Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Orthopaedic Surgery, Dubbo Base Hospital, Dubbo, New South Wales, Australia; Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
J Arthroplasty. 2021 Jul;36(7):2418-2423. doi: 10.1016/j.arth.2021.02.051. Epub 2021 Feb 25.
Total joint arthroplasty (TJA) is among the most common operations performed worldwide, with global volumes on the rise. It is important to understand if the characteristics of this patient population are changing over time for resource allocation and surgical planning. The purpose of this study is to examine how this patient population has changed between 2003 and 2017.
A retrospective review of a prospective TJA database was conducted. Age, gender, body mass index, comorbidities, American Society of Anesthesiologists class, responsible diagnoses, and comorbidities were compared over 5-year intervals between 2003 and 2017. All patients undergoing primary, elective TJA were included.
Overall, 17,138 TJAs were included. Mean body mass index increased over the study period for total hip arthroplasty (THA; 29.4-30.4 kg/m, P < .0001) and total knee arthroplasty (TKA; 32.0-3.1 kg/m, P < .0001) patients. THA patients were significantly younger in more recent years (68.0-66.8 years old, P = .0026); this trend was not observed among TKA patients. Over the study period, a significantly higher proportion of patients were American Society of Anesthesiologists class III/IV for THA (50.5%-72.3%) and TKA (57.5%-80.7%) (P < .00001). Prevalence of common comorbidities did not change significantly.
The key findings of this retrospective analysis of a large prospective database are that patients undergoing TJA are becoming younger and more obese. It is unclear whether patients are becoming more medically complex. These trends paint a concerning picture of a population that is increasingly complex, and may require a greater allocation of resources in the future.
Level III, retrospective cohort study.
全关节置换术（TJA）是全球最常见的手术之一，全球手术量呈上升趋势。了解这一患者群体的特征是否随时间发生变化对于资源配置和手术计划非常重要。本研究旨在探讨该患者群体在 2003 年至 2017 年期间的变化情况。
对前瞻性 TJA 数据库进行回顾性分析。比较了 2003 年至 2017 年每 5 年间隔的年龄、性别、体重指数、合并症、美国麻醉医师协会（ASA）分级、主要诊断和合并症。所有接受初次、择期 TJA 的患者均纳入研究。
共纳入 17138 例 TJA。全髋关节置换术（THA）和全膝关节置换术（TKA）患者的平均体重指数在研究期间逐渐增加（29.4-30.4kg/m2，P<.0001；32.0-3.1kg/m2，P<.0001）。近年来，THA 患者明显更年轻（68.0-66.8 岁，P=.0026）；而 TKA 患者中并未观察到这一趋势。在研究期间，THA（50.5%-72.3%）和 TKA（57.5%-80.7%）患者中 ASA 分级 III/IV 的比例显著升高（P<.00001）。常见合并症的患病率无显著变化。
本研究通过回顾性分析大型前瞻性数据库得出的关键发现是，接受 TJA 的患者变得更年轻且更肥胖。目前尚不清楚患者是否变得更具医学复杂性。这些趋势描绘了一个日益复杂的人群的令人担忧的画面，未来可能需要更多的资源分配。
III 级，回顾性队列研究。
