牛津髋关节评分显示在全髋关节置换术后1年和2年有中等的天花板效应:哪些患者有风险,这有关系吗?

IF 1.4 Q3 ORTHOPEDICS
N D Clement, S Jones, B Qaddoura, I Afzal, D F Kader
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引用次数: 0

摘要

背景:目的是评估术后牛津髋关节评分(OHS)是否在全髋关节置换术(THA)后1年或2年表现出天花板效应,并确定哪些患者更有可能达到天花板评分,以及这是否限制了对其结果的评估。方法:从已建立的关节成形术数据库中确定7871例接受原发性THA的患者的回顾性队列。术前及术后1年和2年收集患者人口统计学、ASA等级、社会经济状况、OHS和EuroQol问卷。回归分析用于确定与达到最高评分相关的独立术前因素。受试者工作特征曲线用于确定术前OHS,预测术后天花板评分。结果:1年的天花板效应(达到最高评分的比例)为21.8% (n = 1372),显著增加(p)结论:全髋关节置换术后1年和2年,OHS均表现出中等的天花板效应,术前评分是达到天花板评分的预测因子。然而,上限效应似乎并未限制相对于基线的改善潜力,并在OHS中达到临床有意义的值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Oxford hip score demonstrates moderate ceiling effects at one and two years after total hip arthroplasty: which patients are at risk and does it matter?

Background: The aim was to assess whether the postoperative Oxford Hip Score (OHS) demonstrated a ceiling effect at 1 or 2 years after total hip arthroplasty (THA) and to identify which patients are more likely to achieve a ceiling score and whether this limits assessment of their outcome.

Methods: A retrospective cohort of 7871 patients undergoing primary THA was identified from an established arthroplasty database. Patient demographics, ASA grade, socioeconomic status, OHS and EuroQol questionnaire were collected preoperatively and at 1 and 2 years postoperatively. Regression analysis was used to identify independent preoperative factors associated with achieving a ceiling score. Receiver operating characteristic curves were used to identify preoperative OHS's that predicted a postoperative ceiling score.

Results: The ceiling effect (proportion achieving the maximal score) at 1 year was 21.8% (n = 1372) which increased significantly (p < 0.001) to 26.6% (n = 1569) at 2 years. Female gender (p ≤ 0.028), younger age (p < 0.001), decreasing socioeconomic deprivation (only for 2-year OHS), a better preoperative OHS (p < 0.001) or EQ-VAS (p < 0.001) were independently associated with a ceiling OHS postoperatively. The preoperative OHS was demonstrated to be a  poor discriminator of achieving postoperative ceiling score at 1 year (AUC 62.4%, 95% CI 60.7 to 64.1, p < 0.001) and 2 years (AUC 61.5%, 95% CI 60.0 to 63.2). Those achieving a postoperative ceiling OHS at 1 and 2 years had statistically significant (p < 0.001) greater improvements in their OHS, EQ-5D and EQ-VAS and were more likely to have achieved a minimal important change in their OHS relative to their preoperative baseline and a postoperative patient acceptable symptom state.

Conclusion: The OHS demonstrated moderate ceiling effects at both 1 and 2 years following THA, and the preoperative score was a predictor of achieving a ceiling score. However, it would seem the ceiling effect did not limit the potential for improvements relative to baseline and achieving clinically meaningful values in the OHS.

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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
265
审稿时长
3-8 weeks
期刊介绍: The European Journal of Orthopaedic Surgery and Traumatology (EJOST) aims to publish high quality Orthopedic scientific work. The objective of our journal is to disseminate meaningful, impactful, clinically relevant work from each and every region of the world, that has the potential to change and or inform clinical practice.
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