Ploeger Milena M, Müller Norbert H, Wirtz Dieter Christian, Kohlhof Hendrik
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Bonn.
Kanzlei Klostermann, Dr. Schmidt, Monstadt, Dr. Eisbrecher, Bochum.
Z Orthop Unfall. 2018 Aug;156(4):436-442. doi: 10.1055/a-0590-5340. Epub 2018 Apr 18.
In recent years, the incidence of overweight and obesity has increased in the German population. Thus the number of obese patients treated with primary total joint arthroplasty has also increased. It is therefore predicted that the number of obese patients undergoing revision total joint arthroplasty will also increase. Nevertheless almost every manufacturer of commercially available revision arthroplasty implants states in his product safety guarantee that obesity is a relative or absolute contraindication. Data on revision total joint arthroplasty in obese patients are sparse. The aim of this systematic review is to assess the current literature on re-revision rate, infection rate, postoperative clinical outcome, and implant survival rate in obese patients undergoing revision total knee arthroplasty. Moreover, potential legal consequences and aspects are discussed which are essential for the surgeon.
We conducted a systematic review of the online databases PubMed and identified clinical studies on obesity and overweight in revision total knee arthroplasty. Study quality was assessed using levels of evidence and the modified Jadad score. We also included descriptive data on case numbers, age, gender, height, weight and follow-up time. Current legal aspects were also analysed.
RESULTS/DISCUSSION: Five studies met the inclusion criteria and were included in the systematic review. The average Jadad score was 1, the average level of evidence 3. In two studies, infection and revision occured more often in obese patients. Patients with morbid obesity had a higher risk of wound revision and periprosthetic joint infections. Three studies showed that obese patients had significantly lower scores for clinical outcome measures in function and pain. The legal aspect was not discussed in any of the five studies. Overall, published data are sparse and very heterogeneous. Therefore comparing these five studies is difficult. However, the results of our review suggest that obesity in revision total knee arthroplasty may have a negative influence on reoperation rate, infection rate and postoperative functional outcome. From a legal point of view, potential weight limitations of the implants intented for use have to be part of the oral preoperative discussion. The patient's informed consent has to be received and documented prior to revision total joint arthroplasty.
近年来，德国人群中超重和肥胖的发生率有所上升。因此，接受初次全关节置换术治疗的肥胖患者数量也有所增加。据此预测，接受翻修全关节置换术的肥胖患者数量也将增加。然而，几乎每一家市售翻修关节置换植入物的制造商都在其产品安全保证中声明肥胖是相对或绝对禁忌证。关于肥胖患者翻修全关节置换术的数据稀少。本系统评价的目的是评估当前有关接受翻修全膝关节置换术的肥胖患者的再次翻修率、感染率、术后临床结局和植入物生存率的文献。此外，还讨论了对外科医生至关重要的潜在法律后果和问题。
我们对在线数据库PubMed进行了系统评价，并确定了有关翻修全膝关节置换术中肥胖和超重的临床研究。使用证据水平和改良的Jadad评分评估研究质量。我们还纳入了有关病例数、年龄、性别、身高、体重和随访时间的描述性数据。同时也分析了当前的法律问题。
结果/讨论：五项研究符合纳入标准并被纳入系统评价。平均Jadad评分为1分，平均证据水平为3级。在两项研究中，肥胖患者感染和翻修的发生率更高。病态肥胖患者伤口翻修和假体周围关节感染的风险更高。三项研究表明，肥胖患者在功能和疼痛的临床结局测量方面得分显著更低。五项研究均未讨论法律问题。总体而言，已发表的数据稀少且差异很大。因此，比较这五项研究很困难。然而，我们的评价结果表明，翻修全膝关节置换术中的肥胖可能会对再次手术率、感染率和术后功能结局产生负面影响。从法律角度来看，预期使用的植入物潜在的重量限制必须作为术前口头讨论的一部分。在翻修全关节置换术前，必须获得并记录患者的知情同意。
