Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
J Arthroplasty. 2023 Sep;38(9):1839-1845.e1. doi: 10.1016/j.arth.2023.02.048. Epub 2023 Feb 28.
Visceral obesity, a strong indicator of chronic inflammation and impaired metabolic health, has been shown to be associated with poor postoperative outcomes and complications. This study aimed to evaluate the relationship between visceral fat area (VFA) and periprosthetic joint infection (PJI) in total joint arthroplasty (TJA) patients.
A retrospective study of 484 patients who had undergone a total hip or knee arthroplasty was performed. All patients had a computed tomography scan of the abdomen/pelvis within two years of their TJA. Body composition data (ie, VFA, subcutaneous fat area, and skeletal muscle area) were calculated at the Lumbar-3 vertebral level via two fully automated and externally validated machine learning algorithms. A multivariable logistic model was created to determine the relationship between VFA and PJI, while accounting for other PJI risk factors. Of the 484 patients, 31 (6.4%) had a PJI complication.
The rate of PJI among patients with VFA in the top quartile (> 264.1 cm) versus bottom quartile (< 82.6 cm) was 5.6% versus 10.6% and 18.8% versus 2.7% in the total hip arthroplasty and total knee arthroplasty cohorts, respectively. In the multivariate model, total knee arthroplasty patients with a VFA in the top quartile had a 30.5 times greater risk of PJI than those in the bottom quartile of VFA (P = .0154).
VFA may have a strong association with PJI in TJA patients. Using a standardized imaging modality like computed tomography scans to calculate VFA can be a valuable tool for surgeons when assessing risk of PJI.
内脏肥胖是慢性炎症和代谢健康受损的一个强有力指标，已被证明与术后不良结局和并发症有关。本研究旨在评估全关节置换术 (TJA) 患者的内脏脂肪面积 (VFA) 与假体周围关节感染 (PJI) 之间的关系。
对 484 例接受全髋关节或膝关节置换术的患者进行回顾性研究。所有患者在 TJA 后两年内均进行了腹部/骨盆 CT 扫描。通过两种全自动、经过外部验证的机器学习算法，在腰椎 3 椎体水平计算体成分数据（即 VFA、皮下脂肪面积和骨骼肌面积）。创建多变量逻辑模型，以确定 VFA 与 PJI 之间的关系，同时考虑其他 PJI 风险因素。在 484 例患者中，有 31 例（6.4%）发生 PJI 并发症。
VFA 处于最高四分位数（>264.1cm）的患者与 VFA 处于最低四分位数（<82.6cm）的患者相比，全髋关节置换术和全膝关节置换术队列中 PJI 的发生率分别为 5.6%和 10.6%，18.8%和 2.7%。在多变量模型中，VFA 处于最高四分位的全膝关节置换术患者发生 PJI 的风险比 VFA 处于最低四分位的患者高 30.5 倍（P=0.0154）。
VFA 与 TJA 患者的 PJI 可能有很强的关联。使用 CT 扫描等标准化成像方式来计算 VFA 可以成为外科医生评估 PJI 风险的有用工具。
