物理参数对全膝关节置换术结果的影响。

Effect of Physical Parameters on Outcomes of Total Knee Arthroplasty.

机构信息

Departments of Orthopedic Surgery (T.C.C., E.R.W., and D.J.B.) and Biostatistics and Health Sciences Research (W.S.H. and C.D.S.), Mayo Clinic, Rochester, Minnesota.

出版信息

J Bone Joint Surg Am. 2018 Nov 7;100(21):1829-1837. doi: 10.2106/JBJS.18.00248.

DOI:10.2106/JBJS.18.00248

PMID:30399077

Abstract

BACKGROUND

Increasing body mass index (BMI) has been shown to correlate with increased rates of complications after total knee arthroplasty. To our knowledge, body surface area, body mass, and height have not been investigated in this manner. BMI and body surface area are affected differently by changes in height, and they are affected similarly by changes in weight. The purpose of this study was to quantify revision for any reason, mechanical failure, aseptic loosening, polyethylene wear, reoperation, and any infection after total knee arthroplasty using BMI, body surface area, body mass, and height as continuous variables.

METHODS

Prospectively collected data from a single institution's total joint registry were used to analyze 22,243 consecutive knees, in 16,106 patients, treated with a primary total knee arthroplasty from 1985 to 2012. The Kaplan-Meier survival method was used to evaluate revision and other common complications, with outcomes assessed using Cox regression analysis. Smoothing spline parameterization was used on physical parameters in these models.

RESULTS

Increasing BMI, body surface area, body mass, and height were associated with an increased risk of any revision surgical procedure, mechanical failure, and aseptic loosening after total knee arthroplasty. The risk of a revision surgical procedure was directly associated with each 1 standard deviation increase in BMI (hazard ratio [HR], 1.19; p < 0.01), body surface area (HR, 1.37; p < 0.01), body mass (HR, 1.30; p < 0.01), and height (HR, 1.22; p < 0.01). This association was especially demonstrated with revision for mechanical failure (BMI: HR, 1.15; p < 0.01; body surface area: HR, 1.35; p < 0.01; body mass: HR, 1.27; p < 0.01; and height: HR, 1.23; p < 0.01). The risk of failure in the subgroups of mechanical failure including a revision surgical procedure for aseptic loosening or polyethylene wear was also associated with increasing body surface area, body mass, and height. Increasing BMI (HR, 1.22; p < 0.01), body surface area (HR, 2.56; p < 0.01), and body mass (HR, 2.54; p < 0.01) were also associated with increased risk of any infection.

CONCLUSIONS

Increasing BMI, body surface area, body mass, and height were strongly associated with the rates of revision, aseptic loosening, and other common complications following total knee arthroplasty. Body surface area and body mass appear to correlate more strongly with mechanical failure outcomes than BMI or height.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

越来越多的身体质量指数（BMI）表明与全膝关节置换术后并发症的发生率增加有关。据我们所知，身体表面积、体重和身高尚未以这种方式进行研究。BMI 和身体表面积受身高变化的影响不同，而受体重变化的影响相似。本研究的目的是使用 BMI、身体表面积、体重和身高作为连续变量来量化任何原因的翻修、机械故障、无菌性松动、聚乙烯磨损、再次手术和全膝关节置换术后的任何感染。

方法

使用来自一家机构的关节总登记处的前瞻性收集的数据，对 1985 年至 2012 年间接受初次全膝关节置换术的 16106 名患者的 22243 例连续膝关节进行了分析。使用 Kaplan-Meier 生存法评估翻修和其他常见并发症的结果，使用 Cox 回归分析评估结果。在这些模型中对物理参数使用平滑样条参数化。

结果

BMI、身体表面积、体重和身高的增加与全膝关节置换术后任何翻修手术、机械故障和无菌性松动的风险增加相关。每增加一个标准差的 BMI（风险比[HR]，1.19；p<0.01）、身体表面积（HR，1.37；p<0.01）、体重（HR，1.30；p<0.01）和身高（HR，1.22；p<0.01）都与翻修手术的风险直接相关。这种关联尤其在机械故障的翻修中得到了证明（BMI：HR，1.15；p<0.01；身体表面积：HR，1.35；p<0.01；体重：HR，1.27；p<0.01；身高：HR，1.23；p<0.01）。包括因无菌性松动或聚乙烯磨损而进行翻修手术的机械故障亚组中失败的风险也与身体表面积、体重和身高的增加有关。BMI（HR，1.22；p<0.01）、身体表面积（HR，2.56；p<0.01）和体重（HR，2.54；p<0.01）的增加也与任何感染的风险增加相关。