Hanna Sammy A, McCalden Richard W, Somerville Lyndsay, Howard James L, Naudie Douglas D, MacDonald Steven J
Department of Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
Department of Orthopaedic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
J Arthroplasty. 2017 Oct;32(10):3098-3101. doi: 10.1016/j.arth.2017.05.014. Epub 2017 May 17.
Although it has been shown that morbidly obese patients experience good outcomes following primary total hip arthroplasty (THA), it is unclear whether this also applies to revision surgery. The purpose of this study was to examine the effect of a high body mass index (BMI) on the outcome of revision THA.
We identified 56 patients with a BMI >40 kg/m who had undergone revision THA between 1994 and 2009 at our hospital (group B). Mean age, BMI, and follow-up were 66.4 years, 45.7 kg/m, and 11.7 years, respectively. This was matched with a second group of patients with a BMI between 30 and 40 kg/m according to age, gender, and date of index procedure (group A). Mean age, BMI, and follow-up were 66.6 years, 33.6 kg/m, and 12 years, respectively. Outcome measures included the rate of subsequent revision, implant survival, and the Harris hip score (HHS).
Patients with a BMI >40 kg/m had a significantly increased risk of revision surgery (27% vs 12%, P = .036). Cumulative implant survival was 85% (95% CI, 69-92) in group A and 69% (95% CI, 54-80) in group B at 15 years. HHS increased significantly following surgery in both groups (group A: 26.3-79.3) and (group B: 37.6-69.9; P < .001). However, HHS at last follow-up was significantly higher in group A (79.3 vs 69.9, P = .042).
Morbid obesity appears to be associated with an increased risk of failure and lower functional scores following revision THA. Patients should be well informed of this before surgery.
尽管已有研究表明病态肥胖患者初次全髋关节置换术（THA）后预后良好，但尚不清楚这是否也适用于翻修手术。本研究的目的是探讨高体重指数（BMI）对THA翻修手术预后的影响。
我们纳入了我院1994年至2009年间接受THA翻修手术的56例BMI>40 kg/m²的患者（B组）。平均年龄、BMI和随访时间分别为66.4岁、45.7 kg/m²和11.7年。根据年龄、性别和初次手术日期，将其与第二组BMI在30至40 kg/m²之间的患者进行匹配（A组）。平均年龄、BMI和随访时间分别为66.6岁、33.6 kg/m²和12年。观察指标包括再次翻修率、植入物生存率和Harris髋关节评分（HHS）。
BMI>40 kg/m²的患者翻修手术风险显著增加（27%对12%，P = .036）。15年时，A组的累积植入物生存率为85%（95%CI，69 - 92），B组为69%（95%CI，54 - 80）。两组患者术后HHS均显著提高（A组：26.3 - 79.3）和（B组：37.6 - 69.9；P < .001）。然而，末次随访时A组的HHS显著更高（79.3对69.9，P = .042）。
病态肥胖似乎与THA翻修术后失败风险增加和功能评分降低有关。术前应将此充分告知患者。
