Orthopaedic Surgery Service, Geneva University Hospitals, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
J Bone Joint Surg Am. 2010 Aug 18;92(10):1964-72. doi: 10.2106/JBJS.I.00749.
The most important long-term complication following total hip arthroplasty is periprosthetic femoral osteolysis. A sizeable proportion of patients who undergo arthroplasty are obese. While patient activity, implant type, and quality of fixation are known risk factors for osteolysis, the literature concerning obesity is sparse and controversial. Our primary objective was to evaluate the influence of obesity on the risk of osteolysis five and ten years after primary total hip arthroplasty with a cemented stem. Secondary objectives were to evaluate clinical outcome and patient satisfaction.
We conducted a prospective cohort study of patients undergoing hip arthroplasty with a third-generation stem-cementing technique from 1996 to 2003. All patients were seen at five or ten years postoperatively. Radiographs and information regarding body-mass index (<25 kg/m(2) = normal weight, 25 to 29.9 kg/m(2) = overweight, and > or = 30 kg/m(2) = obese) and activity were obtained. Activity was assessed with use of the University of California at Los Angeles (UCLA) activity scale. Osteolysis was assessed radiographically. Clinical outcome measurements included the Harris hip and Merle d'Aubigné and Postel scores.
Our study included 503 arthroplasties in 433 patients; the results of 241 (47.9%) of the arthroplasties were evaluated at five years and the results of 262 (52.1%), at ten years. Osteolysis was identified around forty-four stems, with twenty-four (13.3%) in 181 hips of normal-weight patients, eleven (5.4%) in 205 hips of overweight patients, and nine (7.7%) in 117 hips of obese patients. Normal-weight patients had the highest activity level (mean UCLA activity scale score [and standard deviation], 5.5 + or - 2.0 points), and obese patients had the lowest (mean UCLA activity scale score, 5.0 + or - 1.7 points). When adjusted for activity, cementing quality, and patient age and sex, the risk of osteolysis in obese patients was not increased as compared with that for overweight patients (adjusted odds ratio, 1.4; 95% confidence interval, 0.6 to 3.7), whereas the risk of femoral osteolysis in normal-weight patients was found to be significantly higher than that in overweight patients (adjusted odds ratio, 2.6; 95% confidence interval, 1.2 to 5.7). Clinical outcomes were similar among the groups.
We found no increased risk of osteolysis around a cemented femoral stem in obese patients five and ten years after primary total hip arthroplasty. The highest prevalence of osteolysis was observed in normal-weight patients.
Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.
全髋关节置换术后最重要的长期并发症是假体周围股骨溶骨。相当一部分接受关节置换术的患者是肥胖患者。虽然患者的活动度、植入物类型和固定质量是溶骨的已知危险因素，但关于肥胖的文献很少且存在争议。我们的主要目的是评估肥胖对使用第三代骨水泥固定技术的初次全髋关节置换术后 5 年和 10 年时假体周围溶骨风险的影响。次要目标是评估临床结果和患者满意度。
我们对 1996 年至 2003 年间接受第三代骨水泥固定技术髋关节置换术的患者进行了前瞻性队列研究。所有患者在术后 5 年或 10 年时接受了随访。获取了影像学和身体质量指数（<25 kg/m2=正常体重，25 至 29.9 kg/m2=超重，≥30 kg/m2=肥胖）和活动情况的信息。活动度采用加利福尼亚大学洛杉矶分校（UCLA）活动量表进行评估。通过影像学评估溶骨情况。临床结果测量包括 Harris 髋关节评分、Merle d'Aubigné 和 Postel 评分。
我们的研究纳入了 433 名患者中的 503 例关节置换术；241 例（47.9%）关节置换术在 5 年时进行了评估，262 例（52.1%）在 10 年时进行了评估。在 181 髋正常体重患者中有 44 个股骨假体周围发现溶骨，205 髋超重患者中有 11 个（5.4%），117 髋肥胖患者中有 9 个（7.7%）。正常体重患者的活动水平最高（平均 UCLA 活动量表评分[和标准差]，5.5+/-2.0 分），而肥胖患者的活动水平最低（平均 UCLA 活动量表评分，5.0+/-1.7 分）。在调整了活动度、骨水泥质量以及患者年龄和性别后，与超重患者相比，肥胖患者的假体周围溶骨风险没有增加（校正比值比，1.4；95%置信区间，0.6 至 3.7），而正常体重患者的股骨溶骨风险明显高于超重患者（校正比值比，2.6；95%置信区间，1.2 至 5.7）。各组的临床结果相似。
我们发现初次全髋关节置换术后 5 年和 10 年时，肥胖患者股骨骨水泥固定假体周围无溶骨风险增加。在正常体重患者中，溶骨的发生率最高。
预后水平 I。请参阅《作者须知》以获取完整的证据水平描述。
