Department of Orthopaedic Surgery, University of Louisville, Louisville, KY.
Franciscan Health Total Joint Reconstruction, Carmel, IN.
J Arthroplasty. 2019 Feb;34(2):309-314. doi: 10.1016/j.arth.2018.10.016. Epub 2018 Oct 17.
Total knee arthroplasty (TKA) in the morbidly obese patients can be challenging with an increased risk of complications. Studies have shown increased aseptic failures with well-aligned cemented TKAs in the obese patient. The purpose of this study is to determine if TKA in the morbidly obese (body mass index [BMI] ≥ 40) using cementless implants would demonstrate improved results and survivorship compared to cemented TKA at a minimum 5-year follow-up.
This is a retrospective study comparing clinical results of cemented vs cementless primary TKA with a posterior stabilized design TKA in morbidly obese (BMI ≥ 40) patients with minimal 5-year follow-up. There were 108 patients in the cementless group with a mean BMI of 45.6. In the cemented cohort, there were 85 cemented TKAs with a mean BMI of 45.0. Demographic, clinical, surgical, and radiographic data along with complications were extracted for all study patients.
There were 5 failures requiring revision in the cementless group, including 1 for aseptic tibial loosening (0.9%). In the cemented group, there were 22 failures requiring revision, including 16 implants for aseptic loosening (18.8%; P = .0001). Survivorship with aseptic loosening as the endpoint was 99.1% in the cementless group vs 88.2% in the cemented cohort at 8 years (P = .02).
Morbidly obese patients (BMI ≥ 40) have a higher failure due to aseptic loosening with cemented TKA with decreasing survivorship over time. The use of cementless TKA in morbidly obese patients with the potential of durable long-term biologic fixation and increased survivorship appears to be a promising alternative to mechanical cement fixation.
在病态肥胖患者中进行全膝关节置换术（TKA）具有挑战性，并且并发症的风险增加。研究表明，在肥胖患者中，即使使用对线良好的水泥固定 TKA，无菌性失败的风险也会增加。本研究的目的是确定在病态肥胖患者（体重指数[BMI]≥40）中使用非水泥固定植入物进行 TKA 是否会在至少 5 年的随访中显示出更好的结果和存活率。
这是一项回顾性研究，比较了在病态肥胖（BMI≥40）患者中使用后稳定设计的 TKA 进行水泥固定与非水泥固定初次 TKA 的临床结果，随访时间至少为 5 年。非水泥组有 108 例患者，平均 BMI 为 45.6。在水泥组中，有 85 例水泥固定 TKA，平均 BMI 为 45.0。所有研究患者均提取了人口统计学、临床、手术和影像学数据以及并发症。
非水泥组有 5 例需要翻修的失败病例，其中 1 例为无菌性胫骨松动（0.9%）。在水泥组中，有 22 例需要翻修的失败病例，其中 16 例为无菌性松动（18.8%；P=.0001）。以无菌性松动为终点，非水泥组的 8 年存活率为 99.1%，水泥组为 88.2%（P=.02）。
对于水泥固定 TKA，病态肥胖患者（BMI≥40）由于无菌性松动而导致的失败率更高，并且随着时间的推移，存活率逐渐降低。在病态肥胖患者中使用非水泥 TKA 似乎是一种有前途的替代机械水泥固定的方法，因为它具有潜在的长期生物学固定和增加的存活率。
