Prediction of poor outcomes six months following total knee arthroplasty in patients awaiting surgery

BMC Musculoskeletal Disorders

Pascal-André Vendittoli³  Étienne L Belzile¹  Clermont E Dionne²  François Desmeules⁴  Eugen Lungu⁵ 

[1] Centre hospitalier universitaire (CHU) de Québec, Quebec, QC, Canada;Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC, Canada;Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada;School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada;Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital University of Montreal affiliated Research Center, CP 6128 Succursale Centre-Ville, Montréal H3C 3 J7 Quebec, Canada

关键词: Determinants;    Prediction rule;    Osteoarthritis;    Total knee arthroplasty;   

Others  :  1122127
DOI  :  10.1186/1471-2474-15-299

 received in 2014-04-24, accepted in 2014-09-03,  发布年份 2014

【 摘 要 】

Background

Identification of patients experiencing poor outcomes following total knee arthroplasty (TKA) before the intervention could allow better case selection, patient preparation and, likely, improved outcomes. The objective was to develop a preliminary prediction rule (PR) to identify patients enrolled on surgical wait lists who are at the greatest risk of poor outcomes 6 months after TKA.

Methods

141 patients scheduled for TKA were recruited prospectively from the wait lists of 3 hospitals in Quebec City, Canada. Knee pain, stiffness and function were measured 6 months after TKA with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and participants in the lowest quintile for the WOMAC total score were considered to have a poor outcome. Several variables measured at enrolment on the wait lists (baseline) were considered potential predictors: demographic, socioeconomic, psychosocial, and clinical factors including pain, stiffness and functional status measured with the WOMAC. The prediction rule was built with recursive partitioning.

Results

The best prediction was provided by 5 items of the baseline WOMAC. The rule had a sensitivity of 82.1% (95% CI: 66.7-95.8), a specificity of 71.7% (95% CI: 62.8-79.8), a positive predictive value of 41.8% (95% CI: 29.7-55.0), a negative predictive value of 94.2% (95% CI: 87.1-97.5) and positive and negative likelihood ratios of 2.9 (95% CI: 1.8-4.7) and 0.3 (95% CI: 0.1-0.6) respectively.

Conclusions

The developed PR is a promising tool to identify patients at risk of worse outcomes 6 months after TKA as it could help improve the management of these patients. Further validation of this rule is however warranted before clinical use.

【 授权许可】

   
2014 Lungu et al.; licensee BioMed Central Ltd.

【 图 表 】

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