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肥胖并不影响髌股关节置换术后患者报告的结果。

Obesity Does Not Affect Patient-Reported Outcomes following Patellofemoral Arthroplasty.

机构信息

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.

Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.

出版信息

J Knee Surg. 2022 Feb;35(3):312-316. doi: 10.1055/s-0040-1713862. Epub 2020 Jul 13.

Abstract

Patellofemoral arthroplasty (PFA) has garnered attention in recent years as an effective alternative to total knee arthroplasty for patients with symptomatic, isolated patellofemoral joint arthritis. Obesity has previously been identified as a risk factor for revision surgery, but its effect on patient-reported outcome measures (PROMs) has not been evaluated A retrospective review of a consecutive series of PFA surgeries was conducted at a single, specialized orthopedics center in a major urban center. Patients were dichotomized by body mass index (BMI) as obese (O, BMI >30) or nonobese (NO, BMI: 18.5-25). Demographic, surgical information, and PROMs were collected and analyzed accordingly. Seventy-six patients (41 nonobese, 35 obese) were identified. Patients who were obese presented with significantly worse preoperative PROMs regarding knee-specific quality of life, physical function, and MH or mental health (knee injury and osteoarthritis outcome score quality of life [KOOS QoL], NO: 26.2, O: 14.7,  = 0.019; KOOS PF, NO: 38.2, O: 50.5,  = 0.002; Veterans Rand-12 mental health [VR-12 MH], NO: 54.2, O: 47.0,  = 0.033). No significant difference was seen in improvement in knee function scores between patients who were obese or nonobese (KOOS QoL, NO: 39.5, O: 40.6,  = 0.898; KOOS PS [physical function], NO: -17.8, O: -17.3,  = 0.945). Additionally, no difference in the rate of PFA revision was observed and there were no postoperative complications reported. Obese patients with isolated PFA can expect the same improvement in function as nonobese patients following patellofemoral joint arthroplasty. This paper underscores the priority of patient selection in PFA and challenges the notion that surgeons should exclude patients from receiving a PFA on the basis of obesity.

摘要

髌股关节置换术(PFA)作为治疗症状性孤立髌股关节炎的一种有效方法,近年来备受关注。肥胖被认为是翻修手术的一个风险因素,但它对患者报告的结果测量(PROMs)的影响尚未得到评估。对一家大型城市中心的一家专业骨科中心连续进行的 PFA 手术进行了回顾性分析。患者根据体重指数(BMI)分为肥胖(O,BMI>30)或非肥胖(NO,BMI:18.5-25)。收集并分析了人口统计学、手术信息和 PROMs。共确定了 76 名患者(41 名非肥胖,35 名肥胖)。肥胖患者的膝关节特异性生活质量、身体功能和 MH 或心理健康(膝关节损伤和骨关节炎结果评分生活质量[KOOS QoL],NO:26.2,O:14.7,  = 0.019;KOOS PF,NO:38.2,O:50.5,  = 0.002;退伍军人兰德 12 项心理健康[VR-12 MH],NO:54.2,O:47.0,  = 0.033)术前 PROM 明显更差。肥胖和非肥胖患者的膝关节功能评分改善无显著差异(KOOS QoL,NO:39.5,O:40.6,  = 0.898;KOOS PS[身体功能],NO:-17.8,O:-17.3,  = 0.945)。此外,未观察到 PFA 翻修率的差异,也未报告术后并发症。患有孤立性髌股关节炎的肥胖患者在接受髌股关节置换术后,其功能可得到与非肥胖患者相同的改善。本文强调了 PFA 中患者选择的优先级,并对肥胖患者不应接受 PFA 的观点提出了挑战。

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