Singapore General Hospital, Singapore.
Bone Joint J. 2018 May 1;100-B(5):579-583. doi: 10.1302/0301-620X.100B5.BJJ-2017-1263.R1.
AIMS: This study investigated the influence of body mass index (BMI) on patients' function and quality of life ten years after total knee arthroplasty (TKA). PATIENTS AND METHODS: A total of 126 patients who underwent unilateral TKA in 2006 were prospectively included in this retrospective study. They were categorized into two groups based on BMI: < 30 kg/m (control) and ≥ 30 kg/m (obese). Functional outcome was assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), and Oxford Knee Score (OKS). Quality of life was assessed using the Physical (PCS) and Mental Component Scores (MCS) of the 36-Item Short-Form Health Survey. RESULTS: Results Patients in the obese group underwent TKA at a younger age (mean, 63.0 years, sd 8.0) compared with the control group (mean, 65.6 years, sd 7.6; p = 0.03). Preoperatively, both groups had comparable functional and quality-of-life scores. Ten years postoperatively, the control group had significantly higher OKS and MCS compared with the obese group (OKS, mean 18 (sd 5) vs mean 22 (sd 10), p = 0.03; MCS, mean 56 (sd 10) vs mean 50 (sd 11), p = 0.01). After applying multiple linear regression with the various outcomes scores as dependent variables and age, gender, and Charlson Comorbidity Index as independent variables, there was a clear association between obesity and poorer outcome in KSFS, OKS, and MCS at ten years postoperatively (p < 0.01 in both KSFS and OKS, and p = 0.03 in MCS). Both groups had a high satisfaction rate (97.8% in the control group vs 87.9% in the obese group, p = 0.11) and fulfillment of expectations at ten years (98.9% in the control group vs 100% in the obese group, p = 0.32). CONCLUSION: Although both obese and non-obese patients have significant improvements in function and quality of life postoperatively, obese patients tend to have smaller improvements in the OKS and MCS ten years postoperatively. It is important to counsel patients on the importance of weight management to achieve a more sustained outcome after TKA. Cite this article: Bone Joint J 2018;100-B:579-83.
目的：本研究旨在探讨体重指数（BMI）对全膝关节置换术（TKA）十年后患者功能和生活质量的影响。
患者和方法：本研究前瞻性纳入了 2006 年接受单侧 TKA 的 126 例患者，根据 BMI 将其分为两组：<30 kg/m（对照组）和≥30 kg/m（肥胖组）。采用膝关节学会功能评分（KSFS）、膝关节学会膝关节评分（KSKS）和牛津膝关节评分（OKS）评估功能结果。采用 36 项简短健康调查的身体成分（PCS）和心理成分评分（MCS）评估生活质量。
结果：肥胖组患者接受 TKA 的年龄（平均 63.0 岁，标准差 8.0）明显低于对照组（平均 65.6 岁，标准差 7.6；p = 0.03）。术前两组的功能和生活质量评分相当。术后 10 年，对照组的 OKS 和 MCS 明显高于肥胖组（OKS：平均 18（标准差 5）比平均 22（标准差 10），p = 0.03；MCS：平均 56（标准差 10）比平均 50（标准差 11），p = 0.01）。采用多元线性回归，以各结局评分作为因变量，年龄、性别和 Charlson 合并症指数作为自变量，结果显示肥胖与术后 10 年 KSFS、OKS 和 MCS 评分较差存在明确相关性（KSFS 和 OKS 中 p<0.01，MCS 中 p = 0.03）。两组患者的满意度均较高（对照组为 97.8%，肥胖组为 87.9%，p = 0.11），术后 10 年的期望满足率也较高（对照组为 98.9%，肥胖组为 100%，p = 0.32）。
结论：尽管肥胖和非肥胖患者术后功能和生活质量均有显著改善，但肥胖患者术后 OKS 和 MCS 改善较小。对患者进行体重管理的重要性教育，有助于在 TKA 后获得更持久的疗效。
文献出处：Bone Joint J 2018;100-B:579-83.
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