Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
BMC Geriatr. 2021 Jan 4;21(1):2. doi: 10.1186/s12877-020-01929-6.
Sarcopenia often accompanies osteoarthritis (OA), which is managed by total knee arthroplasty (TKA) in the late stage. Recent studies have suggested a higher risk of post-operative complications after TKA in sarcopenic OA subjects, but whether TKA can benefit them similar to non-sarcopenic subjects remains unexplored. This study aimed to examine the dynamic, mutual impact of sarcopenia and TKA in a one-year post-operative period.
This prospective cohort study was conducted between 2015 to 2018 at our hospital. Patients with end-stage OA of the knee waiting for TKA were recruited into the study. Primary outcome measures were change in muscle strength, mass and function. Secondary outcome measures were quality of life (QOL) measurements for pain, psychological and physical health.
Fifty-eight patients were recruited, of which 79.3% were female and 32.8% already had sarcopenia at baseline. The average age of sarcopenic subjects and non-sarcopenic subjects was comparable (67.89 ± 7.07 vs. 67.92 ± 6.85; p = 0.99), but sarcopenic subjects had a lower body mass index (BMI) (25.64 ± 2.64 vs. 28.57 ± 4.04; p = 0.01). There was a statistically significant improvement in walking speed (10.24 ± 5.35 vs. 7.69 ± 2.68, p < 0.01) and muscle strength in both sarcopenic and non-sarcopenic patients after TKA. This was accompanied by an improvement trend in muscle mass in all subjects. There was no change in handgrip power before and after TKA and subsequent follow-up (19.31 ± 5.92 vs. 18.98 ± 6.37 vs. 19.36 ± 7.66; p = 0.97). QOL measured before, after and at follow-up with WOMAC (total: 42.27 ± 15.98 vs. 20.65 ± 15.24 vs. 16.65 ± 18.13) and SF12v2 (PCS: 33.06 ± 8.55 vs. 38.96 ± 8.01 vs. 40.67 ± 7.93) revealed progressive significant improvement (both comparisons p ≤ 0.01). Further analysis with the IPAQ also found increased engagement of high-intensity activities.
This study showed that sarcopenia among patients with end-stage OA of the knee is not uncommon, but both sarcopenic and non-sarcopenic OA patients achieved significant clinical and functional improvement after TKA. Further studies with a larger sample size and different ethnicities could help ascertain a beneficial role of TKA in sarcopenic OA subjects.
Registry: ClinicalTrials.gov , Registration number: NCT03579329 . Date of registration: 6 July 2018. Retrospectively registered.
肌少症常伴有骨关节炎（OA），晚期 OA 通常通过全膝关节置换术（TKA）治疗。最近的研究表明，肌少症 OA 患者在接受 TKA 后发生术后并发症的风险更高，但 TKA 是否能像非肌少症患者那样使他们受益尚未得到探索。本研究旨在探讨 TKA 在术后一年内对肌少症和 TKA 的动态、相互影响。
这是一项前瞻性队列研究，于 2015 年至 2018 年在我院进行。招募等待 TKA 的终末期膝关节 OA 患者入组。主要结局指标为肌肉力量、质量和功能的变化。次要结局指标为疼痛、心理和身体健康的生活质量（QOL）测量。
共招募了 58 名患者，其中 79.3%为女性，32.8%在基线时已患有肌少症。肌少症组和非肌少症组的平均年龄相当（67.89±7.07 岁 vs. 67.92±6.85 岁；p=0.99），但肌少症组的体重指数（BMI）较低（25.64±2.64 千克/平方米 vs. 28.57±4.04 千克/平方米；p=0.01）。TKA 后，肌少症和非肌少症患者的步行速度（10.24±5.35 米/秒 vs. 7.69±2.68 米/秒；p<0.01）和肌肉力量均有显著改善。所有患者的肌肉质量均呈改善趋势。TKA 前后及后续随访时握力（19.31±5.92 牛顿 vs. 18.98±6.37 牛顿 vs. 19.36±7.66 牛顿；p=0.97）无变化。WOMAC（总分：42.27±15.98 分 vs. 20.65±15.24 分 vs. 16.65±18.13 分）和 SF12v2（PCS：33.06±8.55 分 vs. 38.96±8.01 分 vs. 40.67±7.93 分）的 QOL 测量在 TKA 前后及随访时均显示出显著的改善（p≤0.01）。对 IPAQ 的进一步分析发现，高强度活动的参与度增加。
本研究表明，终末期膝关节 OA 患者中肌少症并不少见，但肌少症和非肌少症 OA 患者在接受 TKA 后均获得了显著的临床和功能改善。更大样本量和不同种族的进一步研究可能有助于确定 TKA 对肌少症 OA 患者的有益作用。
ClinicalTrials.gov，注册号：NCT03579329。注册日期：2018 年 7 月 6 日。回顾性注册。
