The Department of Orthopedic Surgery, St. Vincent Hospital, 26713The Catholic University of Korea, Seoul, Korea.
Seoul Sun Orthopedic Clinic, Seoul, Korea.
J Orthop Surg (Hong Kong). 2022 May-Aug;30(2):10225536221113034. doi: 10.1177/10225536221113034.
Sarcopenia, a loss of muscle mass and strength with aging, is associated with various TKA-related complications. In 2020, the AWGS published an undated guideline (AWGS 2019) based on studies from East and Southeast Asia. The purpose of this study was to determine the prevalence of sarcopenia in Asian female patients awaiting primary total knee arthroplasty due to advanced knee osteoarthritis using the updated AWGS criteria.
The present study included 138 female patients who scheduled for primary TKA with severe osteoarthritis. The included patients were assessed with use of an AWGS 2019 diagnostic criteria based on muscle strength, physical performance, and appendicular skeletal muscle mass. Clinical parameters related to sarcopenia were collected and knee status assessed using the Knee Society scoring system. To better define the association with age, patients were stratified into following four groups: <60, 60-69, 70-79, ≥80. The prevalence of sarcopenia was identified, and the association between sarcopenia and clinical variables was analyzed.
The prevalence of sarcopenia and severe sarcopenia in this cohort according to the updated AWGS criteria was 35.5% and 21.7%. Prevalence of sarcopenia and severe sarcopenia significantly increased with advancing age ( = .003, = .040, respectively). Although not statistically significant, the proportion of severe sarcopenia among sarcopenia also increased with age. Multivariate logistic regression analysis revealed that lower BMI and lower 25-OH-vitamin D3 level were independent risk factors associated with sarcopenia in women awaiting TKA.
In conclusion, our study confirmed that sarcopenia is more prominent amongst female patients awaiting primary TKA than the general population. Therefore, orthopedic surgeons should consider sarcopenia prevention and intervention in this group. Further studies are needed to investigate the effect of TKA on sarcopenia, and the difference of TKA outcomes between groups with or without underlying sarcopenia.
肌肉减少症是一种随年龄增长而发生的肌肉质量和力量的损失，与各种 TKA 相关并发症有关。2020 年，AWGS 基于东亚和东南亚的研究发布了一份无日期指南（AWGS 2019）。本研究的目的是使用更新的 AWGS 标准，确定因晚期膝关节骨关节炎而接受初次全膝关节置换术的亚洲女性患者中肌肉减少症的患病率。
本研究纳入了 138 名因严重骨关节炎而计划接受初次 TKA 的女性患者。纳入的患者使用 AWGS 2019 诊断标准进行评估，该标准基于肌肉力量、身体表现和四肢骨骼肌质量。收集与肌肉减少症相关的临床参数，并使用膝关节协会评分系统评估膝关节状况。为了更好地定义与年龄的关系，将患者分为以下四组：<60 岁、60-69 岁、70-79 岁、≥80 岁。确定了肌肉减少症的患病率，并分析了肌肉减少症与临床变量之间的关系。
根据更新的 AWGS 标准，该队列中肌肉减少症和严重肌肉减少症的患病率分别为 35.5%和 21.7%。肌肉减少症和严重肌肉减少症的患病率随着年龄的增长而显著增加（=0.003，=0.040）。虽然没有统计学意义，但严重肌肉减少症在肌肉减少症中的比例也随着年龄的增长而增加。多变量逻辑回归分析显示，较低的 BMI 和较低的 25-OH-维生素 D3 水平是女性接受 TKA 时与肌肉减少症相关的独立危险因素。
总之，我们的研究证实，等待初次 TKA 的女性患者的肌肉减少症比一般人群更为突出。因此，骨科医生应该考虑在这一人群中预防和干预肌肉减少症。需要进一步研究以调查 TKA 对肌肉减少症的影响，以及有无潜在肌肉减少症的两组之间 TKA 结果的差异。
