The quality of life and curative effect among elder patients after total knee replacement surgery for severe knee osteoarthritis

doi:10.3969/j.issn.2095-4344.2014.40.008

Abstract

Abstract:

BACKGROUND: Total knee replacement is regarded an effective treatment of knee osteoarthritis, based on the transformation of biology-psychology-social medicine pattern, the concept of “quality of life” has attracted increasing concerns.

OBJECTIVE: To observe the effects of total knee replacement surgery on the pain, function and quality of life among elder patients with severe knee osteoarthritis.

METHODS: A total of 102 elder patients with severe knee osteoarthritis were recruited from the Second Affiliated Hospital of Inner Mongolia Medical University between January 2010 and January 2013. The clinical manifestations and 12-month follow-up outcomes were observed and recorded. The involved patients were randomly divided into two groups: treatment group (59 cases, receiving total knee replacement) and control group (43 cases, receiving expectant treatment such as drugs, but no surgery). Patients were evaluated using HSS scale and WHOQOL-100 scale before surgery and 12 months after surgery. Furthermore, the correlation between influencing factors and HSS and WHOQOL-100 scores was analyzed.
RESULTS AND CONCLUSION: At 12 months postoperatively, the HSS scores of patients in treatment group was (82.03±10.17) points, which was obviously higher than that in control group (P < 0.01). The WHOQOL-100 scores in treatment group were also significantly higher than that in control group (P < 0.01). The psychology sub-item scores of patients after total knee replacement were close to that of normal controls (P > 0.50). The regression analysis shows that marital status (β=1.988), complication (β=2.035) and HSS scores (β=2.108) are the main influencing factors for the quality of life among patients undergoing replacement. Experimental findings indicate that, HSS score is an effective indicator to assess the effect of total knee replacement on the pain and function of elder patients with severe knee osteoarthritis. WHOQOL-100 is introduced to further improve the assessment of quality of life after total knee replacement surgery in severe knee osteoarthritis. The marital status, complication and HSS scores are the key influencing factors for the quality of life among severe knee osteoarthritis patients. Deep vein thrombosis affects the out-of-bed time, and the mate-accompanying during the follow-ups plays a positive role on the quality of life and mental state of patients.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: arthroplasty, replacement, knee, osteoarthritis, knee, follow-ups

CLC Number:

R318

Xia Run-fu, Li Jian-feng, Yan Jin-yu, Zhang Shu-lian. The quality of life and curative effect among elder patients after total knee replacement surgery for severe knee osteoarthritis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(40): 6438-6443.

Figures/Tables 2

2.1 参与者数量分析本组研究所有病例均采用门诊随访、电话随访的方式，于术前及术后12个月的跟踪随访，由于死亡、失联等原因及其他原因不能配合完成随访患者全膝关节置换组5例(8%)、对照组4例(9%)，失访患者数据亦进行相关统计。 2.2 基线资料比较两组患者基线资料比较差异无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 两组患者膝关节功能恢复情况比较两组患者置换后12个月HSS评分比较，全膝关节置换组膝关节HSS评分等级为良，总分为(82.03±10.17)分，明显优于对照组(32.51±9.40)分，组间差异有显著性意义(P < 0.01)；各分项评分全膝关节置换组明显优于对照组(P < 0.01)，见表2。 2.4 两组患者WHOQOL-100评分比较除社会关系、环境子项评分与对照组比较差异无显著性意义外，全膝关节置换组WHOQOL-100评分量表的其他生活质量指标及总评分均显著优于对照组，组间比较差异有非常显著性意义(P < 0.01)。将全膝关节置换组各维度得分标准化转换后，与本地区普通人群生活质量得分比较发现，人工全膝关节置换患者心理子项评分接近于正常人群(P > 0.05)，总分及其余指标评分均低于正常人群，差异有显著性意义(P < 0.05)，见表3。 2.5 影响膝关节骨关节炎患者生活质量因素的Logistic回归分析以膝关节骨关节炎患者是否行人工全膝关节置换为因变量，以性别、年龄、文化程度、性格、经济状况等多种因素进行Logistic回归分析，结果发现，婚姻状况、并发症及HSS评分是影响膝关节骨关节炎患者生活质量的主要因素，见表4。其中深静脉血栓影响患者离床时间，研究发现随访期间有配偶照顾对患者生活质量及心理状态都有正面的影响。 2.6 不良事件本组除1例患者出现深静脉血栓转入血管外科治疗外，其他患者无明显感染、脂肪栓塞及腓总神经损伤等并发症发生。"

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