Primary Joint Unit, Musgrave Park Hospital, Belfast, UK.
Bone Joint J. 2020 Sep;102-B(9):1146-1150. doi: 10.1302/0301-620X.102B9.BJJ-2020-0207.R1.
Previous research has demonstrated increased early complication rates following total hip arthroplasty (THA) in obese patients, as defined by body mass index (BMI). Subcutaneous fat depth (FD) has been shown to be an independent risk factor for wound infection in cervical and lumbar spine surgery, as well as after abdominal laparotomy. The aim of this study was to investigate whether increased peritrochanteric FD was associated with an increased risk of complications in the first year following THA.
We analyzed prospectively collected data on a consecutive series of 1,220 primary THAs from June 2013 until May 2018. The vertical soft tissue depth from the most prominent part of the greater trochanter to the skin was measured intraoperatively using a sterile ruler and recorded to the nearest millimetre. BMI was calculated at the patient's preoperative assessment. All surgical complications occuring within the initial 12 months of follow-up were identified.
Females had a significantly greater FD at the greater trochanter in comparison to males (median 3.0 cm (interquartile range (IQR) 2.3 to 4.0) vs 2.0 cm (IQR 1.7 to 3.0); p < 0.001) despite equivalent BMI between sexes (male median BMI 30.0 kg/m (IQR 27.0 to 33.0); female median 29.0 kg/m (IQR 25.0 to 33.0)). FD showed a weak correlation with BMI (R² 0.41 males and R² 0.43 females). Patients with the greatest FD (upper quartile) were at no greater risk of complications compared with patients with the lowest FD (lower quartile); 7/311 (2.3%) vs 9/439 (2.1%); p = 0.820 . Conversely, patients with the highest BMI (≥ 40 kg/m) had a significantly increased risk of complications compared with patients with lower BMI (< 40 kg/m); 5/60 (8.3% vs 18/1,160 (1.6%), odds ratio (OR) 5.77 (95% confidence interval (CI) 2.1 to 16.1; p = 0.001)).
We found no relationship between peritrochanteric FD and the risk of surgical complications following primary THA. Cite this article: 2020;102-B(9):1146-1150.
先前的研究表明，肥胖患者（根据体重指数 [BMI] 定义）行全髋关节置换术（THA）后早期并发症的发生率更高。皮下脂肪厚度（FD）已被证明是颈椎和腰椎手术、腹部剖腹手术后伤口感染的独立危险因素。本研究旨在探讨是否增加股骨转子下 FD 与 THA 后 1 年内并发症的风险增加有关。
我们分析了 2013 年 6 月至 2018 年 5 月期间连续进行的 1220 例初次 THA 的前瞻性收集数据。术中使用无菌标尺测量从大转子最突出部分到皮肤的垂直软组织深度，并记录到最近的毫米。在患者术前评估时计算 BMI。识别出所有在最初 12 个月随访期间发生的手术并发症。
女性在大转子处的 FD 明显大于男性（中位数 3.0cm（四分位距（IQR）2.3 至 4.0）比 2.0cm（IQR 1.7 至 3.0）；p<0.001），尽管男女之间的 BMI 相等（男性中位数 BMI 30.0kg/m（IQR 27.0 至 33.0）；女性中位数 29.0kg/m（IQR 25.0 至 33.0））。FD 与 BMI 呈弱相关（男性 R²0.41，女性 R²0.43）。FD 最高（上四分位数）的患者与 FD 最低（下四分位数）的患者相比，并发症的风险没有增加；311 例中有 7 例（2.3%）比 439 例中有 9 例（2.1%）；p=0.820。相反，BMI 最高（≥40kg/m）的患者与 BMI 较低（<40kg/m）的患者相比，并发症的风险显著增加；60 例中有 5 例（8.3%）比 1160 例中有 18 例（1.6%）；比值比（OR）5.77（95%置信区间（CI）2.1 至 16.1；p=0.001）。
我们发现股骨转子下 FD 与初次 THA 后手术并发症的风险之间没有关系。
