Serial changes in patient-reported outcome measures and satisfaction rate during long-term follow-up after total knee arthroplasty: a systematic review and meta-analysis.

Jisu Park, Moon Jong Chang, Tae Woo Kim, Darryl D D'Lima, Hyunkwon Kim, Hyuk-Soo Han
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Abstract

Purpose: This study aimed to investigate the sequential changes in patient-reported outcome measures (PROMs) and the satisfaction rate during long-term follow-up after total knee arthroplasty (TKA).

Methods: Studies published until December 2023 were searched in MEDLINE, EMBASE, SCOPUS and Cochrane Library. The inclusion criteria were TKA as the primary procedure, a final post-operative follow-up period of at least seven years and reporting of PROMs data. The exclusion criteria were studies not reporting serial data of the same patient cohort, studies without mid-term data, comparative studies and reviews, comments or practice guidelines. Heterogeneity was assessed with the I2 and tau2 statistics. The quality of each study was evaluated using the methodological index for non-randomized studies (MINORS) criteria. The follow-up periods were divided into short-term, mid-term and long-term. Data were synthesised by narrative reviews and random-effects meta-analysis using standardised mean difference.

Results: Among the 13 studies included in the review, six were included in the meta-analysis. The overall PROMs were maintained until the mid-term (0.14; 95% CI [confidence interval], -0.05 to 0.34; I2 = 96%; tau2 = 0.10; P = 0.16), but declined in the long-term (-0.23; 95% CI -0.34 to -0.13; I2 = 88%; tau2 = 0.04; P < 0.0001). According to the subgroup analysis, pain improved from the short-term to mid-term (0.21; 95% CI 0.14 to 0.29; I2 = 0%; tau2 = 0). Subscales including function (-0.28; 95% CI -0.52 to -0.03; I2 = 94%; tau2 = 0.09) and objective measure (-0.23; 95% CI -0.31 to -0.15; I2 = 62%; tau2 = 0.01) declined from the mid-term to long-term. The patient satisfaction rate remained consistent throughout the study period.

Conclusions: The overall PROMs after TKA were maintained, with improvement observed in the pain subscale until the mid-term follow-up. However, in the long-term, overall PROMs, including function and objective measure, declined compared with those in the mid-term. Despite the decline in the physical aspects of PROMs over the long-term follow-up period, the patient satisfaction rate remained consistently high throughout the study period. Providing this information to patient pre-operatively may assist in establishing realistic expectations. Trial Registration This research was registered at PROSPERO (registration number: CRD42024578579).

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在全膝关节置换术后的长期随访中,患者报告的结果测量和满意度的一系列变化:系统回顾和荟萃分析。
目的:本研究旨在探讨全膝关节置换术(TKA)后长期随访中患者报告的预后指标(PROMs)和满意度的顺序变化。方法:在MEDLINE、EMBASE、SCOPUS和Cochrane图书馆检索2023年12月前发表的研究。纳入标准为TKA为主要手术,最终术后随访期至少7年,并报告PROMs数据。排除标准为未报告同一患者队列序列数据的研究、没有中期数据的研究、比较研究和综述、评论或实践指南。用I2和tau2统计量评估异质性。采用非随机研究方法学指标(minor)标准对每项研究的质量进行评价。随访期分为短期、中期和长期。数据通过叙述性综述和使用标准化平均差的随机效应荟萃分析进行综合。结果:纳入综述的13项研究中,有6项纳入meta分析。总体PROMs保持到中期(0.14;95% CI[置信区间],-0.05 ~ 0.34;i2 = 96%;tau2 = 0.10;P = 0.16),但长期下降(-0.23;95% CI -0.34 ~ -0.13;i2 = 88%;tau2 = 0.04;p 2 = 0%;tau2 = 0)。子量表包括函数(-0.28;95% CI -0.52 ~ -0.03;i2 = 94%;Tau2 = 0.09)和客观测量(-0.23;95% CI -0.31 ~ -0.15;i2 = 62%;Tau2 = 0.01)从中期到长期呈下降趋势。患者满意率在整个研究期间保持一致。结论:TKA术后患者整体疼痛评分维持,疼痛量表改善,直至中期随访。然而,从长期来看,包括功能和客观测量在内的整体PROMs与中期相比有所下降。尽管在长期随访期间,PROMs的生理方面有所下降,但在整个研究期间,患者满意度始终保持在较高水平。术前向患者提供这些信息可能有助于建立切合实际的期望。本研究在普洛斯彼罗注册(注册号:CRD42024578579)。
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CiteScore
6.50
自引率
0.00%
发文量
42
审稿时长
19 weeks
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