Evan M Dugdale, Mason E Uvodich, Mark W Pagnano, Daniel J Berry, Matthew P Abdel, Nicholas A Bedard
{"title":"对于接受全髋关节置换术的病态肥胖患者来说，预防早期不良后果仍是一项挑战。","authors":"Evan M Dugdale, Mason E Uvodich, Mark W Pagnano, Daniel J Berry, Matthew P Abdel, Nicholas A Bedard","doi":"10.1302/0301-620X.106B11.BJJ-2023-1187.R1","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>The prevalence of obesity is increasing substantially around the world. Elevated BMI increases the risk of complications following total hip arthroplasty (THA). We sought to evaluate trends in BMI and complication rates of obese patients undergoing primary THA over the last 30 years.</p><p><strong>Methods: </strong>Through our institutional total joint registry, we identified 15,455 primary THAs performed for osteoarthritis from 1990 to 2019. Patients were categorized according to the World Health Organization (WHO) obesity classification and groups were trended over time. Cox proportional hazards regression analysis controlling for confounders was used to investigate the association between year of surgery and two-year risk of any reoperation, any revision, dislocation, periprosthetic joint infection (PJI), venous thromboembolism (VTE), and periprosthetic fracture. Regression was stratified by three separate groups: non-obese; WHO Class I and Class II (BMI 30 to 39 kg/m<sup>2</sup>); and WHO Class III patients (BMI ≥ 40 kg/m<sup>2</sup>).</p><p><strong>Results: </strong>There was a significant increase in the proportion of all obesity classes from 1990 to 2019, and the BMI values within each WHO class significantly increased over time. Risk of any reoperation did not change over time among non-obese or WHO Class I/II patients, but increased for WHO Class III patients (hazard ratio (HR) 1.04; p = 0.044). Risk of dislocation decreased over time for non-obese (HR 0.96; p < 0.001) and WHO Class I/II (HR 0.96; p = 0.002) patients, but did not change over time for WHO Class III (HR 0.94; p = 0.073) patients. Risks of any revision and PJI did not change over time for any group.</p><p><strong>Conclusion: </strong>The proportion of patients undergoing THA who are obese has increased dramatically at our institution between 1990 and 2019. Despite BMI values increasing within all WHO classes over time, two-year complication risks have remained stable or decreased in WHO Class I/II patients. However, continued efforts will be required to mitigate risks in the heaviest WHO Class III patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"106-B 11","pages":"1223-1230"},"PeriodicalIF":4.9000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Early adverse outcomes remain challenging to prevent in morbidly obese patients undergoing total hip arthroplasty.\",\"authors\":\"Evan M Dugdale, Mason E Uvodich, Mark W Pagnano, Daniel J Berry, Matthew P Abdel, Nicholas A Bedard\",\"doi\":\"10.1302/0301-620X.106B11.BJJ-2023-1187.R1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>The prevalence of obesity is increasing substantially around the world. Elevated BMI increases the risk of complications following total hip arthroplasty (THA). 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Regression was stratified by three separate groups: non-obese; WHO Class I and Class II (BMI 30 to 39 kg/m<sup>2</sup>); and WHO Class III patients (BMI ≥ 40 kg/m<sup>2</sup>).</p><p><strong>Results: </strong>There was a significant increase in the proportion of all obesity classes from 1990 to 2019, and the BMI values within each WHO class significantly increased over time. Risk of any reoperation did not change over time among non-obese or WHO Class I/II patients, but increased for WHO Class III patients (hazard ratio (HR) 1.04; p = 0.044). Risk of dislocation decreased over time for non-obese (HR 0.96; p < 0.001) and WHO Class I/II (HR 0.96; p = 0.002) patients, but did not change over time for WHO Class III (HR 0.94; p = 0.073) patients. Risks of any revision and PJI did not change over time for any group.</p><p><strong>Conclusion: </strong>The proportion of patients undergoing THA who are obese has increased dramatically at our institution between 1990 and 2019. Despite BMI values increasing within all WHO classes over time, two-year complication risks have remained stable or decreased in WHO Class I/II patients. 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引用次数: 0
摘要
目的：肥胖症的发病率在全球范围内大幅上升。体重指数（BMI）升高会增加全髋关节置换术（THA）后并发症的风险。我们试图评估过去 30 年间接受全髋关节置换术的肥胖患者的体重指数和并发症发生率的变化趋势：通过本机构的全关节登记处，我们确定了 1990 年至 2019 年期间因骨关节炎进行的 15,455 例初次 THA。根据世界卫生组织（WHO）的肥胖分类对患者进行分类，并随时间推移对各组进行趋势分析。采用控制混杂因素的 Cox 比例危险回归分析来研究手术年份与任何再手术、任何翻修、脱位、假体周围关节感染 (PJI)、静脉血栓栓塞 (VTE) 和假体周围骨折的两年风险之间的关系。回归按三个不同组别进行分层：非肥胖、WHO I级和II级（体重指数30至39千克/平方米）以及WHO III级患者（体重指数≥40千克/平方米）：结果：从1990年到2019年，所有肥胖级别的比例都有明显增加，而每个WHO级别内的BMI值也随着时间的推移而明显增加。非肥胖或WHO I/II级患者再次手术的风险随时间变化不大，但WHO III级患者再次手术的风险有所增加（危险比（HR）为1.04；P = 0.044）。非肥胖（HR 0.96；p < 0.001）和 WHO I/II 级（HR 0.96；p = 0.002）患者的脱位风险随时间推移而降低，但 WHO III 级（HR 0.94；p = 0.073）患者的脱位风险随时间推移没有变化。任何组别的翻修风险和PJI风险都没有随着时间的推移而变化：结论：1990年至2019年期间，我院接受THA手术的肥胖患者比例急剧增加。尽管随着时间的推移，所有WHO分级中的BMI值都在增加，但WHO I/II级患者的两年并发症风险保持稳定或有所下降。不过，我们仍需继续努力，降低体重最重的 WHO III 级患者的风险。
Early adverse outcomes remain challenging to prevent in morbidly obese patients undergoing total hip arthroplasty.
Aims: The prevalence of obesity is increasing substantially around the world. Elevated BMI increases the risk of complications following total hip arthroplasty (THA). We sought to evaluate trends in BMI and complication rates of obese patients undergoing primary THA over the last 30 years.
Methods: Through our institutional total joint registry, we identified 15,455 primary THAs performed for osteoarthritis from 1990 to 2019. Patients were categorized according to the World Health Organization (WHO) obesity classification and groups were trended over time. Cox proportional hazards regression analysis controlling for confounders was used to investigate the association between year of surgery and two-year risk of any reoperation, any revision, dislocation, periprosthetic joint infection (PJI), venous thromboembolism (VTE), and periprosthetic fracture. Regression was stratified by three separate groups: non-obese; WHO Class I and Class II (BMI 30 to 39 kg/m2); and WHO Class III patients (BMI ≥ 40 kg/m2).
Results: There was a significant increase in the proportion of all obesity classes from 1990 to 2019, and the BMI values within each WHO class significantly increased over time. Risk of any reoperation did not change over time among non-obese or WHO Class I/II patients, but increased for WHO Class III patients (hazard ratio (HR) 1.04; p = 0.044). Risk of dislocation decreased over time for non-obese (HR 0.96; p < 0.001) and WHO Class I/II (HR 0.96; p = 0.002) patients, but did not change over time for WHO Class III (HR 0.94; p = 0.073) patients. Risks of any revision and PJI did not change over time for any group.
Conclusion: The proportion of patients undergoing THA who are obese has increased dramatically at our institution between 1990 and 2019. Despite BMI values increasing within all WHO classes over time, two-year complication risks have remained stable or decreased in WHO Class I/II patients. However, continued efforts will be required to mitigate risks in the heaviest WHO Class III patients.
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