Elcock Katherine L, MacDonald Deborah J, Clement Nick D, Scott Chloe E H
University of Edinburgh Medical School, Chancellor's Building, The Royal Infirmary of Edinburgh, 49 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SB, UK.
Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
Knee Surg Relat Res. 2023 Apr 11;35(1):9. doi: 10.1186/s43019-023-00184-4.
Patients with severe obesity [body mass index (BMI) ≥ 40 kg/m] potentially overload the tibial component after total knee arthroplasty (TKA), risking tibial subsidence. Using a cemented single-radius cruciate-retaining TKA design, this study compared the outcomes of two tibial baseplate geometries in patients with BMI ≥ 40 kg/m: standard keeled (SK) or universal base plate (UBP), which incorporates a stem.
This was a retrospective, single-centre cohort study with minimum 2 years follow-up of 111 TKA patients with BMI ≥ 40 kg/m: mean age 62.2 ± 8.0 (44-87) years, mean BMI 44.3 ± 4.6 (40-65.7) kg/m and 82 (73.9%) females. Perioperative complications, reoperations, alignment and patient-reported outcomes (PROMS): EQ-5D, Oxford Knee Score (OKS), Visual Analogue Scale (VAS) pain score and satisfaction were collected preoperatively, and at 1 year and final follow-up postoperatively.
Mean follow-up was 4.9 years. SK tibial baseplates were performed in 57 and UBP in 54. There were no significant differences in baseline patient characteristics, post-operative alignment, post-operative PROMs, reoperations or revisions between the groups. Three early failures requiring revision occurred: two septic failures in the UBP group and one early tibial loosening in the SK group. Five-year Kaplan-Meier survival for the endpoint mechanical tibial failure was SK 98.1 [94.4-100 95% confidence interval (CI)] and UBP 100% (p = 0.391). Overall varus alignment of the limb (p = 0.005) or the tibial component (p = 0.031) was significantly associated with revision and return to theatre.
At early to mid-term follow-up, no significant differences in outcomes were found between standard and UBP tibial components in patients with BMI ≥ 40 kg/m. Varus alignment of either tibial component or the limb was associated with revision and return to theatre.
严重肥胖患者（体重指数[BMI]≥40kg/m²）在全膝关节置换术（TKA）后可能会使胫骨部件负荷过重，存在胫骨下沉风险。本研究采用骨水泥固定的单半径保留交叉韧带TKA设计，比较了BMI≥40kg/m²患者中两种胫骨基板几何形状的效果：标准龙骨型（SK）或带有柄的通用基板（UBP）。
这是一项回顾性单中心队列研究，对111例BMI≥40kg/m²的TKA患者进行了至少2年的随访：平均年龄62.2±8.0（44 - 87）岁，平均BMI 44.3±4.6（40 - 65.7）kg/m²，女性82例（73.9%）。收集围手术期并发症、再次手术情况、对线情况以及患者报告结局（PROMS）：EQ - 5D、牛津膝关节评分（OKS）、视觉模拟量表（VAS）疼痛评分和满意度，术前、术后1年及最终随访时均进行收集。
平均随访4.9年。57例采用SK胫骨基板，54例采用UBP。两组患者的基线特征、术后对线、术后PROMS、再次手术或翻修情况均无显著差异。发生了3例需要翻修的早期失败病例：UBP组2例感染性失败，SK组1例早期胫骨松动。终点为机械性胫骨失败的5年Kaplan - Meier生存率，SK为98.1[94. _ 4 - 100 95%置信区间（CI）]，UBP为100%（p = 0.391）。肢体总体内翻对线（p = 0.005）或胫骨部件内翻对线（p = 0.031）与翻修及再次手术显著相关。
在早期至中期随访中，BMI≥40kg/m²患者的标准胫骨部件和UBP胫骨部件在结局方面未发现显著差异。胫骨部件或肢体的内翻对线与翻修及再次手术相关。
