Study On Risk Factors Affecting Functional Recovery After Total Knee Arthroplasty

Research background and purpose:Osteoarthritis(OA)is a chronic and progressive bone and joint disease with the main characteristics of articular cartilage wear,cell reduction,and the production of joint and surrounding inflammatory factors.It mostly occurs in the major joints of the human body,and its clinical symptoms are mainly joint resting pain.knee osteoarthritis(KOA)is the most common joint in the whole body.Along with our aging society’s arrival,prevalence rate of KOA rises gradually,after people for a long time to understand the disease,from the onset mechanism,diagnosis,treatment and other aspects of the inquiry has a mature system.With the further improvement of the quality of life,the treatment of it is also put forward higher requirements.Patients with early conservative effect is better,can alleviate symptoms to a certain extent,but KOA ladder treatment has a certain timeliness,the early course of the disease often does not cause enough attention,easy to delay the time to see a doctor seriously damaged function,then conservative treatment effect is not good,can not solve the fundamental problem,bring trouble to patients’daily life,Increased social and economic burden and decreased labor force,so surgical treatment becomes an important choice for patients with advanced disease.The common procedure is Total knee arthroplasty(TKA).TKA can reconstruct the knee joint and restore the function of daily life to the maximum extent.However,with the increasing operation amount and more and more cases in our country year by year,the demand for functional evaluation after surgery is gradually increasing.The functional effect after TKA directly determines the quality of life.Therefore,the purpose of this study is to analyze related risk factors that affect functional recovery after TKA,which is conducive to later perioperative assessment and control of related factors,so as to provide reference for improving efficacy and prognosis.Materials and Methods:A total of 174 patients who met the inclusion criteria and underwent unilateral TKA due to KOA from July 2020 to August 2022 in the Department of Orthopaedics of the First Affiliated Hospital of Chengdu Medical College and the Department of Orthopaedics of Sichuan Province People’s Hospital were selected to complete the study.According to the functional results at 3 months after operation,the patients with HSS score≥70 were included in the good function group,and those with HSS score<70 were included in the poor function group.The same method was used to group statistics at 6 months after operation,and local complications were recorded at different time points.The age,gender,duration of disease,BMI,smoking history,left/right side of disease,preoperative KOA stage,preoperative osteoporosis,preoperative HSS score,preoperative VAS score,preoperative ASA grade,preoperative hemoglobin level,preoperative serum albumin level,intraoperative blood loss,postoperative CPM,Length of stay,and related risk factors of complications at 3 and 6 months after operation were collected and analyzed by Statsmodels 0.11.1 software.The above factors were analyzed by single factor analysis,the measurement data were expressed by(x±s),and the comparison between groups was performed by independent sample t test.Enumeration data were expressed by constituent ratio and compared between groups byχ~2 test.The Mann-Whitney U test was used for non-parametric independent samples,and comparisons between groups were expressed as median[IQR],with p<0.05 indicating statistically significant differences.Logreg 6.2.0 software was used to exclude the variables without statistical significance.After adjustment,Logistic regression model was used for multivariate analysis to determine whether the above factors were independent risk factors and odds ratio for poor function after TKA.Result:The average age of 174 patients in this study was 67.80±8.09 years old.The number of cases with poor function after 3 months was 22,the incidence rate was12.64%,and 29 cases had local complications,the incidence rate was 16.67%.In 6months after operation,11 cases(7.48%)had poor function and 18 cases(10.34%)had local complications.Univariate analysis showed that age(t=-3.31,p=0.001),preoperative HSS score(t=3.36,p<0.001),preoperative ASA grade≥Ⅲ(χ~2=9.86,p=0.002),preoperative VAS score(Z=-1.99,p=0.035)and postoperative complications(χ~2=20.15,p<0.001)were risk factors for poor function at 3 months after TKA.age(t=-2.79,p=0.006),preoperative HSS score(t=2.59,p=0.011),preoperative ASA grade≥III(χ~2=9.86,p<0.001),preoperative VAS score(Z=-2.06,p=0.029),preoperative hemoglobin<100g/L(χ~2=4.77,p=0.029),preoperative osteoporosis(χ~2=4.60,p=0.032),Complications at 6 months(χ~2=15.61,p<0.001)were a risk factor for poor function at 6 months after TKA.The results of binary Logistic analysis showed that age(OR=1.086,95%CI:1.015～1.170,p=0.021),preoperative HSS score(OR=0.937,95%CI:0.886～0.987,p=0.017),postoperative complications at 3 months(OR=8.311,95%CI:2.773～26.498,p<0.001)was an independent risk factor for poor function 3 months after TKA;ASA grade≥Ⅲ(OR=53.385,95%CI:6.221～1314.02,p=0.002),postoperative complications at 6 months(OR=15.31,95%CI:2.07～172.085,p=0.012),preoperative hemoglobin<100(g/L)(OR=0.092,95%CI:0.004～0.685,p=0.043)was an independent risk factor for poor function at 6 months after TKA.Conclusion:1.The age,preoperative HSS score and postoperative complications of KOA patients were the factors influencing the functional recovery of KOA patients at 3months after TKA.2.Preoperative ASA grade≥Ⅲ,preoperative hemoglobin<100(g/L)and postoperative complications were the factors influencing the functional recovery after 6months of TKA.