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性別は膝関節形成術の機能的転帰に臨床的には影響しないが、女性では痛みの軽減に対する満足度が低い
Sex does not clinically influence the functional outcome of total knee arthroplasty but females have a lower rate of satisfaction with pain relief.
PMID: 32660629 PMCID: PMC7301486. DOI: 10.1186/s43019-020-00048-1.
抄録
背景:
目的は、Western OntarioおよびMcMaster Universities Osteoarthritis Index (WOMAC)スコア、Short Form (SF-) 12スコア、1年後の患者満足度に基づいて、性別が膝関節形成術（TKA）の転帰に臨床的に有意な独立した影響を及ぼすかどうかを評価することであった。
BACKGROUND: The aims were to assess whether sex had a clinically significant independent influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Short Form (SF-) 12 scores and patient satisfaction at 1 year.
方法:
一次TKA患者3510例のレトロスペクティブコホートを同定した。患者の人口統計、併存疾患、WOMAC、SF-12スコアを術前と術後1年に収集した。患者の満足度は1年後に評価された。
METHODS: A retrospective cohort of 3510 primary TKA were identified. Patient demographics, comorbidities, WOMAC and SF-12 scores were collected preoperatively and 1 year postoperatively. Patient satisfaction were assessed at 1 year.
結果:
男性1584人、女性1926人であった。術前のWOMACとSF-12スコアは女性で有意に（p<0.001）悪化したが、最小臨床的に重要な差（MCID）よりは大きかった。交絡因子を調整した場合、女性は男性に比べて機能（1.5点、p=0.03）と合計（1.5点、p=0.03）のWOMACスコアが有意に改善したが、これらはMCIDよりも大きくはなかった。交絡因子の違いを調整した場合、女性は男性に比べて疼痛緩和に満足する可能性が低かった（p=0.03）。
RESULTS: There were 1584 males and 1926 females. The preoperative WOMAC and SF-12 scores were significantly (p < 0.001) worse in females but were not greater than the minimal clinically important difference (MCID). When adjustments had been made for confounding differences, females showed a significantly greater improvement in their function (1.5 points, p = 0.03) and total (1.5 points, p = 0.03) WOMAC scores compared to males, but these were not greater than the MCID. When adjustments had been made for confounding differences, females were less likely to be satisfied with their pain relief (p = 0.03) relative to males.
結論:
性別はTKA後1年後の膝特異的転帰(WOMAC)や総合的な健康状態(SF-12)に臨床的に影響を与えない。しかし、TKA後の疼痛緩和に対する満足度は女性患者で有意に低かった。
CONCLUSION: Sex does not clinically influence the knee specific outcome (WOMAC) or overall generic (SF-12) health 1 year after TKA. However, satisfaction with pain relief after TKA was significantly less likely in female patients.
証拠レベルII:
予後を考慮したレトロスペクティブコホート研究。
LEVEL OF EVIDENCE II: Prognostic retrospective cohort study.