肥胖对全膝关节置换术后疼痛及功能恢复的影响。
Effect of Obesity on Pain and Functional Recovery Following Total Knee Arthroplasty.
作者信息
Collins Jamie E, Donnell-Fink Laurel A, Yang Heidi Y, Usiskin Ilana M, Lape Emma C, Wright John, Katz Jeffrey N, Losina Elena
机构信息
1Departments of Orthopaedic Surgery (J.E.C., H.Y.Y., I.M.U., E.C.L., J.W., J.N.K., and E.L.) and Medicine (L.A.D.-F.), Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) (J.E.C., L.A.D.-F., H.Y.Y., I.M.U., E.C.L., J.N.K., and E.L.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts 2Harvard Medical School, Boston, Massachusetts 3Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
出版信息
J Bone Joint Surg Am. 2017 Nov 1;99(21):1812-1818. doi: 10.2106/JBJS.17.00022.
BACKGROUND
While obesity may be a risk factor for complications following total knee arthroplasty, data remain sparse on the impact of the degree of obesity on patient-reported outcomes following this procedure. Our objective was to determine the extent to which obesity level affects the trajectory of recovery as well as patient-reported pain, function, and satisfaction with surgery following total knee arthroplasty.
METHODS
We followed a cohort of patients who underwent total knee arthroplasty at 1 of 4 medical centers. Patients were ≥40 years of age with a primary diagnosis of osteoarthritis. We stratified patients into 5 groups according to the World Health Organization classification of body mass index (BMI). We assessed the association between BMI group and pain and function over the time intervals of 0 to 3, 3 to 6, and 6 to 24 months using a piecewise linear model. We also assessed the association between BMI group and patient-reported outcomes at 24 months. Multivariable models adjusted for age, sex, race, diabetes, musculoskeletal functional limitations index, pain medication use, and study site.
RESULTS
Of the 633 participants included in our analysis, 19% were normal weight (BMI of <25 kg/m), 32% were overweight (BMI of 25 to 29.9 kg/m), 27% were class-I obese (BMI of 30 to 34.9 kg/m), 12% were class-II obese (BMI of 35 to 39.9 kg/m), and 9% were class-III obese (BMI of ≥40 kg/m). Study participants with a higher BMI had worse preoperative WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain and function scores and had greater improvement from baseline to 3 months. The mean change in pain and function from 3 to 6 and from 6 to 24 months was similar across all BMI groups. At 24 months, participants in all BMI groups had similar levels of pain, function, and satisfaction.
CONCLUSIONS
Because of the differential trajectory of recovery in the first 3 months following total knee arthroplasty, the participants in the higher BMI groups were able to attain absolute pain and function scores similar to those in the nonobese and class-I obese groups. These data can help surgeons discuss expectations of pain relief and functional improvement with total knee arthroplasty candidates with higher BMI.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
虽然肥胖可能是全膝关节置换术后并发症的一个危险因素，但关于肥胖程度对该手术后患者报告结局的影响的数据仍然很少。我们的目的是确定肥胖水平在多大程度上影响全膝关节置换术后的恢复轨迹以及患者报告的疼痛、功能和对手术的满意度。
方法
我们对在4个医疗中心之一接受全膝关节置换术的一组患者进行了随访。患者年龄≥40岁，初步诊断为骨关节炎。我们根据世界卫生组织的体重指数（BMI）分类将患者分为5组。我们使用分段线性模型评估BMI组与0至3个月、3至6个月和6至24个月时间间隔内的疼痛和功能之间的关联。我们还评估了BMI组与24个月时患者报告结局之间的关联。多变量模型对年龄、性别、种族、糖尿病、肌肉骨骼功能限制指数、止痛药物使用和研究地点进行了调整。
结果
在我们分析的633名参与者中，19%体重正常（BMI<25kg/m²），32%超重（BMI为25至29.9kg/m²），27%为I级肥胖（BMI为30至34.9kg/m²），12%为II级肥胖（BMI为35至39.9kg/m²），9%为III级肥胖（BMI≥40kg/m²）。BMI较高的研究参与者术前WOMAC（西安大略和麦克马斯特大学骨关节炎指数）疼痛和功能评分较差，从基线到3个月有更大改善。所有BMI组从3至6个月以及从6至24个月的疼痛和功能平均变化相似。在24个月时，所有BMI组的参与者在疼痛、功能和满意度方面水平相似。
结论
由于全膝关节置换术后前3个月恢复轨迹不同，BMI较高组的参与者能够获得与非肥胖和I级肥胖组相似的绝对疼痛和功能评分。这些数据可以帮助外科医生与BMI较高的全膝关节置换术候选人讨论疼痛缓解和功能改善的预期。
证据水平
预后III级。有关证据水平的完整描述，请参阅作者须知。
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