肥胖对全膝关节置换术后 8 周功能结局和患者满意度的影响：前瞻性 FInGK 研究结果。
The influence of obesity on functional outcomes and patient satisfaction 8 weeks after total knee arthroplasty: results of the prospective FInGK study.
机构信息
Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany.
University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany.
出版信息
BMC Musculoskelet Disord. 2022 Nov 3;23(1):949. doi: 10.1186/s12891-022-05874-w.
OBJECTIVES
To investigate obese versus non-obese subjects´ knee joint function, stiffness, pain, expectations, and outcome satisfaction before and two months after total knee arthroplasty (TKA).
METHODS
This study is a secondary analysis of data retrieved via a prospective single-centre cohort study investigating knee joint function and health care services utilization in patients undergoing TKA (FInGK Study). For the primary study, elective TKA patients were consecutively recruited between December 2019 and May 2021. Preoperative expectations, Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), surgery outcome satisfaction, and sociodemographic variables were assessed via self-reported questionnaires. In the current study, obese (Body Mass Index (BMI) ≥ 30 kg/m²) versus non-obese (BMI < 30 kg/m²) subjects' data were exploratively compared before and two months after TKA. Multivariable logistic regression assessed factors associated with TKA satisfaction two months postoperatively. Linear regression evaluated factors associated with higher WOMAC change two months postoperatively.
RESULTS
A total of 241 subjects participated (response: 85.2%). Eighty-seven were non-obese (mean age: 70.7 years, 63.2% female) and 154 were obese (mean age: 67.1 years, 57.8% female). Obese subjects reported inferior pre- and postoperative pain and knee joint function compared to non-obese subjects. Yet, WOMAC scores of obese and non-obese subjects significantly improved from preoperative means of 52.6 and 46.8 to 32.3 and 24.4 after surgery, respectively. The only significant TKA satisfaction predictor was subjects' smoking status. Non-obesity and worse preoperative WOMAC scores were predictive of higher WOMAC change scores after two months.
CONCLUSION
Both obese and non-obese subjects reported significant symptom improvements. However, as obese subjects' short-term outcomes were still inferior, more research on TKA rehabilitation measures adapted to the needs of this growing patient group is warranted to maximize their benefits from TKA.
目的
研究肥胖与非肥胖患者在全膝关节置换术（TKA）前后膝关节功能、僵硬、疼痛、期望和术后满意度。
方法
本研究是对一项前瞻性单中心队列研究数据的二次分析，该研究调查了接受 TKA 的膝关节功能和医疗保健服务利用情况（FInGK 研究）。在主要研究中，连续招募了 2019 年 12 月至 2021 年 5 月期间接受 TKA 的择期 TKA 患者。通过自我报告问卷评估术前期望、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、手术结果满意度和社会人口学变量。在本研究中，探索性比较了肥胖（BMI≥30kg/m²）与非肥胖（BMI<30kg/m²）患者在 TKA 前后 2 个月的资料。多变量逻辑回归评估了术后 2 个月 TKA 满意度的相关因素。线性回归评估了术后 2 个月 WOMAC 变化更大的相关因素。
结果
共有 241 名受试者参加（应答率：85.2%）。87 名非肥胖者（平均年龄：70.7 岁，63.2%为女性），154 名肥胖者（平均年龄：67.1 岁，57.8%为女性）。肥胖患者报告的术前和术后疼痛及膝关节功能均低于非肥胖患者。然而，肥胖和非肥胖患者的 WOMAC 评分分别从术前的 52.6 和 46.8 显著改善至术后的 32.3 和 24.4。唯一显著的 TKA 满意度预测因素是患者的吸烟状况。非肥胖和术前 WOMAC 评分较差是术后 2 个月 WOMAC 评分变化更大的预测因素。
结论
肥胖和非肥胖患者均报告症状有显著改善。然而，由于肥胖患者的短期结果仍较差，需要更多针对这一不断增长的患者群体需求的 TKA 康复措施的研究，以最大限度地提高他们从 TKA 中获益。
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