Heifner John J, Sakalian Philip A, Rowland Robert J, Corces Arturo
Miami Orthopaedic Research Foundation, 11801 SW 90th Street Suite 201, Miami, FL, 33186, USA.
Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, FL, USA.
J Exp Orthop. 2023 Nov 6;10(1):110. doi: 10.1186/s40634-023-00680-2.
Improved understanding of the factors that predispose TKA patients to infection has considerable economic and medical impact. BMI is commonly used as a proxy for obesity to determine the risk of postoperative infection. However, this metric appears to be fraught with inconsistency in this application. BMI is a simple calculation which provides general insight into body habitus. But it fails to account for anatomic distribution of adipose tissue and the proportion of the mass that is skeletal muscle. Our objective was to review the literature to determine if local adiposity was more predictive than BMI for infection following TKA.
A database search was performed for the following PICO (Population, Intervention, Comparison, and Outcome) characteristics: local measurements of adiposity (defined as soft tissue thickness or fat thickness or soft tissue envelope at the knee) in patients over 18 years of age treated with total knee arthroplasty used to determine the relationship between local adiposity and the risk of infection (defined as prosthetic joint infection or wound complication or surgical site infection). Quality was assessed using the GRADE framework and bias was assessed using ROBINS-I .
Six articles (N=7081) met the inclusion criteria. Four of the six articles determined that adiposity was more associated with or was a better predictor for infection risk than BMI. One of the six articles concluded that increased adiposity was protective for short term infection and that BMI was not associated with the outcome of interest. One of the six articles determined that BMI was more strongly associated with PJI risk than soft tissue thickness.
The use of adiposity as a proxy for obesity in preoperative evaluation of TKA patients is an emerging concept. Although limited by heterogeneity, the current literature suggests that local adiposity may be a more reliable predictor for infection than BMI following primary TKA.
IV systematic review.
更好地理解导致全膝关节置换术（TKA）患者感染的因素具有重大的经济和医学影响。体重指数（BMI）通常被用作肥胖的替代指标来确定术后感染风险。然而，这一指标在该应用中似乎存在诸多不一致之处。BMI是一种简单的计算方法，能提供对身体体型的总体了解。但它没有考虑脂肪组织的解剖分布以及骨骼肌质量所占的比例。我们的目的是回顾文献，以确定局部肥胖对于TKA术后感染的预测性是否高于BMI。
针对以下PICO（人群、干预措施、对照、结局）特征进行数据库检索：对接受全膝关节置换术的18岁以上患者进行局部肥胖测量（定义为膝关节处的软组织厚度、脂肪厚度或软组织包膜），以确定局部肥胖与感染风险（定义为假体关节感染、伤口并发症或手术部位感染）之间的关系。使用GRADE框架评估质量，使用ROBINS-I评估偏倚。
6篇文章（N = 7081）符合纳入标准。6篇文章中的4篇确定肥胖与感染风险的相关性更强或比BMI更能预测感染风险。6篇文章中的1篇得出结论，肥胖增加对短期感染有保护作用，且BMI与所关注的结局无关。6篇文章中的1篇确定BMI与假体关节感染风险的相关性比软组织厚度更强。
在TKA患者的术前评估中，使用肥胖作为肥胖的替代指标是一个新兴概念。尽管受到异质性的限制，但当前文献表明，在初次TKA术后，局部肥胖可能是比BMI更可靠的感染预测指标。
IV级系统评价。
