Martin J R, Watts C D, Taunton M J
Mayo Clinic, 200 1st St. SW Rochester MN 55905, USA.
Bone Joint J. 2015 Nov;97-B(11):1501-5. doi: 10.1302/0301-620X.97B11.36477.
Bariatric surgery has been advocated as a means of reducing body mass index (BMI) and the risks associated with total knee arthroplasty (TKA). However, this has not been proved clinically. In order to determine the impact of bariatric surgery on the outcome of TKA, we identified a cohort of 91 TKAs that were performed in patients who had undergone bariatric surgery (bariatric cohort). These were matched with two separate cohorts of patients who had not undergone bariatric surgery. One was matched 1:1 with those with a higher pre-bariatric BMI (high BMI group), and the other was matched 1:2 based on those with a lower pre-TKA BMI (low BMI group). In the bariatric group, the mean BMI before bariatric surgery was 51.1 kg/m(2) (37 to 72), which improved to 37.3 kg/m(2) (24 to 59) at the time of TKA. Patients in the bariatric group had a higher risk of, and worse survival free of, re-operation (hazard ratio (HR) 2.6; 95% confidence interval (CI) 1.2 to 6.2; p = 0.02) compared with the high BMI group. Furthermore, the bariatric group had a higher risk of, and worse survival free of re-operation (HR 2.4; 95% CI 1.2 to 3.3; p = 0.2) and revision (HR 2.2; 95% CI 1.1 to 6.5; p = 0.04) compared with the low BMI group. While bariatric surgery reduced the BMI in our patients, more analysis is needed before recommending bariatric surgery before TKA in obese patients.
减重手术已被提倡作为降低体重指数（BMI）以及与全膝关节置换术（TKA）相关风险的一种手段。然而，这一点尚未在临床上得到证实。为了确定减重手术对TKA结局的影响，我们确定了一组91例在接受减重手术的患者中进行的TKA（减重队列）。将这些患者与另外两组未接受减重手术的患者队列进行匹配。一组与减重术前BMI较高的患者1:1匹配（高BMI组），另一组根据TKA术前BMI较低的患者1:2匹配（低BMI组）。在减重组中，减重手术前的平均BMI为51.1kg/m²（37至72），在进行TKA时改善至37.3kg/m²（24至59）。与高BMI组相比，减重组再次手术的风险更高，且无再次手术的生存率更差（风险比（HR）2.6；95%置信区间（CI）1.2至6.2；p = 0.02）。此外，与低BMI组相比，减重组再次手术的风险更高，且无再次手术的生存率更差（HR 2.4；95%CI 1.2至3.3；p = 0.2）以及翻修的风险更高（HR 2.2；95%CI 1.1至6.5；p = 0.04）。虽然减重手术降低了我们患者的BMI，但在推荐肥胖患者在TKA前进行减重手术之前，还需要更多分析。
