Jee Young M, Zamzam Mazen, Hasan Sazid, Waheed Muhammad A, Saleh Ehab S, Omari Abdullah M
Corewell Health, 3535 W 13 Mile Road, Suite 744, Royal Oak, MI, 48073, USA.
Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
J Orthop. 2024 Oct 28;63:35-42. doi: 10.1016/j.jor.2024.10.027. eCollection 2025 May.
Obesity is associated with a higher rate of wound complications following primary total knee arthroplasty (TKA). With readily available computer tomography (CT) images from robotic-assisted TKA, we analyzed measurement of fat content on preoperative CT images as a possible predictor of wound complications following primary TKA.
Patients who underwent robotic-assisted TKA at one institution in 2018 were included in this retrospective cohort study. Two independent reviewers measured three SCF areas at different axial CT cuts and normalized them by dividing the area of the distal femur. These areas were distributed into 4 groups. Any wound complication that required clinical or surgical intervention was reviewed and analyzed. For further comparison, prepatellar SCF thickness ratio measured on CT scan and BMI were grouped and analyzed similarly for wound complications. We also analyzed any association of SCF measurement with secondary outcomes such as operative time, length of stay, readmission, and reoperation.
One hundred fifty patients with diagnosis of osteoarthritis, mean age of 64 years and BMI of 34.3 kg/m were included in this study. Ninety-one patients (61 %) were female. Normalized SCF measurements at 2 cm above the patella, mid-patella, and tibial tubercle had excellent intraclass correlation coefficient at 0.987, 0.989, and 0.989, respectively. When SCF at 2 cm above patella was analyzed, Group 1 (smallest amount of SCF) had a significantly higher wound complication rate compared with Groups 2 and 3 combined (18.9 vs 5.3 %, p = 0.036). Group 4 (largest amount of SCF) also had a significantly higher wound complication rate compared with Groups 2 and 3 combined (18.9 vs 5.3 %, p = 0.036).
Accurate and consistent measurement of periarticular fat around the knee based on axial CT images demonstrated that moderate amount of fat is associated with better clinical outcomes following primary TKA. Our study did not find any clinical significance of gender difference in fat distribution. Therefore, more studies should be undertaken to evaluate for any clinical association of gender-specific fat distribution and to confirm our finding that a certain amount of fatty tissue is necessary for improved outcomes following TKA.
肥胖与初次全膝关节置换术（TKA）后伤口并发症发生率较高相关。利用机器人辅助TKA中现成的计算机断层扫描（CT）图像，我们分析了术前CT图像上脂肪含量的测量结果，作为初次TKA后伤口并发症的一个可能预测指标。
本回顾性队列研究纳入了2018年在一家机构接受机器人辅助TKA的患者。两名独立的评估人员在不同的轴向CT层面测量了三个皮下脂肪组织（SCF）区域，并通过将股骨远端面积相除对其进行标准化。这些区域被分为4组。对任何需要临床或手术干预的伤口并发症进行了审查和分析。为了进一步比较，对CT扫描测量的髌前SCF厚度比和体重指数（BMI）进行分组，并对伤口并发症进行类似分析。我们还分析了SCF测量结果与手术时间、住院时间、再入院和再次手术等次要结局之间的任何关联。
本研究纳入了150例诊断为骨关节炎的患者，平均年龄64岁，BMI为34.3kg/m²。91例（61%）为女性。髌骨上方2cm、髌骨中部和胫骨结节处的标准化SCF测量结果的组内相关系数分别为0.987、0.989和0.989，相关性良好。分析髌骨上方2cm处的SCF时，第1组（SCF量最少）的伤口并发症发生率显著高于第2组和第3组合并后的发生率（18.9%对5.3%，p = 0.036）。第4组（SCF量最多）的伤口并发症发生率也显著高于第2组和第3组合并后的发生率（18.9%对5.3%，p = 0.036）。
基于轴向CT图像对膝关节周围关节周围脂肪进行准确且一致的测量表明，适量的脂肪与初次TKA后的更好临床结局相关。我们的研究未发现脂肪分布存在性别差异的任何临床意义。因此，应开展更多研究来评估特定性别脂肪分布的任何临床关联，并证实我们的发现，即一定量的脂肪组织对于TKA后改善结局是必要的。
