Mack Lipkin Fellowship, CUNY School of Medicine, New York, NY.
SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Program, Singapore, Singapore.
J Arthroplasty. 2020 Feb;35(2):375-379. doi: 10.1016/j.arth.2019.09.003. Epub 2019 Sep 7.
BACKGROUND: This prospective cohort study was designed to evaluate weight change patterns and their effects on clinical outcomes following total knee arthroplasty (TKA) in the Asian population. We hypothesized that Asian patients will have a different pattern of weight change following TKA compared to Western patients and that weight loss following TKA will be associated with better clinical outcomes. METHODS: A cohort of consecutive patients who underwent TKA from 2004 to 2015 was included. All patients received a conventional posterior-stabilized TKA implant and underwent a standard perioperative care pathway. Assessments were done preoperatively, at 6 months, and 2 years after surgery. The range of motion, Knee Society Score, Oxford Knee Score, and the Short-Form 36 questionnaire were used to assess outcomes. Height and weight of patients were recorded for body mass index (BMI) calculation. Patterns of weight loss following TKA in this cohort were charted. Clinical outcomes were then analyzed against the change in BMI. RESULTS: A total of 602 patients (602 knees) were reviewed. Mean age was 66.39 ± 7.27 years. Mean BMI was 27.75 ± 4.51 kg/m. Overall, 63.12% of all our patients gained weight following TKA. Moreover, weight loss did not influence patients' odds for better clinical outcomes. Furthermore, patients who were in the preoperative BMI category of obese class I were more likely to gain weight as compared to those in the normal category (odds ratio 0.35, 95% confidence interval 0.2-0.61, P < .001). Moreover, older people were more likely to gain more weight compared to younger people. We also showed that the mean 2-year Knee Society Knee Score was significantly higher in the patients who gained weight while the patients who lost weight had the highest mean 2-year Oxford Knee Score and the lowest mean 2-year Knee Society Function Score. CONCLUSION: Asians tend to gain weight following TKA. However, this weight change following TKA does not affect clinical outcomes, which remain good across all BMI groups. LEVEL OF EVIDENCE: Therapeutic Level III.
背景：本前瞻性队列研究旨在评估亚洲人群全膝关节置换（TKA）后体重变化模式及其对临床结果的影响。我们假设亚洲患者 TKA 后的体重变化模式与西方患者不同，TKA 后体重减轻与更好的临床结果相关。
方法：纳入 2004 年至 2015 年接受 TKA 的连续患者队列。所有患者均接受常规后稳定型 TKA 植入物，并接受标准围手术期护理路径。在术前、术后 6 个月和 2 年进行评估。使用膝关节协会评分、牛津膝关节评分和简明健康调查问卷 36 项（SF-36）评估结果。记录患者的身高和体重以计算体重指数（BMI）。描绘该队列中 TKA 后体重减轻的模式。然后根据 BMI 的变化分析临床结果。
结果：共回顾 602 例患者（602 膝）。平均年龄为 66.39 ± 7.27 岁。平均 BMI 为 27.75 ± 4.51 kg/m。总体而言，63.12%的患者在 TKA 后体重增加。此外，体重减轻并不影响患者获得更好临床结果的几率。此外，与正常类别相比，肥胖 I 级的患者在术前 BMI 类别中更有可能增加体重（优势比 0.35，95%置信区间 0.2-0.61，P<.001）。此外，老年人比年轻人更有可能增加体重。我们还表明，体重增加的患者 2 年膝关节协会膝关节评分的平均值明显更高，而体重减轻的患者 2 年牛津膝关节评分的平均值最高，2 年膝关节协会功能评分的平均值最低。
结论：亚洲人在 TKA 后往往会增加体重。然而，TKA 后这种体重变化并不影响临床结果，所有 BMI 组的结果仍然良好。
证据水平：治疗水平 III。
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