Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
J Arthroplasty. 2017 Aug;32(8):2404-2410. doi: 10.1016/j.arth.2017.03.008. Epub 2017 Mar 16.
The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA).
Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI <30 kg/m) and obese patients (BMI ≥30 kg/m) were compared. Healthy controls were also assessed. Univariate and multivariate linear regression analyses were used to assess the association between gait speed and ROM gains. Adjustment was performed for gender, age, and WOMAC pain improvement.
At baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P < .001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011).
These findings show that all patients improved biomechanically and clinically, regardless of their BMI.
本前瞻性研究旨在探讨体重指数（BMI）对全膝关节置换术（TKA）前后步态参数的影响。
79 例患者在 TKA 前后均进行临床步态分析评估。评估指标包括步态速度、步态过程中的膝关节活动度（ROM）及其增益（与 TKA 后 1 年的差值）、西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）、生活质量和患者满意度。将非肥胖（BMI＜30kg/m）和肥胖（BMI≥30kg/m）患者进行比较，并纳入健康对照组。采用单变量和多变量线性回归分析评估步态速度与 ROM 增益之间的关系。调整性别、年龄和 WOMAC 疼痛改善情况。
基线时，肥胖患者的步态速度和膝关节 ROM 明显低于非肥胖患者（0.99±0.27m/s 比 1.11±0.18m/s；效应量，0.53；P=0.021；ROM，41.33°±9.6°比 46.05°±8.39°；效应量，0.52；P=0.022）。单变量和多变量线性回归均未显示 BMI 与步态速度增益或膝关节 ROM 增益之间存在任何显著关系。基线时，肥胖患者比非肥胖患者症状更明显（WOMAC 疼痛评分：36.1±14.0 比 50.4±16.9；效应量，0.9；P＜0.001），且疼痛改善程度显著更高（WOMAC 疼痛评分增益：44.5 比 32.3；效应量，0.59；P=0.011）。
这些发现表明，无论 BMI 如何，所有患者的生物力学和临床改善情况均相似。
