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

Video：

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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.
3.	王斌, 邢丹, 董圣杰, 等. 中國膝骨關節炎流行病學和疾病負擔的系統評價. 中國循證醫學雜志, 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.	楊曉娜, 趙良虎, 黃金, 等. 依諾肝素鈉與磺達肝癸鈉預防膝關節置換術后深靜脈血栓的對比研究. 中國醫院用藥評價與分析, 2021, 21(10): 1176-1179.
6.	張雙偉, 王朝君, 徐鳳周, 等. 加速康復外科對老年股骨粗隆間骨折患者髖關節功能、生活質量及術后認知的影響. 河北醫藥, 2021, 43(10): 1470-1474.
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8.	中華醫學會骨科學分會關節外科學組, 中國醫師協會骨科醫師分會骨關節炎學組, 國家老年疾病臨床醫學研究中心(湘雅醫院), 等. 中國骨關節炎診療指南(2021 年版). 中華骨科雜志, 2021, 41(18): 1291-1314.
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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, 魯攀攀, 等. 多學科協作診療模式在老年髖部骨折臨床應用中的研究進展. 中國修復重建外科雜志, 2020, 34(1): 132-138.
13.	孫亞召, 陳志坤, 孟杰杰, 等. 血清白蛋白和年齡休克指數及 Qanadli 指數與老年肺血栓栓塞的相關性研究. 中華老年心腦血管病雜志, 2022, 24(11): 1156-1158.
14.	Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med, 2018, 52: 8-12.
15.	周麗麗, 吳丹, 石海燕. 評價 GLIM 標準對食管癌營養評估與術后并發癥預測的有效性. 腫瘤代謝與營養電子雜志, 2022, 9(5): 594-601.
16.	馬靈馭, 劉燕, 徐冠華. 降低脊柱手術患者術后感染率的多學科診療模式探討. 實用臨床醫藥雜志, 2018, 22(18): 80-82, 86.
17.	楊亞, 梁晨, 陳楨, 等. 國內外多學科診療模式研究進展分析. 中國衛生質量管理, 2021, 28(2): 16-19.
18.	芮云峰, 邱曉東, 鄒繼紅, 等. 多學科協作診療模式在老年髖部骨折的臨床應用. 中國修復重建外科雜志, 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. 中國膝骨關節炎流行病學和疾病負擔的系統評價. 中國循證醫學雜志, 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. 楊曉娜, 趙良虎, 黃金, 等. 依諾肝素鈉與磺達肝癸鈉預防膝關節置換術后深靜脈血栓的對比研究. 中國醫院用藥評價與分析, 2021, 21(10): 1176-1179.
6. 張雙偉, 王朝君, 徐鳳周, 等. 加速康復外科對老年股骨粗隆間骨折患者髖關節功能、生活質量及術后認知的影響. 河北醫藥, 2021, 43(10): 1470-1474.
7. 馬建華, 王慶雷, 劉前桂, 等. 多學科診治在高齡患者單髁膝關節置換術中的應用. 北京醫學, 2021, 43(7): 688-690.
8. 中華醫學會骨科學分會關節外科學組, 中國醫師協會骨科醫師分會骨關節炎學組, 國家老年疾病臨床醫學研究中心(湘雅醫院), 等. 中國骨關節炎診療指南(2021 年版). 中華骨科雜志, 2021, 41(18): 1291-1314.
9. 岳辰, 周宗科, 裴福興, 等. 中國髖、膝關節置換術圍術期抗纖溶藥序貫抗凝血藥應用方案的專家共識. 中華骨與關節外科雜志, 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, 魯攀攀, 等. 多學科協作診療模式在老年髖部骨折臨床應用中的研究進展. 中國修復重建外科雜志, 2020, 34(1): 132-138.
13. 孫亞召, 陳志坤, 孟杰杰, 等. 血清白蛋白和年齡休克指數及 Qanadli 指數與老年肺血栓栓塞的相關性研究. 中華老年心腦血管病雜志, 2022, 24(11): 1156-1158.
14. Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med, 2018, 52: 8-12.
15. 周麗麗, 吳丹, 石海燕. 評價 GLIM 標準對食管癌營養評估與術后并發癥預測的有效性. 腫瘤代謝與營養電子雜志, 2022, 9(5): 594-601.
16. 馬靈馭, 劉燕, 徐冠華. 降低脊柱手術患者術后感染率的多學科診療模式探討. 實用臨床醫藥雜志, 2018, 22(18): 80-82, 86.
17. 楊亞, 梁晨, 陳楨, 等. 國內外多學科診療模式研究進展分析. 中國衛生質量管理, 2021, 28(2): 16-19.
18. 芮云峰, 邱曉東, 鄒繼紅, 等. 多學科協作診療模式在老年髖部骨折的臨床應用. 中國修復重建外科雜志, 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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