2023, Vol. 27 ›› Issue (36): 5806-5811

Relationship of preoperative sleep quality and early rehabilitation after unicompartmental knee arthroplasty

Zhu Xunpeng, Xu Hui, Wang Lin, Wang Jun, Zhang Hui   

Abstract: BACKGROUND: Unicompartmental knee arthroplasty is an effective treatment for end-stage knee osteoarthritis, and its surgical procedures are relatively standard and uniform. The trauma caused by surgery in different patients is quite similar, but its postoperative recovery rate and degree are not the same. Perioperative sleep disorders have a high incidence in knee arthroplasty; however, there is still a lack of studies on the correlation between preoperative sleep quality and early rehabilitation after unicompartmental knee arthroplasty in China.
OBJECTIVE: To investigate the effect of preoperative sleep quality on early rehabilitation after unicompartmental knee arthroplasty.
METHODS: A total of 218 patients with knee osteoarthritis who underwent unicompartmental knee arthroplasty in The First Affiliated Hospital of Anhui Medical University from July 2018 to July 2022 were enrolled. Pittsburgh Sleep Quality Index was used to evaluate sleep quality before operation. The study subjects were divided into a high preoperative sleep quality group (Pittsburgh Sleep Quality Index score ≤ 5, n=102) and a low preoperative sleep quality group (Pittsburgh Sleep Quality Index score > 5, n=116) according to the results. The visual analog scale score of pain at 12, 24, 48 and 72 hours after operation, the number of days required for 90° of knee flexion after operation (knee flexed at least 90° without applying external force and without unbearable pain) and the length of postoperative hospital stay were compared between the two groups. The postoperative opioid analgesic use (converted to oral morphine equivalent) was also recorded between the two groups.
RESULTS AND CONCLUSION: (1) There was no significant difference in age, height, body mass index, joint side, preoperative knee range of motion, preoperative visual analog scale score, preoperative Hospital for Special Surgery score and preoperative hemoglobin concentration, and albumin concentration between the two groups (P > 0.05). (2) Compared with the low preoperative sleep quality group, the high preoperative sleep quality group had significantly lower postoperative visual analog scale scores at 12, 24, 48, and 72 hours, opioid analgesic use, hemoglobin difference and albumin difference before and after operation, the number of days required for 90° of knee flexion, the length of postoperative hospital stay, and the differences were statistically significant (P < 0.05). (3) The results show that improving preoperative sleep quality is of great significance in improving prognosis, reducing the use of analgesics, improving patient satisfaction, and reducing social burden, and can directly or indirectly accelerate early rehabilitation after unicompartmental knee arthroplasty from multiple aspects and dimensions.

Key words: knee osteoarthritis, unicompartmental knee arthroplasty, Pittsburgh Sleep Quality Index, preoperative sleep quality, postoperative pain, visual analog scale score, postoperative hospital stay, early rehabilitation