Department of Radiology, Thomas Jefferson University, Philadelphia, PA.
Department of Bioengineering, Clemson-Medical University of South Carolina, Charleston, SC.
J Arthroplasty. 2021 Sep;36(9):3101-3107.e1. doi: 10.1016/j.arth.2021.02.069. Epub 2021 Mar 2.
The number of obese patients seeking a total joint arthroplasty (TJA) continues to increase. Weight loss is often recommended to treat joint pain and reduce risks associated with TJA. We sought to determine the effectiveness of an orthopedic surgeon's recommendation to lose weight.
We identified morbidly obese (body mass index (BMI) 40-49.9 kg/m) and super obese (BMI ≥50 kg/m) patients with hip or knee osteoarthritis. Patients with less than 3-month follow-up were excluded. Patient characteristics (age, gender, BMI, comorbidities), disease characteristics (joint affected, radiographic osteoarthritis grading), and treatments were recorded. Clinically meaningful weight loss was defined as weight loss greater than 5%.
Two hundred thirty morbid and 50 super obese patients were identified. Super obese patients were more likely to be referred to weight management (52.0% vs 21.7%, P < .001) and were less likely to receive TJA (20.0% vs 41.7%, P = .004). Each 1 kg/m increase in BMI decreased the odds of TJA by 10.9% (odds ratio = 0.891, 95% confidence interval: 0.833-0.953, P = .001). Forty (23.0%) of the nonoperatively treated patients achieved clinically meaningful weight loss, and 19 (17.9%) patients who underwent TJA lost weight before surgery. After surgery, the number of patients who achieved a clinically meaningful weight loss grew to 32 (30.2%).
In morbid and super obese patients, increasing BMI reduces the likelihood that a patient will receive TJA, and when counseled by their orthopedic surgeon, few patients participate in weight-loss programs or are otherwise able to lose weight. Weight loss is an inconsistently modifiable risk factor for joint replacement surgery.
寻求全关节置换术（TJA）的肥胖患者人数持续增加。减轻体重通常被推荐用于治疗关节疼痛并降低与 TJA 相关的风险。我们试图确定骨科医生建议减肥的有效性。
我们确定了患有髋或膝关节骨关节炎的病态肥胖（体重指数（BMI）40-49.9 kg/m）和超级肥胖（BMI≥50 kg/m）患者。排除随访时间少于 3 个月的患者。记录患者特征（年龄、性别、BMI、合并症）、疾病特征（受影响的关节、放射照相骨关节炎分级）和治疗方法。临床意义上的体重减轻定义为体重减轻超过 5%。
确定了 230 名病态肥胖患者和 50 名超级肥胖患者。超级肥胖患者更有可能被转介到体重管理（52.0%比 21.7%，P<.001），而接受 TJA 的可能性较小（20.0%比 41.7%，P=.004）。BMI 每增加 1 kg/m，接受 TJA 的几率就降低 10.9%（比值比=0.891，95%置信区间：0.833-0.953，P<.001）。40 名（23.0%）非手术治疗患者实现了临床意义上的体重减轻，19 名（17.9%）接受 TJA 的患者在手术前减轻了体重。手术后，达到临床意义上体重减轻的患者数量增加到 32 名（30.2%）。
在病态肥胖和超级肥胖患者中，BMI 的增加降低了患者接受 TJA 的可能性，并且当他们的骨科医生提供咨询时，很少有患者参与减肥计划或以其他方式减轻体重。体重减轻是关节置换手术的一个不可改变的风险因素。
