全关节置换术后根据肥胖状况的功能改善和疼痛缓解
Functional Gain and Pain Relief After Total Joint Replacement According to Obesity Status.
作者信息
Li Wenjun, Ayers David C, Lewis Courtland G, Bowen Thomas R, Allison Jeroan J, Franklin Patricia D
机构信息
1University of Massachusetts Medical School, Worcester, Massachusetts 2Hartford Hospital, Hartford, Connecticut 3Geisinger Health System, Danville, Pennsylvania.
出版信息
J Bone Joint Surg Am. 2017 Jul 19;99(14):1183-1189. doi: 10.2106/JBJS.16.00960.
BACKGROUND
Obesity has been associated with lower function and more pain before and after total hip or knee replacement (THR or TKR). We examined the changes between preoperative and postoperative function and pain in a large representative U.S. cohort to determine if there was a relationship to obesity status.
METHODS
Preoperative and 6-month postoperative data on function (Short Form-36 Physical Component Summary [PCS] score), joint pain (Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score), and body mass index (BMI) were collected from a national sample of 2,040 patients who had undergone THR and 2,964 who had undergone TKR from May 2011 to March 2013. Preoperative and postoperative function and pain were evaluated according to BMI status, defined as under or of normal weight, overweight, obese, severely obese, or morbidly obese.
RESULTS
Patients undergoing THR were an average of 65 years of age; 59% were women, 94% were white, and 14% were severely or morbidly obese. A greater obesity level was associated with a lower (worse) PCS score at baseline and 6 months postoperatively. Severely and morbidly obese patients had less postoperative functional gain than the other BMI groups. A greater obesity level was associated with more pain at baseline but greater postoperative pain relief, so the average postoperative pain scores did not differ significantly according to BMI status. Patients undergoing TKR had an average age of 69 years; 61% were women, 93% were white, and 25% were severely or morbidly obese. A greater obesity level was associated with a lower PCS score at baseline and 6 months. The postoperative gain in PCS score did not differ by BMI level. A greater obesity level was associated with worse pain at baseline but greater pain relief at 6 months, so the average pain scores at 6 month were similar across the BMI levels.
CONCLUSIONS
Six months after total joint replacement (TJR), severely or morbidly obese patients reported excellent pain relief and substantial functional gain that was similar to the findings in other patients. While obesity is associated with a greater risk of early complications, obesity in itself should not be a deterrent to undergoing TJR to relieve symptoms.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
背景
肥胖与全髋关节或膝关节置换术（THR 或 TKR）前后功能降低及疼痛加剧有关。我们在美国一个具有代表性的大型队列中研究了术前和术后功能及疼痛的变化，以确定其与肥胖状况是否存在关联。
方法
收集了 2011 年 5 月至 2013 年 3 月期间接受 THR 的 2040 例患者和接受 TKR 的 2964 例患者的全国样本的术前及术后 6 个月的功能数据（简短健康调查问卷-36 身体成分总结[PCS]评分）、关节疼痛数据（髋关节功能障碍和骨关节炎结果评分以及膝关节损伤和骨关节炎结果评分）和体重指数（BMI）。根据 BMI 状态评估术前和术后的功能及疼痛，BMI 状态定义为体重过轻或正常、超重、肥胖、重度肥胖或病态肥胖。
结果
接受 THR 的患者平均年龄为 65 岁；59%为女性，94%为白人，14%为重度或病态肥胖。肥胖程度越高，基线时及术后 6 个月的 PCS 评分越低（越差）。重度和病态肥胖患者术后功能改善程度低于其他 BMI 组。肥胖程度越高，基线时疼痛越严重，但术后疼痛缓解越明显，因此根据 BMI 状态，术后平均疼痛评分无显著差异。接受 TKR 的患者平均年龄为 69 岁；61%为女性，93%为白人，25%为重度或病态肥胖。肥胖程度越高，基线时及术后 6 个月的 PCS 评分越低。术后 PCS 评分的改善在不同 BMI 水平间无差异。肥胖程度越高，基线时疼痛越严重，但 6 个月时疼痛缓解越明显，因此 6 个月时不同 BMI 水平的平均疼痛评分相似。
结论
全关节置换术（TJR）6 个月后，重度或病态肥胖患者报告疼痛缓解良好且功能有显著改善，这与其他患者的结果相似。虽然肥胖与早期并发症风险增加有关，但肥胖本身不应成为进行 TJR 以缓解症状的阻碍。
证据水平
治疗性 II 级。有关证据水平的完整描述，请参阅作者指南。
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