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Tytuł:
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Patients follow three distinct outcome trajectories following total knee arthroplasty.
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Autorzy:
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Hamilton DF; School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.; Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK.
Shim J; Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Howie CR; Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK.
Macfarlane GJ; Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
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Źródło:
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The bone & joint journal [Bone Joint J] 2021 Jun; Vol. 103-B (6), pp. 1096-1102.
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Typ publikacji:
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Journal Article; Multicenter Study
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Język:
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English
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Imprint Name(s):
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Original Publication: London : British Editorial Society of Bone & Joint Surgery
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MeSH Terms:
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Health Status Indicators*
Outcome Assessment, Health Care*
Arthroplasty, Replacement, Knee/*methods
Activities of Daily Living ; Aged ; Attitude to Health ; Female ; Humans ; Longitudinal Studies ; Male ; Pain Measurement ; Patient Satisfaction ; Prospective Studies ; Quality of Life ; Sleep Wake Disorders/epidemiology ; Surveys and Questionnaires ; United Kingdom
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Contributed Indexing:
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Keywords: Outcomes; Oxford Knee Score; Total knee arthroplasty; Trajectory modelling
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Entry Date(s):
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Date Created: 20210601 Date Completed: 20210604 Latest Revision: 20210604
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Update Code:
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20240105
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DOI:
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10.1302/0301-620X.103B6.BJJ-2020-1821.R1
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PMID:
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34058868
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Aims: Although total knee arthroplasty (TKA) is a highly successful procedure, about 20% of patients remain dissatisfied postoperatively. This proportion is derived from dichotomous models of the assessment of surgical success or failure, which may not reflect the spectrum of outcomes. The aim of this study was to explore differing responses to surgery, and assess whether there are distinct groups of patients with differing patterns of outcome.
Methods: This was a secondary analysis of a UK multicentre TKA longitudinal cohort study. We used a group-based trajectory modelling analysis of Oxford Knee Score (OKS) in the first year following surgery with longitudinal data involving five different timepoints and multiple predictor variables. Associations between the derived trajectory groups and categorical baseline variables were assessed, and predictors of trajectory group membership were identified using Poisson regression and multinomial logistic regression, as appropriate. The final model was adjusted for sociodemographic factors (age, sex) and baseline OKS.
Results: Data from 731 patients were available for analysis. Three distinct trajectories of outcome were identified: "poor" 14.0%, "modest" 39.1%, and "good" 46.9%. The predicted probability of membership for patients assigned to each trajectory group was high (0.89 to 0.93). Preoperative mental, physical health, and psychosocial factors determined which trajectory is likely to be followed. Poor responders were characterized by a comparatively small number of factors, preoperative expectations of pain and limitations, coping strategies, and a lower baseline physical health status, while the good responders were characterized by a combination of clinical, psychosocial, mental health, and quality of life factors.
Conclusion: We identified three distinct response trajectories in patients undergoing TKA. Controlling for baseline score, age, and sex, psychosocial factors such as expectations of pain and limited function and poor coping strategies differentiated the trajectory groups, suggesting a role for preoperative psychosocial support in optimizing the clinical outcome. Cite this article: Bone Joint J 2021;103-B(6):1096-1102.
