Bagge Anders, Jensen Christian B, Mikkelsen Mette, Gromov Kirill, Nielsen Christian S, Troelsen Anders
Hvidovre Hospital Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark.
J Arthroplasty. 2023 Feb;38(2):252-258.e2. doi: 10.1016/j.arth.2022.09.002. Epub 2022 Sep 10.
In this study, we examined the association between obesity and patient-reported outcome measures after medial unicompartmental knee arthroplasty (MUKA), assessed through score changes, Patient Acceptable Symptom State (PASS), and minimal important change (MIC). Second, the association between obesity and early readmissions was examined.
A total of 450 MUKAs (mean body mass index [BMI] 30.3, range, 19.6-53.1), performed from February 2016 to December 2020, were grouped using BMI: <30, 30-34.9, and >34.9. Oxford Knee Score (OKS), Forgotten Joint Score (FJS), and Activity and Participation Questionnaire (APQ) were assessed preoperatively and at 3, 12, and 24 months, postoperatively. The 12-month PASS and MIC were also assessed, defining PASS as OKS = 30, MIC-OKS as change in OKS = 8, and MIC-FJS as change in FJS = 14.
No significant differences in OKS change were found between BMI groups. After 12 months, patients who had a BMI of 30-34.9 had lower change in FJS (estimate -8.1, 95% CI -14.9 to -1.4) and were less likely to reach PASS (odds ratio 0.4, 95% CI 0.2-0.7) as well as MIC-FJS (odds ratio 0.5, 95% CI 0.2-0.9). Both obese groups had lower change in APQ after 12 months. Differences in 90-day readmission rates were nonsignificant between groups.
Our findings of no differences in OKS improvement between BMI groups and achieving MIC for BMI > 34.9 suggest good improvements in obese patients despite lower preoperative scores, supporting contemporary indications for MUKA. Lower APQ development and achievement of 12-month PASS may be used when addressing expectations of recovery.
在本研究中，我们通过评分变化、患者可接受症状状态（PASS）和最小有意义变化（MIC），研究了内侧单髁膝关节置换术（MUKA）后肥胖与患者报告结局指标之间的关联。其次，研究了肥胖与早期再入院之间的关联。
对2016年2月至2020年12月期间进行的450例MUKA手术（平均体重指数[BMI]30.3，范围19.6 - 53.1），根据BMI分组：<30、30 - 34.9和>34.9。术前以及术后3、12和24个月评估牛津膝关节评分（OKS）、遗忘关节评分（FJS）和活动与参与问卷（APQ）。还评估了12个月时的PASS和MIC，将PASS定义为OKS = 30，MIC - OKS定义为OKS变化 = 8，MIC - FJS定义为FJS变化 = 14。
BMI组之间OKS变化无显著差异。12个月后，BMI为30 - 34.9的患者FJS变化较低（估计值 - 8.1，95%置信区间 - 14.9至 - 1.4），达到PASS的可能性较小（比值比0.4，95%置信区间0.2 - 0.7）以及达到MIC - FJS的可能性较小（比值比0.5，95%置信区间0.2 - 0.9）。两个肥胖组在12个月后APQ变化均较低。组间90天再入院率差异无统计学意义。
我们的研究结果表明，BMI组之间OKS改善无差异，且BMI>34.9的患者达到MIC，这表明肥胖患者尽管术前评分较低，但仍有良好改善，支持MUKA的当代适应证。在处理恢复期望时，可考虑较低的APQ进展情况和12个月PASS的实现情况。
