Development and validation of a nomogram model for predicting knee function improvement in early postoperative period after total knee arthroplasty_West China Medical Journal

Authors：

DU Dan , FU Jia , YANG Xi , FENG Lin ,  ZHANG Huiwu

Department of Geriatric Orthopedics 2, Sichuan Province Orthopedic Hospital (Chengdu Sports Hospital, Chengdu Institute of Sports Trauma), Chengdu, Sichuan 610051, P. R. China;

Corresponding author：

ZHANG Huiwu, Email: miao074033069@163.com

Keywords：

Total knee arthroplasty; knee function; multiple analysis; nomogram model

DOI：

10.7507/1002-0179.202306156

Video：

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Objective To develop and validate a nomogram prediction model of early knee function improvement after total knee arthroplasty (TKA). Methods One hundred and sixty-eight patients who underwent TKA at Sichuan Province Orthopedic Hospital between January 2018 and February 2021 were prospectively selected to collect factors that might influence the improvement of knee function in the early postoperative period after TKA, and the improvement of knee function was assessed using the Knee Score Scale of the Hospital for Special Surgery (HSS) at 6 months postoperatively. The patients were divided into two groups according to the postoperative knee function improvement. The preoperative, intraoperative and postoperative factors were compared between the two groups; multiple logistic regression was performed after the potential factors screened by LASSO regression; then, a nomogram predictive model was established by R 4.1.3 language and was validated internally. Results All patients were followed up at 6 months postoperatively, and the mean HSS score of the patients increased from 55.19±8.92 preoperatively to 89.27±6.18 at 6 months postoperatively (t=−40.706, P<0.001). LASSO regression screened eight influencing factors as potential factors, with which the results of multiple logistic regression analysis showed that preoperative body mass index, etiology, preoperative joint mobility, preoperative HSS scores, postoperative lower limb force line, and postoperative analgesia were independent influencing factors for the improvement of knee function in the early postoperative period after TKA (P<0.05). A nomogram model was established based on the multiple logistic regression results, and the calibration curve showed that the prediction curve basically fitted the standard curve; the receiver operating characteristic curve showed that the area under the curve of the nomogram model for the prediction of suboptimal knee function in the early postoperative period after TKA was 0.894 [95% confidence interval (0.825, 0.963)]. Conclusions There is a significant improvement in knee function in patients after TKA, and the improvement of knee function in the early postoperative period after TKA is influenced by preoperative body mass index, etiology, and preoperative joint mobility, etc. The nomogram model established accordingly can be used to predict the improvement of knee function in the early postoperative period after TKA with a high degree of differentiation and accuracy.

Citation： DU Dan, FU Jia, YANG Xi, FENG Lin, ZHANG Huiwu. Development and validation of a nomogram model for predicting knee function improvement in early postoperative period after total knee arthroplasty. West China Medical Journal, 2023, 38(12): 1868-1873. doi: 10.7507/1002-0179.202306156 Copy

1.	金宏亮, 白广超, 李宽新, 等. 全膝关节置换术后疗效评分系统的研究进展. 生物骨科材料与临床研究, 2018, 15(1): 64-68.
2.	Moukarzel M, Di Rienzo F, Lahoud JC, et al. The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study. Disabil Rehabil, 2019, 41(8): 926-933.
3.	吴琼, 马殿栋, 罗金维, 等. 膝关节置换术患者临床流行病学回顾性分析与对策. 临床医学进展, 2019, 9(6): 739-743.
4.	Qin G, Liu X, He K, et al. Surgical treatment and reconstruction strategy of knee valgus deformity. Chin J Tissue Eng Res, 2019, 23(24): 3889-3892.
5.	刘磊, 徐石庄, 杨冠杰, 等. 不同程度膝内翻患者初次全膝关节置换术后下肢力线分布与近期临床疗效的关系. 中国骨伤, 2020, 33(6): 530-535.
6.	高嘉翔, 邢丹, 林剑浩. 下肢力线的测量及其在全膝关节置换术中的应用. 中华外科杂志, 2020, 58(6): 478-480.
7.	Zhao L, Xu F, Lao S, et al. Comparison of the clinical effects of computer-assisted and traditional techniques in bilateral total knee arthroplasty: a meta-analysis of randomized controlled trials. PLoS One, 2020, 15(9): e0239341.
8.	严广斌. 膝关节评分标准. 中华关节外科杂志(电子版), 2010(6): 845.
9.	Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty, 2018, 33(12): 3678-3684.
10.	Hsiao YH, Chien SH, Tu HP, et al. Early post-operative intervention of whole-body vibration in patients after total knee arthroplasty: a pilot study. J Clin Med, 2019, 8(11): 1902-1905.
11.	Tang XS, Zhang H, Chen L, et al. Stretching force of incision affects early clinical results after primary total knee arthroplasty: a retrospective study. Orthop Surg, 2021, 13(1): 237-243.
12.	丁韶龙, 康波, 李志军. 膝骨关节炎患者全膝关节置换后关节功能恢复影响因素分析. 新乡医学院学报, 2020, 37(6): 563-565.
13.	Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Acta Orthop, 2020, 91(1): 3-19.
14.	Nedopil AJ, Singh AK, Howell SM, et al. Does calipered kinematically aligned TKA restore native left to right symmetry of the lower limb and improve function?. J Arthroplasty, 2018, 33(2): 398-340.
15.	Zhang ZQ, Mei Yf, Zhang L, et al. Therapeutic effects comparison and revision case analysis of unicompartmental knee arthroplasty and open wedge high tibial osteotomy in treating medial knee osteoarthritis in patients under 60 years: a 2-6-year follow-up study. Orthop Surg, 2020, 12(6): 1635-1643.
16.	Wang HR, Li ZL, Li J, et al. Arthroscopy combined with unicondylar knee arthroplasty for treatment of isolated unicompartmental knee arthritis: a long-term comparison. World J Clin Cases, 2019, 7(24): 4196-4207.
17.	Mahdi A, Svantesson M, Wretenberg P, et al. Patients’ experiences of discontentment one year after total knee arthroplasty- a qualitative study. BMC Musculoskelet Disord, 2020, 21(1): 29.
18.	Zhang R, Lin J, Chen F, et al. Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review. J Orthop Surg Res, 2021, 16(1): 495.
19.	Völlner F, Fischer J, Weber M, et al. Weakening of the knee ligament complex due to sequential medial release in total knee arthroplasty. Arch Orthop Trauma Surg, 2019, 139(7): 999-1006.

1. 金宏亮, 白广超, 李宽新, 等. 全膝关节置换术后疗效评分系统的研究进展. 生物骨科材料与临床研究, 2018, 15(1): 64-68.
2. Moukarzel M, Di Rienzo F, Lahoud JC, et al. The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study. Disabil Rehabil, 2019, 41(8): 926-933.
3. 吴琼, 马殿栋, 罗金维, 等. 膝关节置换术患者临床流行病学回顾性分析与对策. 临床医学进展, 2019, 9(6): 739-743.
4. Qin G, Liu X, He K, et al. Surgical treatment and reconstruction strategy of knee valgus deformity. Chin J Tissue Eng Res, 2019, 23(24): 3889-3892.
5. 刘磊, 徐石庄, 杨冠杰, 等. 不同程度膝内翻患者初次全膝关节置换术后下肢力线分布与近期临床疗效的关系. 中国骨伤, 2020, 33(6): 530-535.
6. 高嘉翔, 邢丹, 林剑浩. 下肢力线的测量及其在全膝关节置换术中的应用. 中华外科杂志, 2020, 58(6): 478-480.
7. Zhao L, Xu F, Lao S, et al. Comparison of the clinical effects of computer-assisted and traditional techniques in bilateral total knee arthroplasty: a meta-analysis of randomized controlled trials. PLoS One, 2020, 15(9): e0239341.
8. 严广斌. 膝关节评分标准. 中华关节外科杂志(电子版), 2010(6): 845.
9. Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty, 2018, 33(12): 3678-3684.
10. Hsiao YH, Chien SH, Tu HP, et al. Early post-operative intervention of whole-body vibration in patients after total knee arthroplasty: a pilot study. J Clin Med, 2019, 8(11): 1902-1905.
11. Tang XS, Zhang H, Chen L, et al. Stretching force of incision affects early clinical results after primary total knee arthroplasty: a retrospective study. Orthop Surg, 2021, 13(1): 237-243.
12. 丁韶龙, 康波, 李志军. 膝骨关节炎患者全膝关节置换后关节功能恢复影响因素分析. 新乡医学院学报, 2020, 37(6): 563-565.
13. Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Acta Orthop, 2020, 91(1): 3-19.
14. Nedopil AJ, Singh AK, Howell SM, et al. Does calipered kinematically aligned TKA restore native left to right symmetry of the lower limb and improve function?. J Arthroplasty, 2018, 33(2): 398-340.
15. Zhang ZQ, Mei Yf, Zhang L, et al. Therapeutic effects comparison and revision case analysis of unicompartmental knee arthroplasty and open wedge high tibial osteotomy in treating medial knee osteoarthritis in patients under 60 years: a 2-6-year follow-up study. Orthop Surg, 2020, 12(6): 1635-1643.
16. Wang HR, Li ZL, Li J, et al. Arthroscopy combined with unicondylar knee arthroplasty for treatment of isolated unicompartmental knee arthritis: a long-term comparison. World J Clin Cases, 2019, 7(24): 4196-4207.
17. Mahdi A, Svantesson M, Wretenberg P, et al. Patients’ experiences of discontentment one year after total knee arthroplasty- a qualitative study. BMC Musculoskelet Disord, 2020, 21(1): 29.
18. Zhang R, Lin J, Chen F, et al. Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review. J Orthop Surg Res, 2021, 16(1): 495.
19. Völlner F, Fischer J, Weber M, et al. Weakening of the knee ligament complex due to sequential medial release in total knee arthroplasty. Arch Orthop Trauma Surg, 2019, 139(7): 999-1006.

West China Medical Journal

Development and validation of a nomogram model for predicting knee function improvement in early postoperative period after total knee arthroplasty

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