接受初级全膝关节置换术的肥胖患者的疗效:30年来的趋势。

Mason E Uvodich,Evan M Dugdale,Mark W Pagnano,Daniel J Berry,Matthew P Abdel,Nicholas A Bedard
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引用次数: 0

摘要

背景接受全膝关节置换术(TKA)的患者肥胖率大幅上升。此外,肥胖也是导致 TKA 术后并发症的一个公认的风险因素。本研究的目的是分析三十年来在一家机构接受初级 TKA 治疗的肥胖患者的体重指数(BMI)和并发症风险的变化趋势。方法利用机构全关节登记处,对 1990 年至 2019 年间为治疗骨关节炎而实施的 13919 例初级 TKA 进行了鉴定。根据世界卫生组织(WHO)的分类,按体重指数将患者分为三组:非肥胖(体重指数<30 kg/m2)、WHO一级和二级肥胖(体重指数30至39.9 kg/m2)以及WHO三级肥胖(体重指数≥40 kg/m2)。结果在研究期间,II级肥胖的患病率增加了90%(从13%增加到25%),III级肥胖的患病率增加了300%(从3%增加到12%)。对整个队列进行的分析表明,随着时间的推移,2 年内再次手术、翻修手术和 PJI 的风险均有所下降(P < 0.05)。非肥胖患者再次手术(p = 0.029)和翻修手术(p = 0.004)的风险随着时间的推移明显降低,III级肥胖患者再次手术(p = 0.038)和翻修手术(p = 0.012)的风险随着时间的推移明显降低,但I级和II级肥胖患者的风险保持稳定。从 1990 年到 2019 年,非肥胖患者的 PJI 风险有所下降(p = 0.005),但任何肥胖组的 PJI 风险均无显著变化。非肥胖患者的再手术和翻修风险下降,I 级和 II 级肥胖患者的风险保持稳定,III 级肥胖患者的风险下降。在研究期间,非肥胖患者的 PJI 风险有所下降,但任何肥胖类别的患者的 PJI 风险都没有下降。尽管再次手术和翻修的风险有所下降,但仍需进一步努力以改善肥胖患者的 PJI 风险。有关证据等级的完整描述,请参阅 "作者须知"。
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Outcomes of Obese Patients Undergoing Primary Total Knee Arthroplasty: Trends Over 30 Years.
BACKGROUND The rates of obesity among patients undergoing total knee arthroplasty (TKA) have substantially increased. In addition, obesity is a well-established risk factor for complications after TKA. The purpose of this study was to analyze trends in body mass index (BMI) and complication risk among obese patients undergoing primary TKA treated at a single institution over 3 decades. METHODS Utilizing an institutional total joint registry, 13,919 primary TKAs performed to treat osteoarthritis between 1990 and 2019 were identified. Patients were stratified by BMI according to the World Health Organization (WHO) classification into 3 groups: non-obese (BMI, <30 kg/m2), WHO Class-I and II obese (BMI, 30 to 39.9 kg/m2), and WHO Class-III obese (BMI, ≥40 kg/m2). Trends in BMI and survivorship free from reoperation, revision, and periprosthetic joint infection (PJI) were analyzed over time while controlling for age, sex, and the Charlson Comorbidity Index. RESULTS Over the study period, there was a 90% increase in the prevalence of Class-II obesity (13% to 25%) and a 300% increase in Class-III obesity (3% to 12%). Analysis of the entire cohort demonstrated a decrease in the 2-year risk of any reoperation, any revision, and PJI (p < 0.05 for all) with time. The risk decreased significantly over time for non-obese patients for any reoperation (p = 0.029) and any revision (p = 0.004) and for Class-III obese patients for any reoperation (p = 0.038) and any revision (p = 0.012), but it remained stable for Class-I and II obese patients. The risk of PJI decreased from 1990 to 2019 for non-obese patients (p = 0.005), but there were no significant changes in PJI risk for any obesity group. CONCLUSIONS Despite increasing rates of obesity among our patients who underwent TKA, we observed decreasing risks of reoperation, revision, and PJI over time. The risks of reoperation and revision declined among non-obese patients, remained stable for Class-I and II obese patients, and declined for Class-III obese patients. The PJI risk declined for non-obese patients over the study period, but no such decline occurred for any category of obesity. Despite the decreasing risks of reoperation and revision, further work is needed to improve PJI risk in obese patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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