Schmerler Jessica, Harris Andrew B, Srikumaran Uma, Khanuja Harpal S, Oni Julius K, Hegde Vishal
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Arthroplasty. 2023 Dec;38(12):2504-2509.e1. doi: 10.1016/j.arth.2023.06.019. Epub 2023 Jun 17.
Body mass index (BMI) impacts risk for revision total knee arthroplasty (rTKA), but the relationship between BMI and cause for revision remains unclear. We hypothesized that patients in different BMI classes would have disparate risk for causes of rTKA.
There were 171,856 patients who underwent rTKA from 2006 to 2020 from a national database. Patients were classified as underweight (BMI < 19), normal-weight, overweight/obese (BMI 25 to 39.9), or morbidly obese (BMI > 40). Multivariable logistic regressions adjusted for age, sex, race/ethnicity, socioeconomic status, payer status, hospital geographic setting, and comorbidities were used to examine the effect of BMI on risk for different rTKA causes.
Compared to normal-weight controls, underweight patients were 62% less likely to undergo revision due to aseptic loosening, 40% less likely due to mechanical complications, 187% more likely due to periprosthetic fracture, 135% more likely due to periprosthetic joint infection (PJI). Overweight/obese patients were 25% more likely to undergo revision due to aseptic loosening, 9% more likely due to mechanical complications, 17% less likely due to periprosthetic fracture, and 24% less likely due to PJI. Morbidly obese patients were 20% more likely to undergo revision due to aseptic loosening, 5% more likely due to mechanical complications, and 6% less likely due to PJI.
Mechanical reasons were more likely to be the cause of rTKA in overweight/obese and morbidly obese patients, compared to underweight patients, for whom revision was more likely to be infection or fracture related. Increased awareness of these differences may promote patient-specific management to reduce complications.
III.
体重指数（BMI）会影响全膝关节置换翻修术（rTKA）的风险，但BMI与翻修原因之间的关系仍不清楚。我们假设不同BMI类别的患者rTKA病因的风险会有所不同。
从一个全国性数据库中选取了2006年至2020年期间接受rTKA的171,856例患者。患者被分为体重过轻（BMI<19）、正常体重、超重/肥胖（BMI 25至39.9）或病态肥胖（BMI>40）。采用多变量逻辑回归分析，对年龄、性别、种族/民族、社会经济地位、付款人状态、医院地理位置和合并症进行调整，以研究BMI对不同rTKA病因风险的影响。
与正常体重对照组相比，体重过轻的患者因无菌性松动进行翻修的可能性低62%，因机械并发症进行翻修的可能性低40%，因假体周围骨折进行翻修的可能性高187%，因假体周围关节感染（PJI）进行翻修的可能性高135%。超重/肥胖患者因无菌性松动进行翻修的可能性高25%，因机械并发症进行翻修的可能性高9%，因假体周围骨折进行翻修的可能性低17%，因PJI进行翻修的可能性低24%。病态肥胖患者因无菌性松动进行翻修的可能性高20%，因机械并发症进行翻修的可能性高5%，因PJI进行翻修的可能性低6%。
与体重过轻的患者相比，超重/肥胖和病态肥胖患者rTKA的原因更可能是机械性的，而体重过轻的患者翻修更可能与感染或骨折有关。对这些差异的认识提高可能会促进针对患者的管理，以减少并发症。
III级。
