Institute of Health Faculty of Education, Health and Wellbeing the University of Wolverhampton Wolverhampton, WV1 1DT UK.
Institute of Health Faculty of Education, Health and Wellbeing the University of Wolverhampton Wolverhampton, WV1 1DT UK.
Int J Orthop Trauma Nurs. 2021 Jul;42:100850. doi: 10.1016/j.ijotn.2021.100850. Epub 2021 Feb 16.
Primary Total Knee Replacement (TKR) is one of the most commonly performed elective orthopaedic procedures globally. Many patients undergoing this type of surgery are overweight or obese. In the UK, clinical commissioning groups have imposed arbitrary Body Mass Index (BMI) thresholds for TKR surgery. Many obese patients undergoing TKR believe they will lose weight following the procedure because of increased mobility.
This paper aims to present the findings of a scoping literature review about the relationship between obesity and primary TKR and to make recommendations for clinical practice, education and policy.
A scoping literature review investigated the impact of BMI/body weight on the need for TKR, the impact of body weight and or BMI on patient outcomes following TKR, weight loss/gain following TKR and the implications of obesity on cost of TKR.
Seventy-one papers were included in the review. Seven studies reported statistically significant associations between increased BMI/obesity with the need for TKR. Thirty of the studies reported worse outcomes for obese patients compared to non-obese comparisons. Forty of the studies reported no difference between obese and non-obese participants, including some where outcomes of obese patients were better than non-obese comparisons. Eight studies reported on changes to weight before and after TKR, three of the studies reporting a higher percentage losing weight than gaining weight and four studies reporting that obese patients gained weight. The 8th study reported that morbidly obese patients largely returned to their baseline BMI postoperatively.
The findings of the review challenge the legitimacy of setting BMI thresholds to control access to TKR surgery. There is an urgent need to develop evidence based approaches to support weight loss and weight management for this group of patients. Obese patients undergoing TKR should receive specific information regarding potential additional risks of complications and poorer outcomes. There is a need for health promotion regarding the association of being overweight/obese in young adulthood and developing osteoarthritis of the knee joints requiring TKR in middle and older age.
初次全膝关节置换术（TKR）是全球范围内最常进行的择期矫形手术之一。接受此类手术的许多患者超重或肥胖。在英国，临床委托组对 TKR 手术施加了任意的体重指数（BMI）阈值。许多接受 TKR 的肥胖患者相信，由于活动能力增加，他们在手术后会减轻体重。
本文旨在介绍一项范围广泛的文献综述的结果，该综述探讨了肥胖与初次 TKR 的关系，并为临床实践、教育和政策提供建议。
范围广泛的文献综述调查了 BMI/体重对 TKR 需求的影响、体重和/或 BMI 对 TKR 后患者结果的影响、TKR 后体重减轻/增加以及肥胖对 TKR 成本的影响。
综述共纳入 71 篇论文。有 7 项研究报告 BMI/肥胖与 TKR 需求之间存在统计学显著关联。30 项研究报告肥胖患者的结果比非肥胖对照组差。40 项研究报告肥胖和非肥胖参与者之间没有差异，其中一些肥胖患者的结果优于非肥胖对照组。有 8 项研究报告了 TKR 前后体重的变化，其中 3 项研究报告体重减轻的比例高于体重增加的比例，4 项研究报告肥胖患者体重增加。第 8 项研究报告病态肥胖患者术后大部分恢复到基线 BMI。
综述结果对设定 BMI 阈值来控制 TKR 手术的准入提出了质疑。迫切需要制定基于证据的方法来支持这组患者的减肥和体重管理。接受 TKR 的肥胖患者应获得有关潜在并发症和较差结果的额外风险的具体信息。需要进行有关超重/肥胖与年轻时膝关节骨关节炎发展以及中年和老年时需要 TKR 的关联的健康促进。
