Service de chirurgie orthopédique et traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
Service de chirurgie orthopédique et traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
Orthop Traumatol Surg Res. 2023 Dec;109(8):103704. doi: 10.1016/j.otsr.2023.103704. Epub 2023 Oct 11.
Associations between obesity and knee osteoarthritis or complications after total knee arthroplasty (TKA) are well established. The procedure can significantly improve knee function, favoring weight loss, despite the risk of surgical complications. The main objective of the present study was to assess change in body mass index (BMI) after TKA in patients with severe or morbid obesity (BMI≥35kg/m). The secondary endpoint was the rate of surgical revision. The hypotheses were that there is no significant change in BMI after TKA and that there is a significant rate of revision.
This retrospective descriptive study was conducted for the period June 2009 to December 2019. Thirty-three patients (48 knees) were included: 27 women, 6 men; mean age, 66.5 years (range, 55-80). Preoperatively, 11 patients had BMI 35-39.9kg/m and 22 BMI≥40 (including 11 with BMI≥45kg/m). The preoperative axis was in varus for 35 patients (73%, including 54%≥10°) and in valgus for 13 (27% including 33%≥10°). Radiological and clinical evaluation was carried out at 3 months and 1 year postoperatively. At≥2 years, change in BMI and EQ5D functional score were established by telephone survey; >5% change in BMI was considered significant.
Mean follow-up was 6.9±2.3 years (range, 2.9-10.5). Twenty-five patients (38 knees) were included for analysis. Mean postoperative BMI was 41±5kg/m, with a mean decrease of 1.2±3.6kg/m. At the last follow-up, BMI had increased in 8 patients (32%), including 3 by >5% (12%), and decreased in 16 (64%), including 7 by >5% (28%). The higher the baseline BMI, the greater the decrease: for BMI [35-39.9], -0.81 (range, -6.8; +4.3); for BMI [40-44.5],-1 (range, -9; +5.22); and for BMI>45, -1.54 (range, -3.97; +1.3). EQ5D averaged 0.75 at last follow-up. The higher the preoperative BMI, the more satisfactory the postoperative EQ5D: EQ5D for BMI [35-39.9]=0.71 (range, 0.36; 1); for BMI [40-44.5]=0.75 (range, 0.45; 1); and for BMI>45=0.80 (range, 0.48; 1). Four early surgical site infections (10.5%) and 2 isolated changes of the tibial component for early loosening (5.2%) required surgical revision.
Patients with severe or morbid obesity had a low tendency to lose weight after TKA, but this does not appear to us to be clinically relevant: the functional results were good. Nevertheless, this series showed a significant rate of revision (15%). TKA was feasible in patients with BMI≥35kg/m, but requires appropriate patient information.
IV.
肥胖与膝关节骨关节炎或全膝关节置换术（TKA）后并发症之间存在关联已得到充分证实。尽管存在手术并发症的风险，但该手术可以显著改善膝关节功能，有利于减轻体重。本研究的主要目的是评估严重或病态肥胖（BMI≥35kg/m）患者 TKA 后体重指数（BMI）的变化。次要终点是手术修正率。假设是 TKA 后 BMI 没有显著变化，且有显著的修正率。
这是一项回顾性描述性研究，研究期间为 2009 年 6 月至 2019 年 12 月。共纳入 33 名患者（48 膝）：27 名女性，6 名男性；平均年龄 66.5 岁（范围 55-80 岁）。术前，11 名患者 BMI 为 35-39.9kg/m，22 名患者 BMI≥40（包括 11 名 BMI≥45kg/m）。术前轴为内翻 35 例（73%，包括 54%≥10°），外翻 13 例（27%，包括 33%≥10°）。术后 3 个月和 1 年进行影像学和临床评估。在≥2 年后，通过电话调查确定 BMI 和 EQ5D 功能评分的变化；BMI 变化超过 5%被认为有显著意义。
平均随访时间为 6.9±2.3 年（范围 2.9-10.5 年）。25 名患者（38 膝）纳入分析。术后平均 BMI 为 41±5kg/m，平均减少 1.2±3.6kg/m。最后一次随访时，8 名患者（32%）BMI 增加，其中 3 名增加超过 5%（12%），16 名患者（64%）BMI 减少，其中 7 名减少超过 5%（28%）。基线 BMI 越高，下降幅度越大：BMI[35-39.9]，-0.81（范围-6.8；+4.3）；BMI[40-44.5]，-1（范围-9；+5.22）；BMI>45，-1.54（范围-3.97；+1.3）。最后一次随访时 EQ5D 平均为 0.75。术前 BMI 越高，术后 EQ5D 越满意：BMI[35-39.9]，0.71（范围 0.36；1）；BMI[40-44.5]，0.75（范围 0.45；1）；BMI>45，0.80（范围 0.48；1）。4 例早期手术部位感染（10.5%）和 2 例孤立的胫骨组件早期松动（5.2%）需要手术修正。
严重或病态肥胖患者 TKA 后体重减轻的倾向较低，但在我们看来这并不具有临床意义：功能结果良好。然而，本系列显示出较高的修正率（15%）。BMI≥35kg/m 的患者可以进行 TKA，但需要对患者进行适当的信息告知。
IV。
