Ersozlu Salim, Akkaya Tolga, Ozgur Ahmet Fevzi, Sahin Orcun, Senturk Ihsan, Tandogan Reha
Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, 06490 Ankara, Turkey.
Arch Orthop Trauma Surg. 2008 Feb;128(2):143-8. doi: 10.1007/s00402-007-0356-1. Epub 2007 Aug 11.
The purpose of this study was to compare the clinical and functional results and complications associated with staged bilateral total knee arthroplasty (TKA) performed 4-11 days apart during a single hospitalization in patients who were obese and patients who were not obese.
We retrospectively evaluated 48 (96 knees) patients who were obese and divided into two groups based on their body mass indices (BMI). Morbidly obese patients (group A1, BMI > or = 40 kg/m2) consisted of 21 patients (42 knees), and obese patients (group A2, BMI > or = 30 kg/m2) consisted of 27 patients (54 knees). The control group (group B, BMI < 30 kg/m2) consisted of 20 non-obese patients (40 knees), who were undergoing staged bilateral procedure within the same time frame. All patients had cemented TKAs with use of posterior cruciate sparing prosthesis without patellar resurfacing. If medically stable after the first arthroplasty the patients then underwent the second arthroplasty 4-11 days later. The data on major complications and minor complications were evaluated.
Although, there was no statistically significant difference in overall complication rates in any of the groups, the non-obese group had fewer wound complications than the other groups (P > 0.05). No significant differences in preoperative or postoperative Knee Society score, and functional score could be demonstrated between the three groups (P > 0.05). Both obese and nonobese patients showed improvements in pain and function from pre-surgery to a minimum 2 years follow-up.
Results of bilateral staged TKAs in obese patients have low complication and high success rates and increased BMI has no negative effect on the early outcome. Bilateral staged TKA might be a good treatment alternative for the improvement of the patient's quality of life and functional and clinical outcomes.
本研究的目的是比较肥胖患者和非肥胖患者在单次住院期间间隔4 - 11天进行分期双侧全膝关节置换术（TKA）的临床和功能结果以及并发症情况。
我们回顾性评估了48例（96膝）肥胖患者，并根据其体重指数（BMI）分为两组。病态肥胖患者（A1组，BMI≥40 kg/m²）有21例（42膝），肥胖患者（A2组，BMI≥30 kg/m²）有27例（54膝）。对照组（B组，BMI < 30 kg/m²）由20例非肥胖患者（40膝）组成，他们在同一时间框架内接受分期双侧手术。所有患者均使用后交叉韧带保留假体且不进行髌骨表面置换的骨水泥型TKA。如果在首次关节置换术后病情稳定，患者在4 - 11天后接受第二次关节置换术。评估主要并发症和次要并发症的数据。
尽管任何一组的总体并发症发生率在统计学上均无显著差异，但非肥胖组的伤口并发症比其他组少（P > 0.05）。三组之间术前或术后膝关节协会评分以及功能评分均无显著差异（P > 0.05）。肥胖和非肥胖患者从术前到至少2年的随访中疼痛和功能均有改善。
肥胖患者分期双侧TKA的结果并发症发生率低、成功率高，且BMI增加对早期结果无负面影响。分期双侧TKA可能是改善患者生活质量以及功能和临床结果的一种良好治疗选择。
