Oosting Ellen, Hoogeboom Thomas J, Dronkers Jaap J, Visser Marlieke, Akkermans Reinier P, van Meeteren Nico L U
Department of Physical Therapy, Gelderse Vallei Hospital, Ede, The Netherlands; Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
J Arthroplasty. 2017 Jun;32(6):1918-1922. doi: 10.1016/j.arth.2016.12.037. Epub 2016 Dec 27.
There is ongoing discussion about whether preoperative obesity is negatively associated with inpatient outcomes of total hip arthroplasty (THA). The aim was to investigate the interaction between obesity and muscle strength and the association with postoperative inpatient recovery after THA.
Preoperative obesity (body mass index [BMI] >30 kg/m) and muscle weakness (hand grip strength <20 kg for woman and <30 kg for men) were measured about 6 weeks before THA. Patients with a BMI <18.5 kg/m were excluded. Outcomes were delayed inpatient recovery of activities (>2 days to reach independence of walking) and prolonged length of hospital stay (LOS, >4 days and/or discharge to extended rehabilitation). Univariate and multivariable regression analyses with the independent variables muscle weakness and obesity, and the interaction between obesity and muscle weakness, were performed and corrected for possible confounders.
Two hundred and ninety-seven patients were included, 54 (18%) of whom were obese and 21 (7%) who also had muscle weakness. Obesity was not significantly associated with prolonged LOS (odds ratio [OR] 1.36, 95% confidence interval [CI] 0.75-2.47) or prolonged recovery of activities (OR 1.77, 95% CI 0.98-3.22), but the combination of obesity and weakness was significantly associated with prolonged LOS (OR 3.59, 95% CI 1.09-11.89) and prolonged recovery of activities (OR 6.21, 95% CI 1.64-23.65).
Obesity is associated with inpatient recovery after THA only in patients with muscle weakness. The results of this study suggest that we should measure muscle strength in addition to BMI (or body composition) to identify patients at risk of prolonged LOS.
关于术前肥胖是否与全髋关节置换术（THA）的住院结局呈负相关，目前仍在讨论中。目的是研究肥胖与肌肉力量之间的相互作用以及与THA术后住院恢复的关系。
在THA术前约6周测量术前肥胖（体重指数[BMI]>30kg/m²）和肌肉无力（女性握力<20kg，男性握力<30kg）。排除BMI<18.5kg/m²的患者。结局指标为住院活动恢复延迟（>2天达到独立行走）和住院时间延长（LOS，>4天和/或出院至延长康复机构）。对肌肉无力、肥胖以及肥胖与肌肉无力之间的相互作用等自变量进行单因素和多因素回归分析，并对可能的混杂因素进行校正。
纳入297例患者，其中54例（18%）肥胖，21例（7%）同时存在肌肉无力。肥胖与住院时间延长（优势比[OR]1.36，95%置信区间[CI]0.75 - 2.47）或活动恢复延长（OR 1.77，95%CI 0.98 - 3.22）无显著相关性，但肥胖与无力的组合与住院时间延长（OR 3.59，95%CI 1.09 - 11.89）和活动恢复延长（OR 6.21，95%CI 1.64 - 23.65）显著相关。
肥胖仅在合并肌肉无力的患者中与THA术后住院恢复相关。本研究结果表明，除BMI（或身体成分）外，我们还应测量肌肉力量，以识别住院时间延长风险的患者。
