Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.
Division of Rheumatology, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2024 Aug;39(8S1):S167-S173.e1. doi: 10.1016/j.arth.2024.02.062. Epub 2024 Feb 28.
The use of body mass index (BMI) cutoff values has been suggested for proceeding with total knee arthroplasty (TKA) in obese patients. However, the relationship between obesity severity and early reoperations after TKA is poorly defined. This study evaluated whether increased World Health Organization (WHO) obesity class was associated with risk, severity, and timing of reintervention within one year after TKA.
There were 8,674 patients from our institution who had a BMI ≥ 30 and underwent unilateral TKA for primary osteoarthritis between 2016 and 2021. Patients were grouped by WHO obesity class: 4,456 class I (51.5%), 2,527 class II (29.2%), and 1,677 class III (19.4%). A chart review was performed to determine patient characteristics and identify patients who underwent any closed or open reintervention requiring anesthesia within the first postoperative year. Regression analyses were performed to identify variables associated with increased odds ratios (ORs) for requiring a reintervention, its timing, and invasiveness.
There were 158 patients (1.8%) who required at least one reintervention, and 15 patients (0.2%) required at least 2 reinterventions. Reintervention rates for obesity classes I, II, and III were 1.8% (n = 81), 2.0% (n = 51), and 1.4% (n = 23), respectively. There were 65 closed procedures (41.1%), 47 minor procedures (29.7%), 34 open with or without liner exchange (21.5%), and 12 revisions with component exchange (7.6%). Obesity class was not associated with reintervention rate (P = .3), timing (P = .36), or invasiveness (P = .93). Diabetes (odds ratio [OR] = 2.47; P = .008) was associated with a need for reintervention. Non-Caucasian race (OR = 1.7; P = .01) and Charlson comorbidity index (OR = 2.1; P = .008) were associated with earlier reintervention. No factors were associated with the invasiveness of reintervention.
The WHO obesity class did not associate with rate, timing, or invasiveness of reintervention after TKA in obese patients. These findings suggest that policies that restrict the indication for elective TKA based only on a BMI limit have limited efficacy in reducing early reintervention after TKA in obese patients.
III.
已经有人提出使用体重指数（BMI）截断值来进行肥胖患者的全膝关节置换术（TKA）。然而，肥胖严重程度与 TKA 后早期再手术之间的关系尚未明确。本研究评估了世界卫生组织（WHO）肥胖类别增加是否与 TKA 后一年内的再手术风险、严重程度和时间有关。
我们对来自本机构的 8674 名 BMI≥30 且在 2016 年至 2021 年间因原发性骨关节炎接受单侧 TKA 的患者进行了研究。患者按 WHO 肥胖类别分组：4456 例 I 类（51.5%），2527 例 II 类（29.2%）和 1677 例 III 类（19.4%）。进行了病历回顾，以确定患者特征并确定在术后第一年接受任何需要麻醉的闭合或开放再手术的患者。进行了回归分析，以确定与再手术需要、手术时间和手术侵入性增加相关的变量。
有 158 名患者（1.8%）需要至少一次再手术，15 名患者（0.2%）需要至少两次再手术。I、II 和 III 肥胖类别的再手术率分别为 1.8%（n=81）、2.0%（n=51）和 1.4%（n=23）。有 65 例闭合性手术（41.1%）、47 例小手术（29.7%）、34 例开放性手术（21.5%）伴或不伴衬垫更换、12 例有组件更换的翻修手术（7.6%）。肥胖类别与再手术率（P=0.3）、时间（P=0.36）或侵入性（P=0.93）无关。糖尿病（比值比[OR] = 2.47；P=0.008）与再手术需要相关。非白种人种族（OR=1.7；P=0.01）和 Charlson 合并症指数（OR=2.1；P=0.008）与更早的再手术相关。没有因素与再手术的侵入性有关。
WHO 肥胖类别与肥胖患者 TKA 后再手术的发生率、时间和侵入性无关。这些发现表明，仅基于 BMI 限制来限制择期 TKA 适应证的政策，在减少肥胖患者 TKA 后早期再手术方面效果有限。
III 级。
