Update 

This article was updated on October 26, 2020, because of a previous error. On page e114(1), in the byline, the listed authors that had read “Nicolas S. Piuzzi, MD, and Cleveland Clinic OME Arthroplasty Group*” now reads “Ahmed Siddiqi, MD, MBA, Carlos A. Higuera-Rueda, MD, Viktor E. Krebs, MD, Robert M. Molloy, MD, Alison Klika, MS, Nicolas S. Piuzzi, MD, and the Cleveland Clinic OME Arthroplasty Group*.”

Background: 

Despite the growing frequency of revision total knee arthroplasty (rTKA), there is limited information regarding patient-reported outcome measures (PROMs) after that procedure. Therefore, the purpose of this study was to determine (1) PROM improvements in pain, function, quality of life (QOL), and global health and (2) predictors of PROMs for patients undergoing aseptic rTKA as determined using a multilevel model with patients nested within surgeons.

Methods: 

A prospective cohort of 246 patients who underwent aseptic rTKA from January 2016 to December 2017 and had baseline and 1-year postoperative PROMs were analyzed. The most common surgical indications were aseptic loosening (n = 109), instability (n = 73), and implant failure (n = 64). The PROMs included in this study were the Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain, -Physical Function Short Form (PS), and -Quality of Life (QOL) as well as the Veterans Rand-12 (VR-12) Physical Component Summary (PCS) and Mental Component Summary (MCS). Multivariable linear regression models with patients nested within surgeons were constructed for predicting change in PROMs from baseline to 1 year.

Results: 

The mean 1-year postoperative improvements in the KOOS-Pain and PS PROMs were 30.3 and 19.15 points, respectively, for the overall rTKA series. Improvement in the KOOS-Pain was associated with older age, baseline arthrofibrosis, lower baseline pain, and non-Medicare/Medicaid insurance and worsening of the scores was associated with multiple prior surgical procedures and instability. Improvement in the KOOS-PS was associated with baseline arthrofibrosis and female sex and worsening was associated with limited baseline function, an instability diagnosis, multiple prior surgical procedures, and increased hospital length of stay (LOS). Overall, the mean KOOS-QOL improved by 29.7 points. Although the mean VR-12 PCS improved, 54.9% of the patients saw no clinical improvement. Additionally, only 31.3% of the patients reported improvements in the VR-12 MCS. A multilevel mixed-effects model with patients/operations nested within surgeons demonstrated that the differences in the surgeons’ results were minimal and explained only ∼1.86%, ∼1.12%, and ∼1.65% of the KOOS-Pain, KOOS-PS, and KOOS-QOL variance that was not explained by other predictors, respectively.

Conclusions: 

Overall, patients undergoing aseptic rTKA had improvements in pain, function, and QOL PROMs at 1 year. Although overall QOL improved, other global-health PROMs remained unchanged. The associations highlighted in this study can help guide the preoperative clinical decision-making process by setting expectations before aseptic rTKA.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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无菌翻修全膝关节置换术后患者报告的结局指标（疼痛，功能和生活质量）

更新资料 

由于先前的错误，本文于2020年10月26日更新。在第e114（1）页上，在下划线中，已读过“ Nicolas S. Piuzzi，医学博士和克利夫兰诊所OME人工关节成形术*”的列出的作者现在读为“ Ahmed Siddiqi，医学博士，MBA，Carlos A. Higuera-Rueda医学博士，医学博士Viktor E. Krebs，医学博士Robert M. Molloy，医学博士Alison Klika，医学博士Nicolas S. Piuzzi和克利夫兰诊所OME关节置换组*。”

背景： 

尽管翻修全膝关节置换术（rTKA）的频率越来越高，但有关该手术后患者报告的结局指标（PROM）的信息有限。因此，本研究的目的是确定（1）无菌rTKA患者在疼痛，功能，生活质量（QOL）和整体健康方面的PROM改善，以及（2）使用患者的多水平模型确定的PROM预测因子嵌套在外科医生中。

方法： 

分析了2016年1月至2017年12月接受无菌rTKA且基线和术后1年PROM的246例患者的前瞻性队列。最常见的手术指征是无菌性松动（n = 109），不稳定（n = 73）和植入失败（n = 64）。这项研究中包括的PROM是膝关节损伤和骨关节炎成果评分（KOOS）-疼痛，-身体机能简短形式（PS）和-生活质量（QOL）以及退伍军人Rand-12（VR-12）身体成分摘要（PCS）和心理成分摘要（MCS）。构建了将患者嵌套在外科医生中的多变量线性回归模型，以预测从基线到1年PROM的变化。

结果： 

整个rTKA系列的KOOS-Pain和PS PROM的术后1年平均改善分别为30.3和19.15点。KOOS疼痛的改善与年龄增长，基线纤维化，基线疼痛降低以及非医疗/医疗保险有关，并且评分恶化与先前的多次手术程序和不稳定有关。KOOS-PS的改善与基线关节纤维化和女性性别有关，而恶化与基线功能受限，诊断不稳定，先前进行过多次外科手术以及住院时间延长（LOS）有关。总体而言，平均KOOS-QOL提高了29.7点。尽管平均VR-12 PCS有所改善，但54.9％的患者未见临床改善。此外，只有31个。3％的患者报告说VR-12 MCS有改善。多级混合效应模型（患者/手术嵌套在外科医生中）表明，外科医生结果的差异很小，仅解释了KOOS-Pain，KOOS-PS和KOOS-Pain，KOOS-PS和KOOS-Pain的〜1.86％，〜1.12％和〜1.65％。未由其他预测变量分别解释的KOOS-QOL方差。

结论： 

总体而言，接受无菌rTKA的患者在1年时疼痛，功能和QOL PROM均有改善。尽管总体生活质量有所改善，但其他全球卫生项目管理计划保持不变。通过在无菌rTKA之前设定期望值，本研究中突出显示的关联可以帮助指导术前临床决策过程。

证据级别： 

治疗级别IV。有关证据水平的完整说明，请参见《作者说明》。