Department of Orthopaedics and Traumatology, Adana City Training and Research Hospital, Adana, Turkey.
Department of Orthopaedics and Traumatology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
J Knee Surg. 2021 Jul;34(9):1026-1032. doi: 10.1055/s-0040-1702932. Epub 2020 Mar 4.
This study aims to investigate clinical and functional factors in patients undergoing unilateral and simultaneous bilateral total knee arthroplasty (TKA) who were classified into subgroups of nonobese, obese, and morbidly obese, and to determine perioperative and postoperative complications. We conducted an evaluation of 489 nonobese, obese, and morbidly obese patients who underwent TKA due to primary knee osteoarthritis between January 2006 and December 2013. The arthroplasties were performed by three different surgeons. Patients who underwent unilateral (group 1) or simultaneous bilateral (group 2) TKAs were divided into subgroups in accordance with BMI levels, that is, (a) nonobese (BMI < 30 kg/m), (b) obese (BMI = 30-34.9 kg/m), and (c) morbidly obese (BMI ≥35 kg/m). Clinical and functional assessments were performed using Knee Society Scores (KSSs), the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and range of motion (ROM) values. Perioperative and early postoperative complications were assessed. The mean follow-up period was 46.65 months (minimum: 24 months; maximum: 84 months). There were no significant differences between the patients undergoing unilateral or simultaneous bilateral TKA procedures regarding postoperative ROM, WOMAC indices, and KSSs ( > 0.05), except for morbidly obese patients. Most intraoperative and early postoperative complications occurred in the morbidly obese group, especially in those undergoing simultaneous bilateral TKA procedures ( < 0.001). Unilateral and simultaneous bilateral TKA procedures showed no differences regarding ROM, clinical scores, and perioperative and early postoperative complications in nonobese and obese patients. A moderate increase was detected in complication rates in the unilateral TKA morbidly obese patients (group 1c); however, morbidly obese patients constituted the major risk group in simultaneous bilateral TKA patients (group 2c) regarding clinical scores (lower WOMAC scores and KSSs) and the development of complications.
本研究旨在探讨行单侧和同期双侧全膝关节置换术（TKA）的患者的临床和功能因素，这些患者被分为非肥胖、肥胖和病态肥胖亚组，并确定围手术期和术后并发症。我们评估了 2006 年 1 月至 2013 年 12 月期间因原发性膝骨关节炎行 TKA 的 489 例非肥胖、肥胖和病态肥胖患者。关节置换术由三位不同的外科医生进行。单侧（第 1 组）或同期双侧（第 2 组）行 TKA 的患者根据 BMI 水平分为亚组，即（a）非肥胖（BMI＜30kg/m），（b）肥胖（BMI=30-34.9kg/m）和（c）病态肥胖（BMI≥35kg/m）。采用膝关节协会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和关节活动度（ROM）值对临床和功能进行评估。评估围手术期和早期术后并发症。平均随访时间为 46.65 个月（最短：24 个月；最长：84 个月）。单侧或同期双侧 TKA 术后 ROM、WOMAC 指数和 KSS 之间无显著差异（＞0.05），病态肥胖患者除外。大多数术中及早期术后并发症发生在病态肥胖组，尤其是同期双侧 TKA 患者（＜0.001）。非肥胖和肥胖患者单侧和同期双侧 TKA 术后 ROM、临床评分和围手术期及早期术后并发症无差异。单侧 TKA 肥胖患者（第 1c 组）并发症发生率略有增加；然而，同期双侧 TKA 患者（第 2c 组）中，病态肥胖患者是临床评分（较低的 WOMAC 评分和 KSS）和并发症发生的主要高危人群。
