Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY.
Department of Orthopaedic Surgery, University of Louisville, Louisville, KY.
J Arthroplasty. 2020 Aug;35(8):2097-2100. doi: 10.1016/j.arth.2020.04.010. Epub 2020 Apr 11.
Obese and morbidly obese patients undergoing primary total knee arthroplasty (TKA) place significant stress at the bone-cement-implant interface over the life of the patient. The purpose of this study is to evaluate results of cemented, posterior-stabilized TKA in obese and morbidly obese patients at an average follow-up of 10 years.
Retrospective study of 181 patients who had a cemented, posterior-stabilized TKA between 2000 and 2013 with body mass index >35 at the time of surgery was conducted. Clinical data and radiographs were evaluated along with survivorship, complications, and revisions. Minimum follow-up was 5 years with an average follow-up of 10 years.
There were 135 women and 46 men in the study, with mean age of 60.2 years (range 43-80), mean body mass index of 42.0 (range 35.1-66.1), and an average follow-up of 10 years (range 5-18). There were a total of 39 failures (22%) that underwent revision TKA surgery with mean time to revision of 8 years. Failures included 25 (14%) cases of aseptic loosening; 9 (5%) polyethylene wear; 2 (1%) prosthetic joint infection; and 3 additional revisions for instability, pain, and stiffness. There were a total of 11 cases of isolated tibial component loosening and 13 for both tibial and femoral loosening. Survivorship at 15 years with aseptic loosening as the endpoint was 86.7%, and for all causes 79.6% at 15 years.
Aseptic loosening is the leading cause of failure following TKA in obese and morbidly obese patients with decreasing survivorship from 96.1% to 91.2% and 86.7% at 5, 10, and 15 years, respectively.
肥胖和病态肥胖患者在其整个生命周期中都会对骨-水泥-植入物界面造成很大的压力，而初次全膝关节置换术（TKA）就是为了治疗这些患者。本研究旨在评估在平均随访 10 年时，肥胖和病态肥胖患者接受骨水泥固定、后稳定型 TKA 的结果。
对 2000 年至 2013 年间接受骨水泥固定、后稳定型 TKA 的 181 例患者进行回顾性研究，这些患者在手术时的体重指数（BMI）均大于 35。评估了临床数据、影像学结果以及生存率、并发症和翻修情况。最低随访时间为 5 年，平均随访时间为 10 年。
研究中共有 135 名女性和 46 名男性，平均年龄为 60.2 岁（范围 43-80），平均 BMI 为 42.0（范围 35.1-66.1），平均随访时间为 10 年（范围 5-18）。共有 39 例（22%）患者因失败而接受了翻修 TKA 手术，翻修时间的平均为 8 年。失败原因包括 25 例（14%）无菌性松动；9 例（5%）聚乙烯磨损；2 例（1%）假体关节感染；另外 3 例因不稳定、疼痛和僵硬进行了翻修。共有 11 例单纯胫骨组件松动，13 例胫骨和股骨均松动。以无菌性松动为终点，15 年生存率为 86.7%，所有原因的 15 年生存率为 79.6%。
无菌性松动是肥胖和病态肥胖患者 TKA 失败的主要原因，生存率从 5 年的 96.1%降至 10 年的 91.2%和 15 年的 86.7%。
