Heifner John J, Pannu Tejbir S, Gomez Osmanny, Sakalian Philip A, Corces Arturo
Miami Orthopaedic Research Foundation, Miami, Florida.
Larkin Hospital Department of Orthopedic Surgery, Miami, Florida.
J Arthroplasty. 2025 Feb;40(2):346-351. doi: 10.1016/j.arth.2024.08.020. Epub 2024 Aug 22.
The American Academy of Orthopaedic Surgeons defined the acceptable threshold for elective safe surgery as a body mass index (BMI) under 40 due to the increased risk of complications. A consequence of this recommendation has been a hard cutoff based on BMI, which restricts access to care for an increasingly large and diverse population. There is an improved understanding that excess adipose tissue confers additional risk for postoperative complications, including infection, through mechanical and physiologic mechanisms. But, it is unclear if BMI is an accurate indicator of adiposity in total joint arthroplasty (TJA) patients and, thus, whether BMI is capturing clinically relevant information in obese patients. Our objective was to determine the relationship between peri-incisional adiposity (PIA) and BMI in a consecutive series of diverse primary TJA patients.
A consecutive series of patients indicated for primary TJA were preoperatively evaluated. For each patient, the following variables were collected: BMI and measures of PIA on radiographs and ultrasounds.
In THA patients (N = 99), Pearson's correlation coefficient (r) = 0.436, which indicates a moderate correlation between BMI and adiposity. In total knee arthroplasty patients (N = 271), r = 0.395 for femoral PIA (FPIA) and r = 0.249 for tibial PIA, which indicates a weak correlation between BMI and adiposity measured on radiography. In total knee arthroplasty patients, r = 0.560 for femoral PIA and r = 0.544 for tibial PIA, which indicates a moderate correlation between BMI and adiposity measured on ultrasound.
Quantification of obesity has become a common practice in the preoperative evaluation of primary TJA patients. The intent is to determine the magnitude of adipose tissue, which is one of the main drivers of postoperative complications in obesity. The BMI is ubiquitously used as a proxy for obesity due to its simplicity of attainment and calculation. We report that BMI has a weak-to-moderate association with PIA in this population. These findings indicate that BMI may not accurately represent the condition of peri-incisional adipose tissue and, thus, is not capturing the relevant obesity data for preoperative risk stratification in primary TJA patients.
III.
美国骨科医师学会将择期安全手术的可接受阈值定义为体重指数（BMI）低于40，因为并发症风险会增加。这一建议的结果是基于BMI设置了严格的界限，这限制了越来越多不同人群获得治疗的机会。人们越来越认识到，过多的脂肪组织通过机械和生理机制会增加术后并发症的风险，包括感染。但是，目前尚不清楚BMI是否是全关节置换术（TJA）患者肥胖程度的准确指标，因此，BMI是否能反映肥胖患者的临床相关信息也不明确。我们的目的是确定一系列连续的不同原发性TJA患者的切口周围脂肪堆积（PIA）与BMI之间的关系。
对一系列连续的拟行原发性TJA的患者进行术前评估。为每位患者收集以下变量：BMI以及X线片和超声检查的PIA测量值。
在髋关节置换术（THA）患者中（N = 99），Pearson相关系数（r）= 0.436，表明BMI与肥胖程度之间存在中度相关性。在全膝关节置换术患者中（N = 271），股骨PIA（FPIA）的r = 0.395，胫骨PIA的r = 0.249，这表明BMI与X线片测量的肥胖程度之间存在弱相关性。在全膝关节置换术患者中，股骨PIA的r = 0.560，胫骨PIA的r = 0.544，这表明BMI与超声测量的肥胖程度之间存在中度相关性。
肥胖量化已成为原发性TJA患者术前评估的常见做法。目的是确定脂肪组织的量，脂肪组织是肥胖患者术后并发症的主要驱动因素之一。由于BMI获取和计算简单，因此被广泛用作肥胖的替代指标。我们报告在该人群中BMI与PIA之间存在弱至中度关联。这些发现表明，BMI可能无法准确反映切口周围脂肪组织的状况，因此，无法获取原发性TJA患者术前风险分层的相关肥胖数据。
III级
