Department of Traumatology, Orthopedics and Disaster Surgery, I.M. Sechenov First Moscow State Medical University, 119992 Moscow, Russia.
Medicina (Kaunas). 2021 Nov 15;57(11):1247. doi: 10.3390/medicina57111247.
There is a general clinical concern on the negative impact of obesity on surgical complications and functional outcomes. We hypothesized that the patients with morbid obesity are exceptionally prone to a significantly increased risk for surgical and short-term complications after primary total hip arthroplasty (THA). We aimed to identify the range of Body Mass Index (BMI) values of patients with a significant risk for lower functional improvement after THA. In Stage 1 of the study, we conducted a retrospective comparative analysis of the rate of complications and functional outcomes in patients treated by primary THA, with normal weight (BMI 19-25, = 1205) vs. Class 1 (BMI 26-34, = 450), Class 2 (BMI 35-39, = 183), and Class 3 (BMI ≥ 40, = 47) obese patients. After the statistical similarity rates of complications and 6- and 12-month functional outcomes (by Harris Hip and SF-36 scores) were revealed in Class 1 patients and patients with normal BMI, we conducted the Stage 2 prospective study, by the same comparison protocol, on the cohorts of Class 2 ( = 29) and Class 3 ( = 16) patients compared to the Class 1 patients ( = 37) as controls. Stage 1: There was no difference in surgical complications and function on 6- and 12-month postoperative follow-up (physical and mental) between Class 1 and patients with normal BMI ( > 0.05). Surgical complications were significantly higher in Class 2 ( < 0.05) and Class 3 ( < 0.001) patients. Functional activity on the 12-month follow-up increased significantly in all study groups, but in the Class 3 patients, the functional parameters were significantly lower (0.001). The mental health status on the follow-up was similar in all study groups. Stage 2 study revealed similar to the retrospective study comparison of parameters, except for the significantly lower mental health scores in Class 2 and Class 3 patients ( < 0.05) and functional scores in Class 3 patients ( < 0.05). Although the functional ability increased in all patients, it was significantly lower in Class 3 patients (with morbid obesity). Therefore, the patients with Class 1 and Class 2 obesity should be conceptionally distinguished from Class 3 patients in the decision-making process for a primary THA because of the less favorable functional and mental health improvement in those with morbid obesity (Class 3).
人们普遍关注肥胖对手术并发症和功能结果的负面影响。我们假设病态肥胖患者在初次全髋关节置换术后（THA）发生手术和短期并发症的风险显著增加。我们旨在确定 BMI 值范围，以便识别在初次 THA 后功能改善幅度较小的患者。在研究的第一阶段，我们对初次 THA 治疗的患者进行了并发症和功能结果的回顾性比较分析，分为正常体重（BMI 19-25，n=1205）、I 级肥胖（BMI 26-34，n=450）、II 级肥胖（BMI 35-39，n=183）和 III 级肥胖（BMI≥40，n=47）。在 I 级肥胖患者和正常 BMI 患者中发现并发症发生率和 6 个月及 12 个月功能结果（通过 Harris 髋关节评分和 SF-36 评分评估）相似后，我们按照相同的比较方案进行了第二阶段前瞻性研究，比较了 II 级肥胖（n=29）和 III 级肥胖（n=16）患者与 I 级肥胖患者（n=37）作为对照组。第一阶段：在 6 个月和 12 个月的术后随访中（身体和精神方面），I 级肥胖患者和正常 BMI 患者的手术并发症和功能无差异（>0.05）。II 级肥胖（<0.05）和 III 级肥胖（<0.001）患者的手术并发症发生率显著升高。所有研究组在 12 个月的随访中功能活动显著增加，但 III 级肥胖患者的功能参数显著降低（<0.001）。所有研究组的心理健康状况在随访中相似。第二阶段研究显示，除了 II 级肥胖和 III 级肥胖患者的心理健康评分（<0.05）和 III 级肥胖患者的功能评分（<0.05）显著降低外，参数比较与回顾性研究相似。尽管所有患者的功能能力都有所提高，但 III 级肥胖患者（病态肥胖）的功能能力明显较低。因此，在初次 THA 的决策过程中，应将 I 级肥胖和 II 级肥胖患者与 III 级肥胖患者区分开来，因为病态肥胖（III 级）患者的功能和心理健康改善程度较差。
