Heifner John J, Fox Yitzak M, Sakalian Philip A, Corces Arturo
Miami Orthopaedic Research Foundation, Coral Gables, FL, USA.
Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA.
J Orthop. 2023 Mar 27;38:79-84. doi: 10.1016/j.jor.2023.03.012. eCollection 2023 Apr.
Preoperative optimization of obese patients is a critical component of risk stratification in primary total hip arthroplasty (THA). Body mass index is ubiquitously utilized as a proxy for obesity due to its ease of attainment and simplistic interpretation. The use of adiposity as a proxy for obesity is an emerging concept. Local adiposity provides insight into the magnitude of peri-incisional tissue and has demonstrated an association with postoperative complications. Our objective was to review the literature to determine if local adiposity is a reliable predictor for complications following primary total hip arthroplasty.
In keeping with the PRISMA guidelines, a database search of PubMed was conducted for articles which reported on the relationship between quantified measures of adiposity at the hip and rates of complication following primary THA. Methodological quality was assessed using GRADE and risk of bias using ROBINS-I.
A total of six articles (N = 2931) met the inclusion criteria. Local adiposity at the hip was measured on anteroposterior radiograph in four articles and was measured intraoperatively in two. Across four of the six articles, adiposity was significantly associated with postoperative complications including prosthesis failure and infection.
The use of BMI as a predictor for postoperative complication has been fraught with inconsistency. There is momentum for adiposity to be used as a proxy for obesity in preoperative THA risk stratification. The current findings demonstrated that local adiposity may be a reliable predictor for complications following primary THA.
肥胖患者的术前优化是初次全髋关节置换术（THA）风险分层的关键组成部分。由于体重指数易于获取且解释简单，它被广泛用作肥胖的替代指标。将肥胖度用作肥胖的替代指标是一个新兴概念。局部肥胖度能反映切口周围组织的情况，并已证明与术后并发症有关。我们的目的是回顾文献，以确定局部肥胖度是否是初次全髋关节置换术后并发症的可靠预测指标。
按照PRISMA指南，在PubMed数据库中搜索报道髋关节肥胖量化指标与初次THA术后并发症发生率之间关系的文章。使用GRADE评估方法学质量，使用ROBINS-I评估偏倚风险。
共有6篇文章（N = 2931）符合纳入标准。4篇文章通过前后位X线片测量髋关节局部肥胖度，2篇文章在术中测量。在6篇文章中的4篇中，肥胖度与包括假体失败和感染在内的术后并发症显著相关。
将BMI用作术后并发症的预测指标一直存在不一致性。在术前THA风险分层中，将肥胖度用作肥胖的替代指标有一定的趋势。目前的研究结果表明，局部肥胖度可能是初次THA术后并发症的可靠预测指标。
