Effect of multi-disciplinary treatment on surgical outcome and satisfaction of patients undergoing primary unilateral total knee arthroplasty_West China Medical Journal

Authors：

YANG Tianxiang ^1,2 , CAO Dede ¹ , PAN Guojie ¹ , YUAN Ang ¹ , WANG Wenpeng ¹ , ZHANG Bowen ¹ , ZHANG Jinning ¹ ,  CHEN Desheng ³

1. School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia 750004, P. R. China;
2. Department of Orthorpaedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750001, P. R. China;
3. Department of Orthorpaedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia 700002, P. R. China;

Corresponding author：

CHEN Desheng, Email: charles_cds@163.com

Keywords：

Knee osteoarthritis; total knee arthroplasty; multi-disciplinary treatment; satisfaction

DOI：

10.7507/1002-0179.202301057

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Objective To study the effect of multi-disciplinary treatment (MDT) on the surgical efficacy and satisfaction of patients undergoing total knee arthroplasty (TKA) for the first time. Methods The clinical data of patients who underwent unilateral TKA for single-compartment osteoarthritis of the knee in the General Hospital of Ningxia Medical University between January and September 2022 were retrospectively collected and analyzed. According to whether MDT was performed on patients during the perioperative period, they were divided into MDT group and traditional group. Perioperative nutrition-related indicators, perioperative complications, total hospitalization time, Visual Analogue Scale (VAS), and Hospital for Special Surgery Knee Score (HSS) before and after surgery were detected and recorded. Results A total of 95 patients were included. Among them, there were 42 cases in the MDT group and 53 cases in the traditional group. The postoperative complications and total hospital stay of patients in the MDT group were lower than those in the traditional group, and their satisfaction scores were higher than those in the traditional group (P<0.05). The perioperative serum total protein (TP), hemoglobin (Hb), serum albumin (ALB) levels, VAS score, and HSS score of both groups of patients changed over time. The intra group comparison results showed that compared with preoperative, the levels of TP, Hb, and ALB in both groups decreased on the 1st and 3rd postoperative days (P<0.05). On the 3rd day after surgery, the levels of TP, Hb, ALB in the MDT group and Hb, ALB in the traditional group were lower than on the 1st day after surgery (P<0.05). There was no statistically significant difference in TP levels between the traditional group on the 3rd day after surgery and the 1st day after surgery (P>0.05). The results of intra group comparison at different time points showed that there were statistically significant differences in VAS score and HSS score between the two groups (P<0.05). Conclusion The application of MDT in elderly patients undergoing unilateral TKA for the first time can shorten the total hospitalization time, reduce the incidence of perioperative complications, and improve the surgical efficacy and patient satisfaction.

Citation： YANG Tianxiang, CAO Dede, PAN Guojie, YUAN Ang, WANG Wenpeng, ZHANG Bowen, ZHANG Jinning, CHEN Desheng. Effect of multi-disciplinary treatment on surgical outcome and satisfaction of patients undergoing primary unilateral total knee arthroplasty. West China Medical Journal, 2023, 38(6): 864-869. doi: 10.7507/1002-0179.202301057 Copy

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2.	Wallace IJ, Worthington S, Felson DT, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A, 2017, 114(35): 9332-9336.
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4.	Zhang X, Ma D, Pan J, et al. Effects of different applications of tranexamic acid on perioperative blood transfusion rate and postoperative pain in unilateral total knee arthroplasty. Adv Ther, 2021, 38(2): 1143-1154.
5.	杨晓娜, 赵良虎, 黄金, 等. 依诺肝素钠与磺达肝癸钠预防膝关节置换术后深静脉血栓的对比研究. 中国医院用药评价与分析, 2021, 21(10): 1176-1179.
6.	张双伟, 王朝君, 徐凤周, 等. 加速康复外科对老年股骨粗隆间骨折患者髋关节功能、生活质量及术后认知的影响. 河北医药, 2021, 43(10): 1470-1474.
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10.	Blevins JL, Chiu YF, Lyman S, et al. Comparison of expectations and outcomes in rheumatoid arthritis versus osteoarthritis patients undergoing total knee arthroplasty. J Arthroplasty, 2019, 34(9): 1946-1952.e2.
11.	Naylor JM, Pocovi N, Descallar J, et al. Participation in regular physical activity after total knee or hip arthroplasty for osteoarthritis: prevalence, associated factors, and type. Arthritis Care Res (Hoboken), 2019, 71(2): 207-217.
12.	周洋洋, 芮云峰, 鲁攀攀, 等. 多学科协作诊疗模式在老年髋部骨折临床应用中的研究进展. 中国修复重建外科杂志, 2020, 34(1): 132-138.
13.	孙亚召, 陈志坤, 孟杰杰, 等. 血清白蛋白和年龄休克指数及 Qanadli 指数与老年肺血栓栓塞的相关性研究. 中华老年心脑血管病杂志, 2022, 24(11): 1156-1158.
14.	Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med, 2018, 52: 8-12.
15.	周丽丽, 吴丹, 石海燕. 评价 GLIM 标准对食管癌营养评估与术后并发症预测的有效性. 肿瘤代谢与营养电子杂志, 2022, 9(5): 594-601.
16.	马灵驭, 刘燕, 徐冠华. 降低脊柱手术患者术后感染率的多学科诊疗模式探讨. 实用临床医药杂志, 2018, 22(18): 80-82, 86.
17.	杨亚, 梁晨, 陈桢, 等. 国内外多学科诊疗模式研究进展分析. 中国卫生质量管理, 2021, 28(2): 16-19.
18.	芮云峰, 邱晓东, 邹继红, 等. 多学科协作诊疗模式在老年髋部骨折的临床应用. 中国修复重建外科杂志, 2019, 33(10): 1276-1282.

1. Han Y, Huang H, Pan J, et al. Meta-analysis comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis. Pain Med, 2019, 20(7): 1418-1429.
2. Wallace IJ, Worthington S, Felson DT, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A, 2017, 114(35): 9332-9336.
3. 王斌, 邢丹, 董圣杰, 等. 中国膝骨关节炎流行病学和疾病负担的系统评价. 中国循证医学杂志, 2018, 18(2): 134-142.
4. Zhang X, Ma D, Pan J, et al. Effects of different applications of tranexamic acid on perioperative blood transfusion rate and postoperative pain in unilateral total knee arthroplasty. Adv Ther, 2021, 38(2): 1143-1154.
5. 杨晓娜, 赵良虎, 黄金, 等. 依诺肝素钠与磺达肝癸钠预防膝关节置换术后深静脉血栓的对比研究. 中国医院用药评价与分析, 2021, 21(10): 1176-1179.
6. 张双伟, 王朝君, 徐凤周, 等. 加速康复外科对老年股骨粗隆间骨折患者髋关节功能、生活质量及术后认知的影响. 河北医药, 2021, 43(10): 1470-1474.
7. 马建华, 王庆雷, 刘前桂, 等. 多学科诊治在高龄患者单髁膝关节置换术中的应用. 北京医学, 2021, 43(7): 688-690.
8. 中华医学会骨科学分会关节外科学组, 中国医师协会骨科医师分会骨关节炎学组, 国家老年疾病临床医学研究中心(湘雅医院), 等. 中国骨关节炎诊疗指南(2021 年版). 中华骨科杂志, 2021, 41(18): 1291-1314.
9. 岳辰, 周宗科, 裴福兴, 等. 中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识. 中华骨与关节外科杂志, 2015, 8(4): 281-285.
10. Blevins JL, Chiu YF, Lyman S, et al. Comparison of expectations and outcomes in rheumatoid arthritis versus osteoarthritis patients undergoing total knee arthroplasty. J Arthroplasty, 2019, 34(9): 1946-1952.e2.
11. Naylor JM, Pocovi N, Descallar J, et al. Participation in regular physical activity after total knee or hip arthroplasty for osteoarthritis: prevalence, associated factors, and type. Arthritis Care Res (Hoboken), 2019, 71(2): 207-217.
12. 周洋洋, 芮云峰, 鲁攀攀, 等. 多学科协作诊疗模式在老年髋部骨折临床应用中的研究进展. 中国修复重建外科杂志, 2020, 34(1): 132-138.
13. 孙亚召, 陈志坤, 孟杰杰, 等. 血清白蛋白和年龄休克指数及 Qanadli 指数与老年肺血栓栓塞的相关性研究. 中华老年心脑血管病杂志, 2022, 24(11): 1156-1158.
14. Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med, 2018, 52: 8-12.
15. 周丽丽, 吴丹, 石海燕. 评价 GLIM 标准对食管癌营养评估与术后并发症预测的有效性. 肿瘤代谢与营养电子杂志, 2022, 9(5): 594-601.
16. 马灵驭, 刘燕, 徐冠华. 降低脊柱手术患者术后感染率的多学科诊疗模式探讨. 实用临床医药杂志, 2018, 22(18): 80-82, 86.
17. 杨亚, 梁晨, 陈桢, 等. 国内外多学科诊疗模式研究进展分析. 中国卫生质量管理, 2021, 28(2): 16-19.
18. 芮云峰, 邱晓东, 邹继红, 等. 多学科协作诊疗模式在老年髋部骨折的临床应用. 中国修复重建外科杂志, 2019, 33(10): 1276-1282.

West China Medical Journal

Effect of multi-disciplinary treatment on surgical outcome and satisfaction of patients undergoing primary unilateral total knee arthroplasty

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