Houdek Matthew T, Wagner Eric R, Watts Chad D, Osmon Douglas R, Hanssen Arlen D, Lewallen David G, Mabry Tad M
Department of Orthopedic Surgery (M.T.H., E.R.W., C.D.W., A.D.H., D.G.L., and T.M.M.) and Division of Infectious Diseases, Department of Internal Medicine (D.R.O.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for M.T. Houdek:
J Bone Joint Surg Am. 2015 Feb 18;97(4):326-32. doi: 10.2106/JBJS.N.00515.
Morbid obesity (BMI [body mass index], ≥40 kg/m2) is associated with a higher risk of complications, including infection and implant failure, following primary total hip arthroplasty. The purpose of this study was to compare the results of two-stage revision total hip arthroplasty for infection in a morbidly obese patient cohort (BMI, ≥40 kg/m2) and nonobese patients (BMI, <30 kg/m2).
Using an institutional total joint registry, we reviewed the medical records of 653 patients treated with two-stage revision total hip arthroplasty for periprosthetic joint infection over a twenty-year period (1987 to 2007). Patients were stratified according to preoperative BMI. Thirty-three patients (fourteen male and nineteen female) with a BMI of ≥40 kg/m2 were identified. These patients were matched 1:2 with a cohort of sixty-six patients (twenty-eight male and thirty-eight female) of the same sex and similar age (91% within two years) who were not obese (BMI, <30 kg/m2). All patients had a minimum of five years of clinical follow-up (mean, 8.1 years in the morbidly obese group and 10.3 years in the nonobese group).
Compared with nonobese patients, morbidly obese patients had significantly greater rates of reinfection (18% compared with 2%, p<0.005), revision (42% compared with 11%, p<0.001) and reoperation for any reason (61% compared with 12%, p<0.001). Prior to surgery, the mean Harris Hip Score had been 50.6 in the morbidly obese group and 48.8 in the nonobese group, and these scores improved significantly in both groups postoperatively (p<0.01).
Morbidly obese patients have markedly elevated risks of reinfection, reoperation, and component resection as well as poorer intermediate-term clinical outcome scores compared with nonobese patients following revision total hip arthroplasty for periprosthetic joint infection.
病态肥胖（体重指数[BMI]≥40kg/m²）与初次全髋关节置换术后包括感染和植入物失败在内的并发症风险较高相关。本研究的目的是比较病态肥胖患者队列（BMI≥40kg/m²）和非肥胖患者（BMI<30kg/m²）行两阶段翻修全髋关节置换术治疗感染的结果。
利用机构全关节登记系统，我们回顾了653例在20年期间（1987年至2007年）因人工关节周围感染接受两阶段翻修全髋关节置换术治疗的患者的病历。患者根据术前BMI进行分层。确定了33例BMI≥40kg/m²的患者（14例男性和19例女性）。这些患者与66例同性且年龄相近（91%在两年内）的非肥胖患者（BMI<30kg/m²）（28例男性和38例女性）按1:2进行匹配。所有患者至少有5年的临床随访（病态肥胖组平均8.1年，非肥胖组平均10.3年）。
与非肥胖患者相比，病态肥胖患者的再感染率（18%比2%，p<0.005）、翻修率（42%比11%，p<0.001）以及因任何原因再次手术的比率（61%比12%，p<0.001）均显著更高。术前，病态肥胖组的平均Harris髋关节评分是50.6，非肥胖组是48.8，两组术后这些评分均显著改善（p<0.01）。
与非肥胖患者相比，病态肥胖患者在因人工关节周围感染行翻修全髋关节置换术后，再感染、再次手术和部件切除的风险显著升高，且中期临床结果评分更差。
