Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Bone Joint J. 2024 Oct 1;106-B(10):1074-1083. doi: 10.1302/0301-620X.106B10.BJJ-2024-0087.R1.
The influence of metabolic syndrome (MetS) on the outcome after hip and knee arthroplasty is debated. We aimed to investigate the change in patient-reported outcome measure (PROM) scores after hip and knee arthroplasty, comparing patients with and without MetS.
From 1 May 2017 to 30 November 2019, a prospective cohort of 2,586 patients undergoing elective unilateral hip and knee arthroplasty was established in Denmark. Data from national registries and a local database were used to determine the presence of MetS. Patients' scores on Oxford Hip Score (OHS) or Oxford Knee Score (OKS), EuroQol five-dimension five-level questionnaire (EQ-5D-5L), University of California, Los Angeles (UCLA) Activity Scale, and Forgotten Joint Score (FJS) at baseline, three, 12, and 24 months after surgery were collected. Primary outcome was the difference between groups from baseline to 12 months in OHS and OKS. Secondary outcomes were scores of OHS and OKS at three and 24 months and EQ-5D-5L, UCLA Activity Scale, and FJS at three, 12, and 24 months after surgery. Generalized linear mixed model was applied, adjusting for age, sex, Charlson Comorbidity Index, and smoking to present marginal mean and associated 95% CIs.
A total of 62.3% (1,611/2,586) of the cohort met the criteria for MetS. Both groups showed similar increase in mean OHS (MetS group 22.5 (95% CI 21.8 to 23.1), non-MetS group 22.1 (21.3 to 22.8); p = 0.477) and mean OKS (MetS group 18.0 (17.4 to 18.6), non-MetS group 17.8 (17.0 to 18.7); p = 0.722) at 12 months' follow-up. Between groups, similar improvements were seen for OHS and OKS at three and 24 months postoperatively and for the mean EQ-5D-5L, EuroQol-visual analogue scale (EQ-VAS), UCLA Activity Scale, and FJS at every timepoint.
Patients meeting the criteria for MetS obtain the same improvement in PROM scores as individuals without MetS up to 24 months after hip and knee arthroplasty. This is important for the clinician to take into account when assessing and advising patients with MetS.
代谢综合征（MetS）对髋关节和膝关节置换术后结局的影响存在争议。本研究旨在比较合并和不合并 MetS 的患者，调查髋关节和膝关节置换术后患者报告结局测量（PROM）评分的变化。
2017 年 5 月 1 日至 2019 年 11 月 30 日，丹麦建立了一个前瞻性队列，纳入 2586 例择期行单侧髋关节和膝关节置换术的患者。使用国家登记处和本地数据库的数据来确定 MetS 的存在。收集患者牛津髋关节评分（OHS）或牛津膝关节评分（OKS）、欧洲五维健康量表 5 维度问卷（EQ-5D-5L）、加利福尼亚大学洛杉矶分校（UCLA）活动量表和遗忘关节评分（FJS）在基线、术后 3、12 和 24 个月时的评分。主要结局为 OHS 和 OKS 从基线到 12 个月的组间差异。次要结局为 OHS 和 OKS 在术后 3 和 24 个月时的评分以及 EQ-5D-5L、UCLA 活动量表和 FJS 在术后 3、12 和 24 个月时的评分。应用广义线性混合模型，调整年龄、性别、Charlson 合并症指数和吸烟因素，以呈现边缘均值及其 95%置信区间。
队列中共有 62.3%（1611/2586）的患者符合 MetS 标准。两组 OHS（MetS 组 22.5（95%CI 21.8 至 23.1），非 MetS 组 22.1（21.3 至 22.8）；p = 0.477）和 OKS（MetS 组 18.0（17.4 至 18.6），非 MetS 组 17.8（17.0 至 18.7）；p = 0.722）在术后 12 个月的平均评分均相似增加。术后 3 个月和 24 个月时，两组之间 OHS 和 OKS 的改善情况相似，而在每个时间点，EQ-5D-5L、EuroQol 视觉模拟量表（EQ-VAS）、UCLA 活动量表和 FJS 的平均评分也相似。
在髋关节和膝关节置换术后 24 个月内，符合 MetS 标准的患者的 PROM 评分改善与无 MetS 的患者相同。这对于临床医生在评估和咨询合并 MetS 的患者时很重要。
