Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Bone Joint J. 2024 Nov 1;106-B(11):1223-1230. doi: 10.1302/0301-620X.106B11.BJJ-2023-1187.R1.
The prevalence of obesity is increasing substantially around the world. Elevated BMI increases the risk of complications following total hip arthroplasty (THA). We sought to evaluate trends in BMI and complication rates of obese patients undergoing primary THA over the last 30 years.
Through our institutional total joint registry, we identified 15,455 primary THAs performed for osteoarthritis from 1990 to 2019. Patients were categorized according to the World Health Organization (WHO) obesity classification and groups were trended over time. Cox proportional hazards regression analysis controlling for confounders was used to investigate the association between year of surgery and two-year risk of any reoperation, any revision, dislocation, periprosthetic joint infection (PJI), venous thromboembolism (VTE), and periprosthetic fracture. Regression was stratified by three separate groups: non-obese; WHO Class I and Class II (BMI 30 to 39 kg/m); and WHO Class III patients (BMI ≥ 40 kg/m).
There was a significant increase in the proportion of all obesity classes from 1990 to 2019, and the BMI values within each WHO class significantly increased over time. Risk of any reoperation did not change over time among non-obese or WHO Class I/II patients, but increased for WHO Class III patients (hazard ratio (HR) 1.04; p = 0.044). Risk of dislocation decreased over time for non-obese (HR 0.96; p < 0.001) and WHO Class I/II (HR 0.96; p = 0.002) patients, but did not change over time for WHO Class III (HR 0.94; p = 0.073) patients. Risks of any revision and PJI did not change over time for any group.
The proportion of patients undergoing THA who are obese has increased dramatically at our institution between 1990 and 2019. Despite BMI values increasing within all WHO classes over time, two-year complication risks have remained stable or decreased in WHO Class I/II patients. However, continued efforts will be required to mitigate risks in the heaviest WHO Class III patients.
肥胖在全球范围内呈显著上升趋势。升高的 BMI 增加了全髋关节置换术后（THA）发生并发症的风险。我们旨在评估过去 30 年来，超重患者接受初次 THA 的 BMI 趋势和并发症发生率。
通过我们的机构全关节登记处，我们确定了 1990 年至 2019 年间因骨关节炎接受初次 THA 的 15455 例患者。根据世界卫生组织（WHO）肥胖分类对患者进行分类，并随时间推移对各分组进行趋势分析。采用 Cox 比例风险回归分析控制混杂因素，调查手术年份与两年内任何再手术、任何翻修、脱位、假体周围关节感染（PJI）、静脉血栓栓塞（VTE）和假体周围骨折的风险之间的关联。回归分析分层为三个独立的分组：非肥胖；WHO 分类 I 和 II（BMI 为 30 至 39kg/m²）；和 WHO 分类 III 患者（BMI≥40kg/m²）。
从 1990 年到 2019 年，所有肥胖类别的比例显著增加，每个 WHO 类别内的 BMI 值随时间推移显著增加。非肥胖或 WHO I/II 患者中，任何再手术的风险随时间推移没有变化，但 WHO III 患者的风险增加（风险比（HR）为 1.04；p=0.044）。非肥胖（HR 0.96；p<0.001）和 WHO I/II（HR 0.96；p=0.002）患者的脱位风险随时间推移而降低，但 WHO III（HR 0.94；p=0.073）患者的脱位风险随时间推移没有变化。任何翻修和 PJI 的风险在任何分组中都没有随时间变化。
在我们的机构中，1990 年至 2019 年间，接受 THA 的肥胖患者比例大幅增加。尽管所有 WHO 类别内的 BMI 值随时间推移而增加，但 WHO I/II 患者的两年并发症风险保持稳定或降低。然而，仍需要继续努力降低最重的 WHO III 类患者的风险。
