Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Pittsburgh Bone, Joint & Spine, Inc., Allegheny Health Network, Jefferson Hills, Pennsylvania.
Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
J Arthroplasty. 2019 May;34(5):932-938. doi: 10.1016/j.arth.2019.01.010. Epub 2019 Jan 14.
The purpose of this study is to compare surgical and clinical outcomes between matched groups of morbidly obese (body mass index [BMI] >40 kg/m) and non-morbidly obese (BMI <40 kg/m) patients undergoing first-time revision total knee arthroplasty with a minimum 5-year follow-up.
Two groups of 87 patients (BMI >40 or <40 kg/m) were matched 1:1 based on age at the time of revision, gender, and diagnosis for revision (aseptic or septic causes).
The morbidly obese group had a significantly greater incidence of re-operation (34.5% [30/87] vs 16.1% [14/87], P = .005) and re-revision (27.6% [24/87] vs 12.6% [11/87], P = .014) with a significantly lower 10-year survivorship for re-operation (P = .05) and subsequent revision (P = .014). In particular, the aseptic sub-group had a greater incidence of re-operation (29.9% [20/67] vs 13.4% [9/67], P = .021) and re-revision (26.9% [18/67] vs 11.9% [8/67], P = .029). The non-morbidly obese group demonstrated higher final Western Ontario and McMaster Universities Index scores (63.1 ± 19.5 vs 55.5 ± 22.5, P = .030) and a greater change between pre-operative and final KSS (45.6 ± 44.3 vs 39.7 ± 48.4, P = .040) and SF-12 Mental component (3.6 ± 10.8 vs -1.4 ± 10.3, P = .013).
Morbidly obese patients undergoing revision total knee arthroplasty have a greater risk of re-operation and re-revision while experiencing lower clinical outcome scores compared to non-morbidly obese patients. These patients should be informed of the higher potential for re-operation and the possibility of poor results.
本研究旨在比较肥胖（BMI>40kg/m）和非肥胖（BMI<40kg/m）初次翻修全膝关节置换术患者的手术和临床结果，这些患者均随访至少 5 年。
根据翻修时的年龄、性别和翻修原因（无菌或感染性），将 87 例患者（BMI>40 或<40kg/m）分为两组，每组 87 例，进行 1:1 匹配。
肥胖组的再手术率（34.5%[30/87]与 16.1%[14/87]，P=0.005）和再翻修率（27.6%[24/87]与 12.6%[11/87]，P=0.014）显著更高，10 年再手术生存率（P=0.05）和随后的翻修生存率（P=0.014）显著较低。特别是，无菌亚组的再手术率（29.9%[20/67]与 13.4%[9/67]，P=0.021）和再翻修率（26.9%[18/67]与 11.9%[8/67]，P=0.029）更高。非肥胖组的最终 Western Ontario 和 McMaster 大学指数评分更高（63.1±19.5 与 55.5±22.5，P=0.030），术前和最终 KSS 之间的变化更大（45.6±44.3 与 39.7±48.4，P=0.040）和 SF-12 心理成分更高（3.6±10.8 与-1.4±10.3，P=0.013）。
与非肥胖患者相比，肥胖患者初次翻修全膝关节置换术的再手术和再翻修风险更高，而临床结果评分更低。这些患者应被告知再手术的潜在可能性更高，以及结果不佳的可能性。
