Launceston General Hospital, University of Tasmania, Tamar Valley Orthopaedics, Newstead, Tasmania, Australia.
Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, School of Public Health and Preventative Medicine, Monash University, Monash, Victoria, Australia.
ANZ J Surg. 2023 Jun;93(6):1665-1673. doi: 10.1111/ans.18449. Epub 2023 Apr 5.
The objective is to determine whether body mass index is associated with patient-reported expectations and well-being before primary total hip or total knee arthroplasty, and patient-reported outcomes 6 months after surgery.
Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Outcome measures included pre-operative expectations for post-operative mobility, joint pain and health, pre- and post-operative EQ-5D-5L, EQ-VAS, Oxford Hip/Knee Scores and joint pain scales, and post-operative perceived change and perceived satisfaction. Associations with BMI were assessed using chi-square tests, analysis of variance and Linear Mixed Models equations.
Data were available for 12 816 primary THA patients and 20 253 primary TKA patients. Pre-operatively, patients in higher BMI categories were significantly more likely to expect ongoing problems with mobility, more joint pain and poorer health following surgery (P<0.01 for all analyses). For arthroplasty patients, higher BMI was associated with poorer pre-operative and post-operative scores for all measures. BMI was positively associated with improvements in EQ-5D, OHS/KS and joint pain. While between-group differences were statistically significant, many were small in magnitude. There was no association between BMI and patient-perceived change or satisfaction after arthroplasty.
Patients undergoing THA/TKA, higher BMI was associated with lower pre-operative expectations, poorer well-being before surgery, and worse scores after surgery. Patients who were obese demonstrated comparable satisfaction with their operated joint, compared with non-obese patients. BMI was associated with greater pre- to post-operative improvements in outcome scores for EQ-5D, VAS knee, OHS/OKS and joint pain but these differences may not be clinically important.
本研究旨在确定体重指数（BMI）是否与初次全髋关节或全膝关节置换术前患者的预期和幸福感相关，以及术后 6 个月的患者报告结局。
数据来自澳大利亚矫形协会国家关节置换登记处。结局测量包括术前对术后活动能力、关节疼痛和健康的预期，术前和术后 EQ-5D-5L、EQ-VAS、牛津髋关节/膝关节评分和关节疼痛量表，以及术后感知变化和满意度。使用卡方检验、方差分析和线性混合模型方程评估与 BMI 的关联。
共有 12816 例初次 THA 患者和 20253 例初次 TKA 患者的数据可用。术前，BMI 较高类别的患者更有可能预期术后活动能力持续存在问题，关节疼痛和健康状况更差（所有分析 P<0.01）。对于关节置换患者，较高的 BMI 与所有测量指标的术前和术后评分较差相关。BMI 与 EQ-5D、OHS/KS 和关节疼痛的改善呈正相关。虽然组间差异具有统计学意义，但许多差异的幅度较小。BMI 与关节置换后患者感知的变化或满意度之间没有关联。
接受 THA/TKA 的患者，BMI 较高与术前预期较低、手术前幸福感较差和手术后评分更差相关。与非肥胖患者相比，肥胖患者对手术关节的满意度相当。BMI 与 EQ-5D、VAS 膝关节、OHS/OKS 和关节疼痛的术前至术后改善程度呈正相关，但这些差异可能无临床意义。
