Ledford Cameron K, Kumar Arun R, Guier Christian G, Fruth Kristin M, Pagnano Mark W, Berry Daniel J, Abdel Matthew P
Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2023 Feb;38(2):259-265. doi: 10.1016/j.arth.2022.08.040. Epub 2022 Sep 3.
Metabolic syndrome (MetS) is an increasingly frequent condition characterized by insulin resistance, abdominal obesity, hypertension, and dyslipidemia. This study evaluated implant survivorship, complications, and clinical outcomes of primary TKAs performed in patients who have MetS.
Utilizing our institutional total joint registry, 2,063 primary TKAs were performed in patients with a diagnosis of MetS according to the World Health Organization criteria. MetS patients were matched 1:1 based on age, sex, and surgical year to those who did not have the condition. The World Health Organization's body mass index (BMI) classification was utilized to evaluate the effect of obesity within MetS patients. Kaplan-Meier methods were utilized to determine implant survivorship. Clinical outcomes were assessed with Knee Society scores. The mean follow-up was 5 years.
MetS and non-MetS patients did not have significant differences in 5-year implant survivorship free from any reoperation (P = .7), any revision (P = .2), and reoperation for periprosthetic joint infection (PJI; P = .2). When stratifying, patients with MetS and BMI >40 had significantly decreased 5-year survivorship free from any revision (95 versus 98%, respectively; hazard ratio = 2.1, P = .005) and reoperation for PJI (97 versus 99%, respectively; hazard ratio = 2.2, P = .02). Both MetS and non-MetS groups experienced significant improvements in Knee Society Scores (77 versus 78, respectively; P < .001) that were not significantly different (P = .3).
MetS did not significantly increase the risk of any reoperation after TKA; however, MetS patients with BMI >40 had a two-fold risk of any revision and reoperation for PJI. These results suggest that obesity is an important condition within MetS criteria and remains an independent risk factor.
Level 3, Case-control study.
代谢综合征（MetS）是一种日益常见的病症，其特征为胰岛素抵抗、腹型肥胖、高血压和血脂异常。本研究评估了在患有MetS的患者中进行初次全膝关节置换术（TKA）后的植入物生存率、并发症及临床结局。
利用我们机构的全关节登记系统，根据世界卫生组织标准，对2063例诊断为MetS的患者进行了初次TKA。将MetS患者按年龄、性别和手术年份与未患该病症的患者进行1:1匹配。采用世界卫生组织的体重指数（BMI）分类来评估MetS患者中肥胖的影响。采用Kaplan-Meier方法确定植入物生存率。用膝关节协会评分评估临床结局。平均随访时间为5年。
MetS患者和非MetS患者在5年无任何再次手术（P = 0.7）、任何翻修（P = 0.2）以及因假体周围关节感染（PJI）进行再次手术（P = 0.2）的植入物生存率方面无显著差异。分层分析时，BMI>40的MetS患者在5年无任何翻修（分别为95%和98%；风险比=2.1，P = 0.005）以及因PJI进行再次手术（分别为97%和99%；风险比=2.2，P = 0.02）的生存率显著降低。MetS组和非MetS组的膝关节协会评分均有显著改善（分别为77分和78分；P<0.001），但差异不显著（P = 0.3）。
MetS并未显著增加TKA后任何再次手术的风险；然而，BMI>40的MetS患者进行任何翻修以及因PJI进行再次手术的风险增加两倍。这些结果表明，肥胖是MetS标准中的一个重要因素，并且仍然是一个独立的风险因素。
3级，病例对照研究。
