Comment on Liu et al.: a comparative study of clinical effect of total knee arthroplasty in the treatment of primary ost
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LETTER TO THE EDITOR
Comment on Liu et al.: a comparative study of clinical effect of total knee arthroplasty in the treatment of primary osteoarthritis and osteoarthritis of Kashin-Beck disease Kaihu Li 1 & Yong Zhu 1 Received: 4 October 2020 / Accepted: 9 October 2020 # SICOT aisbl 2020
Dear Editor, In the September 2020 issue of International Orthopaedics, we read with great interest the article by Liu et al. [1] entitled, a comparative study of clinical effect of total knee arthroplasty in the treatment of primary osteoarthritis and osteoarthritis of Kashin-Beck disease. The authors concluded that KBD-TKA had as good post-operative outcomes as OA-TKA in VAS score, ROM, HSS score, but had significantly worse SF-36 score than OA-TKA. The multiple linear regression revealed that diagnosis of KBD was an independent risk factor for poor quality of life after TKA, whereas pre-operative pain was an important predictor of post-operative pain. Pre-operative age, gender, BMI and the angles of knee prosthesis were not associated with the clinical efficacy of TKA. It is a meaningful research. Nevertheless, there are some slips and flaws in their study. 1. The follow-up time of KBD-TKA was 72.68 ± 37.55 months and that of OA-TKA was 49.2 ± 28.91 months, which was significantly different (P < 0.001). It was hard to compare the post-operative clinical effect between them, for patients in KBD-TKA group had much longer recovery time. We suggest that the assessment time should be the same in each patient. 2. There were two statistically different data in the tables that had been regarded as meaningless in the text. One was pre-operative aLDFA (P = 0.028) in Table 4, the other was pre-operative PCS scores (P = 0.021, estimated coefficient of final follow-up VAS) in Table 6. 3. The time of patients included varied from September 2008 to June 2018, and surgical techniques of the same * Yong Zhu [email protected] 1
Department of Orthopaedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, Hunan, China
surgeon may also vary extensively during such a long time. Moreover, it was difficult to exclude the influence of different joint prosthesis selected for patients on the post-operative clinical efficacy, which should also be included as a categorical variable into the multiple linear regression. 4. The KBD often impairs multiple joints besides knees and it has been figured out that the unsolved pain in other joints in KBD-TKA patients lowered the clinical efficacy [2]. Thus, whether or not the patients had multiple joint involvement should be recorded and this variable should also be added to regression analysis. In the regression of this study, there may exist colinearity among the selected clinical indexes, because HSS and SF36 scores were closely related to VAS and ROM. 5. The pathologic changes and deformity of KBD are often more complicated than primary OA [3], but there are few objective indexes to assess. We recommend to use perioperative indicators to indirectly reflect the difference, s
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