Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Arthroplasty. 2021 Jul;36(7S):S184-S191. doi: 10.1016/j.arth.2020.11.004. Epub 2020 Nov 10.
The aims of this study were to determine if increasing body mass index (BMI) is a risk factor for failure to attain the 1-year Patient Reported Outcomes Measurement Information System Physical Function (PROMIS PF-10a) minimal clinically important difference (MCID) following total joint arthroplasty (TJA) and to determine a possible BMI threshold beyond which this risk increases significantly.
This retrospective study was performed using 3506 TJAs sourced from a regional-based registry. An anchor-based MCID threshold of 7.9 was chosen. PROMIS PF-10a scores were collected at the preoperative and 1-year postoperative timepoints, and the change was used to determine failure to achieve the 1-year MCID. Demographic and surgical variables were also collected. The association between BMI and failure to achieve 1-year PROMIS PF-10 MCID was then evaluated using logistic regression. A BMI threshold was determined using receiver operating characteristic (ROC) curve analysis.
Increasing BMI assessed continuously was a significant risk factor for failure to achieve the MCID (P < .001). "Obese Class I" (30-35 kg/m), "Obese Class II" (35-40 kg/m), and "Obese Class III" (>40 kg/m) subgroups compared to "Normal BMI" (<25 kg/m) were significantly associated (P < .05) with this adverse outcome as well.
Our study showed that increasing BMI is a risk factor for failure to achieve the 1-year PROMIS PF-10a MCID following TJA. Among our patients, an increase in 1 kg/m increased the risk of failure to achieve the MCID by 2%. With these findings, surgeons will be better equipped to preoperatively advise patients with elevated BMIs considering TJA.
本研究旨在确定体重指数（BMI）的增加是否是全关节置换术后未能达到 1 年患者报告结局测量信息系统（PROMIS）身体机能（PROMIS PF-10a）最小临床重要差异（MCID）的危险因素，并确定可能存在 BMI 阈值，超过该阈值，这种风险会显著增加。
本回顾性研究使用了一个基于区域的登记处的 3506 例 TJA。选择了 7.9 的基于锚定的 MCID 阈值。在术前和 1 年术后收集 PROMIS PF-10a 评分，并使用该变化来确定是否未能达到 1 年 MCID。还收集了人口统计学和手术变量。然后使用逻辑回归评估 BMI 与未能达到 1 年 PROMIS PF-10 MCID 的关联。使用受试者工作特征（ROC）曲线分析确定 BMI 阈值。
连续评估的 BMI 增加是未能达到 MCID 的显著危险因素（P <.001）。与“正常 BMI”（<25 kg/m）相比，“肥胖 I 级”（30-35 kg/m）、“肥胖 II 级”（35-40 kg/m）和“肥胖 III 级”（>40 kg/m）亚组与这种不良结局显著相关（P <.05）。
我们的研究表明，BMI 的增加是 TJA 后未能达到 1 年 PROMIS PF-10a MCID 的危险因素。在我们的患者中，BMI 增加 1 kg/m 会使未能达到 MCID 的风险增加 2%。有了这些发现，外科医生将能够更好地在术前为考虑接受 TJA 的 BMI 升高的患者提供建议。
