Abhari Sarag, Rhea Evan B, Arrington Derek D, Smith Langan S, Yakkanti Madhusudhan R, Malkani Arthur L
Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA.
School of Medicine, University of Louisville, Louisville, KY, USA.
Arthroplast Today. 2023 Jul 22;22:101169. doi: 10.1016/j.artd.2023.101169. eCollection 2023 Aug.
Patient satisfaction and patient-reported outcome measures (PROMs) are important for patients, surgeons, and payers in the current healthcare climate. Morbidly obese patients (body mass index [BMI] >40) have demonstrated higher incidence of complications after total knee arthroplasty (TKA) and can have difficulty obtaining access for their surgical care. The purpose of this study was to evaluate PROMs and patient satisfaction in morbidly obese patients undergoing primary TKA.
A total of 75 patients with BMI >40 kg/m undergoing robotic-assisted TKA were retrospectively identified and matched 2:1 to a consecutive cohort of patients with BMI <35. The average BMI of the study cohort was 42.4 kg/m (39.5-51.3) compared to 28.6 kg/m (18.5-34.9) in the control group. Clinical outcomes, PROMs, and patient satisfaction were evaluated at a minimum 2-year follow-up.
The patients of the BMI >40 cohort were less likely to be discharged home ( = .0076), had less active flexion at 2 years ( = .0046), and had worse knee scores at 2 years (0.0497). Despite this, the percentage of patients who were satisfied or very satisfied after surgery was similar between the groups (87.5% vs 91.2%, = .1943).
Morbidly obese patients are less likely to be discharged directly to home and may have functional differences after primary TKA. However, morbidly obese patients have similar PROMs and are as satisfied as nonobese patients at 2 years. Morbidly obese patients with end-stage knee osteoarthritis should also be able to enjoy the benefits of primary TKA following medical and surgical optimization.
在当前的医疗环境中，患者满意度和患者报告结局指标（PROMs）对患者、外科医生和支付方而言都很重要。病态肥胖患者（体重指数[BMI]>40）在全膝关节置换术（TKA）后并发症发生率较高，并且在获得手术治疗方面可能存在困难。本研究的目的是评估接受初次TKA的病态肥胖患者的PROMs和患者满意度。
回顾性确定了75例BMI>40kg/m²且接受机器人辅助TKA的患者，并按2:1的比例与连续的BMI<35的患者队列进行匹配。研究队列的平均BMI为42.4kg/m²（39.5-51.3），而对照组为28.6kg/m²（18.5-34.9）。在至少2年的随访中评估临床结局、PROMs和患者满意度。
BMI>40队列的患者出院回家的可能性较小（P=0.0076），2年时主动屈曲度较小（P=0.0046），2年时膝关节评分较差（P=0.0497）。尽管如此，两组术后满意或非常满意的患者百分比相似（87.5%对91.2%，P=0.1943）。
病态肥胖患者直接出院回家的可能性较小，初次TKA后可能存在功能差异。然而，病态肥胖患者的PROMs相似，且在2年时与非肥胖患者一样满意。终末期膝关节骨关节炎的病态肥胖患者在经过医学和手术优化后也应能够享受初次TKA的益处。
