Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan.
Knee Surg Sports Traumatol Arthrosc. 2021 May;29(5):1483-1493. doi: 10.1007/s00167-021-06435-9. Epub 2021 Jan 20.
The aim of this study was to systematically review the existing literature comparing the postoperative outcomes after following hip arthroscopy in obese and non-obese patients.
Studies comparing the outcomes following hip arthroscopy of obese and non-obese patients were systematically identified via a computer-assisted literature search of Pubmed (Medline), EMBASE, and Cochrane Library using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies comparing the outcome of hip arthroscopy in different body mass index (BMI) groups were included. Data including patient-reported outcome measures (PROMs), revision arthroscopy rate, conversion rate to total hip arthroplasty (THA), and complications were collected. The methodological index for non-randomized studies (MINORS) and Newcastle-Ottawa Scale (NOS) were used to assess the quality of each study quality. The effect of heterogeneity was quantified by calculating the I value.
A total of eight studies were finally included in the qualitative analysis, and three studies of high quality involving 373 hips were included in the quantitative assessment. All the studies defined obesity as a BMI of ≥ 30 kg/m. The modified Harris Hip Score and the Non-Arthritic Hip Score were 5.1 (95% CI 1.1-9.1) and 9.0 (95% CI 5.0-13.1) points lower, respectively, in the obese group than in the non-obese group. The pooled odds ratios were 1.2 (95% CI 0.5-2.7) for revision arthroscopy, 2.4 (95% CI 1.3-4.6) for conversion to THA, and 3.2 (95% CI 1.2-8.6 for complications in favor of the non-obese group. The heterogeneity was low in all outcome assessments (I 0-18%).
Obese patients had significantly lower PROMs than non-obese patients following hip arthroscopic surgery, and the THA conversion and complication rates were 2.4 times and 3.2 times higher, respectively. Understanding the effect of obesity on hip arthroscopy will allow appropriate surgical indications for surgery to be further refined and help obese patients to understand their individual risk profile.
Systematic review of Level III-IV studies, Level IV.
本研究旨在系统回顾比较肥胖患者和非肥胖患者髋关节镜术后结果的现有文献。
通过计算机辅助文献检索 Pubmed（Medline）、EMBASE 和 Cochrane Library，根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，系统地确定了比较肥胖和非肥胖患者髋关节镜术后结果的研究。纳入比较不同体重指数（BMI）组髋关节镜手术结果的研究。收集的数据包括患者报告的结果测量（PROMs）、翻修关节镜检查率、转换为全髋关节置换术（THA）的比率以及并发症。使用非随机研究的方法学指数（MINORS）和纽卡斯尔-渥太华量表（NOS）评估每个研究的质量。通过计算 I 值来量化异质性的影响。
最终纳入 8 项研究进行定性分析，3 项高质量研究（共 373 髋）纳入定量评估。所有研究均将肥胖定义为 BMI≥30kg/m²。肥胖组的改良 Harris 髋关节评分和非关节炎髋关节评分分别低 5.1（95%CI 1.1-9.1）和 9.0（95%CI 5.0-13.1）分。汇总的优势比分别为翻修关节镜检查的 1.2（95%CI 0.5-2.7）、转换为 THA 的 2.4（95%CI 1.3-4.6）和并发症的 3.2（95%CI 1.2-8.6），均有利于非肥胖组。所有结局评估的异质性均较低（I 0-18%）。
肥胖患者髋关节镜术后的 PROMs 明显低于非肥胖患者，THA 转换率和并发症发生率分别高 2.4 倍和 3.2 倍。了解肥胖对髋关节镜手术的影响将有助于进一步细化手术的适应证，并帮助肥胖患者了解其个体风险状况。
系统评价 III-IV 级研究，IV 级。
