Brodt Steffen, Jacob Benjamin, Windisch Christoph, Seeger Joern, Matziolis Georg
Orthopedic Department, Campus Eisenberg, University Hospital, Jena, Germany.
Department of Orthopaedics and Orthopaedic Surgery, University Hospital of Giessen and Marburg, Giessen, Germany.
J Bone Joint Surg Am. 2016 May 4;98(9):729-34. doi: 10.2106/JBJS.15.00893.
The presence of obesity negatively affects the results after total hip arthroplasty. The influence of morbid obesity on cup positioning is investigated.
A retrospective analysis of radiographs from 790 patients in 2013 and 2014 was performed. The correlation of cup inclination and anteversion with body mass index (BMI) was analyzed. Three groups were formed: 139 patients with normal weight (BMI of <25 kg/m(2)), 566 patients with moderate obesity (BMI between 25 and 34 kg/m(2)), and 85 patients with morbid obesity (BMI of ≥35 kg/m(2)).
Cup anteversion significantly correlated with BMI (R = -0.127, p < 0.001) and patient age (R = 0.115, p = 0.001). This corresponded with a reduction of anteversion by 3.4° (p < 0.001) in the morbidly obese group compared with the normal-weight group. Cup inclination was not influenced by BMI or patient age.
The precision of cup positioning declines with increasing obesity. In addition, significantly reduced anteversion is found in younger patients. We assume that this is due to iatrogenically changed pelvic tilt resulting from increased pressure exerted on the dorsal and ventral acetabular rim retractors.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
肥胖的存在会对全髋关节置换术后的结果产生负面影响。本研究调查了病态肥胖对髋臼杯位置的影响。
对2013年和2014年790例患者的X线片进行回顾性分析。分析髋臼杯倾斜度和前倾角与体重指数（BMI）的相关性。将患者分为三组：139例体重正常者（BMI<25kg/m²），566例中度肥胖者（BMI在25至34kg/m²之间），85例病态肥胖者（BMI≥35kg/m²）。
髋臼杯前倾角与BMI（R=-0.127，p<0.001）和患者年龄（R=0.115，p=0.001）显著相关。与正常体重组相比，病态肥胖组的前倾角降低了3.4°（p<0.001）。髋臼杯倾斜度不受BMI或患者年龄的影响。
随着肥胖程度的增加，髋臼杯定位的精确性下降。此外，在年轻患者中发现前倾角显著降低。我们认为这是由于髋臼背侧和腹侧边缘牵开器上压力增加导致医源性骨盆倾斜改变所致。
预后III级。有关证据水平的完整描述，请参阅作者指南。
