DeClercq Madeleine Grace, Sacchetti Michael, Coleman Jacob, Dunne Kevin, Zamzam Mazen, Lockard Carly, Omari Ali, Hurst Zachary, Saleh Ehab, Omari Abdullah
Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
J Orthop. 2024 Jul 3;58:128-134. doi: 10.1016/j.jor.2024.06.038. eCollection 2024 Dec.
The purpose of this study was to assess if subcutaneous fat (SCF) or BMI is a predictor of surgical complications and patient reported outcomes in patients undergoing robotic-assisted total hip arthroplasty (THA).
Patients who underwent robotic-assisted primary THAs at one institution between 2018 and 2020 were included in this retrospective cohort study. Prior to surgery, computed tomography (CT) was used to measure SCF in the posterolateral quadrant of the hip. SCF was measured 3 centimeters (cm) proximal to the greater trochanter (PGT) and 3 cm inferior to the distal tip of the greater trochanter (DGT).Measurements were normalized to the size of the patient's bony anatomy by dividing the subcutaneous fat area measurement by the transverse diameter of the femur 10 cm inferior to the tip of the greater trochanter. Patients were divided into quintiles determined by SCF distribution around the mean (groups 1-5) and BMI (BMI<25, BMI 25-29.9, BMI 30-34.9, BMI 35-39.9, and >40). Ninety day outcomes and PROMIS (Patient Reported Outcome Measures Information System) scores were acquired from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database preoperatively, at 14-112 days post-operative and at the latest follow up.
There were 175 patients identified with a mean age of 63.83 years (range 27-89) and a mean BMI of 30.73kg/m2 (range 18.2-48.4). Interclass correlation coefficient was greater than 0.9 in all PGT, DGT, and GT measurements. Analysis of Variance (ANOVA) found there was a significantly shorter time from incision to closure in quintiles 1 and 3 when compared to the SCF quintile 5 (p<0.05) and that there was a significantly shorter time from incision to closure in BMI categories 1, 2, and 3 when compared to BMI category 5 (BMI > 40). There were no differences between SCF and BMI as predictive of length of stay, transfusion status, infection, or PROMIS scores.
It can be concluded that hip SCF on axial CT images can reliably measure SCF and is predictive of time from incision to closure, but it does not show a significant difference in predicting the length of stay, infection, or PROMIS scores when compared to BMI.
本研究的目的是评估皮下脂肪（SCF）或体重指数（BMI）是否是接受机器人辅助全髋关节置换术（THA）患者手术并发症及患者报告结局的预测指标。
本回顾性队列研究纳入了2018年至2020年期间在一家机构接受机器人辅助初次THA的患者。术前，使用计算机断层扫描（CT）测量髋关节后外侧象限的SCF。在大转子近端3厘米（cm）（PGT）和大转子远端尖端下方3 cm（DGT）处测量SCF。通过将皮下脂肪面积测量值除以大转子尖端下方10 cm处股骨的横径，将测量值按患者骨骼解剖结构的大小进行标准化。患者根据SCF围绕均值的分布（第1 - 5组）和BMI（BMI<25、BMI 25 - 29.9、BMI 30 - 34.9、BMI 35 - 39.9和>40）分为五等份。术前、术后14 - 112天及最近一次随访时，从密歇根关节置换登记协作质量倡议（MARCQI）数据库中获取90天结局和患者报告结局测量信息系统（PROMIS）评分。
共纳入175例患者，平均年龄63.83岁（范围27 - 89岁），平均BMI为30.73kg/m²（范围18.2 - 48.4）。所有PGT、DGT和GT测量的组内相关系数均大于0.9。方差分析（ANOVA）发现，与SCF五分位数5相比，第1和第3五分位数从切开到关闭的时间显著缩短（p<0.05）；与BMI类别5（BMI>40）相比，BMI类别1、2和3从切开到关闭的时间显著缩短。在预测住院时间、输血状态、感染或PROMIS评分方面，SCF和BMI之间没有差异。
可以得出结论，轴向CT图像上的髋部SCF能够可靠地测量SCF，并可预测从切开到关闭的时间，但与BMI相比，在预测住院时间、感染或PROMIS评分方面没有显著差异。
