reserved.
引用
收藏
页码:1345 / 1350
页数:6
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