Davulcu Cumhur Deniz, Ozer Mete
Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, TUR.
Cureus. 2024 Oct 18;16(10):e71790. doi: 10.7759/cureus.71790. eCollection 2024 Oct.
Introduction High body mass index (BMI) often causes immobility and functional impairment before arthroplasty. Patients expect weight loss post-surgery due to increased mobility, but paradoxically, studies show that weight may not decrease and might even increase postoperatively. This study aims to evaluate if patients lose weight after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to examine the impact of BMI change on functional scores. Methods We analyzed 459 patients who underwent primary TKA and THA between January 2018 and December 2022, with a two-year follow-up. Patients with incomplete data or bariatric surgery were excluded. Demographic characteristics, BMI, Oxford scores, comorbidities, corticosteroid use, physiotherapy, and surgery type (unilateral or bilateral) were assessed. Results Patients showed a significant increase in BMI postoperatively, especially those with comorbidities and younger age. Throughout the entire follow-up period, the BMI value of the knee group was higher than that of the hip group. Comorbidities significantly influenced BMI increase, while corticosteroid use and physiotherapy follow-up did not. Oxford scores improved postoperatively, but the presence of comorbidities and physiotherapy follow-up negatively impacted score changes. A negative correlation between BMI change and Oxford score change was observed (p = 0.013), indicating that increased BMI is associated with less improvement in functional scores. This correlation was significant for hip arthroplasty patients (p = 0.000), but not for knee arthroplasty patients (p = 0.822). Conclusions BMI changes post-TKA and THA are influenced by various clinical and demographic factors. Increased BMI negatively affects functional outcomes, particularly in hip arthroplasty patients. Comorbidities significantly influenced weight gain, while oral corticosteroid use had no notable effect on BMI. Patients undergoing bilateral procedures experienced lower BMI increases. The hip group gained more weight, but the knee group's BMI remained higher throughout the follow-up. In terms of Oxford scores, comorbidities, corticosteroid use, affected joints, and age did not significantly impact outcomes. Patients under physiotherapist supervision showed smaller score increases. While bilateral procedure patients achieved higher scores, simultaneous bilateral procedures did not lead to greater increases. These findings highlight the importance of weight control and rehabilitation in improving postoperative recovery and quality of life.
引言 高体重指数（BMI）在关节置换术前常导致行动不便和功能障碍。患者期望术后因活动能力增强而体重减轻，但矛盾的是，研究表明体重可能不会下降，甚至术后可能增加。本研究旨在评估全膝关节置换术（TKA）和全髋关节置换术（THA）后患者是否体重减轻，并研究BMI变化对功能评分的影响。方法 我们分析了2018年1月至2022年12月期间接受初次TKA和THA的459例患者，进行为期两年的随访。排除数据不完整或接受减重手术的患者。评估人口统计学特征、BMI、牛津评分、合并症、皮质类固醇使用情况、物理治疗和手术类型（单侧或双侧）。结果 患者术后BMI显著增加，尤其是合并症患者和较年轻患者。在整个随访期间，膝关节组的BMI值高于髋关节组。合并症显著影响BMI增加，而皮质类固醇使用和物理治疗随访则无影响。牛津评分术后改善，但合并症的存在和物理治疗随访对评分变化有负面影响。观察到BMI变化与牛津评分变化之间存在负相关（p = 0.013），表明BMI增加与功能评分改善较少相关。这种相关性在髋关节置换术患者中显著（p = 0.000），但在膝关节置换术患者中不显著（p = 0.822）。结论 TKA和THA术后BMI变化受多种临床和人口统计学因素影响。BMI增加对功能结局有负面影响，尤其是在髋关节置换术患者中。合并症显著影响体重增加，而口服皮质类固醇使用对BMI无显著影响。接受双侧手术的患者BMI增加较低。髋关节组体重增加更多，但膝关节组的BMI在整个随访期间仍较高。就牛津评分而言，合并症、皮质类固醇使用、受影响关节和年龄对结局无显著影响。接受物理治疗师监督的患者评分增加较小。虽然双侧手术患者获得更高评分，但同时进行双侧手术并未导致更大增加。这些发现凸显了体重控制和康复对改善术后恢复和生活质量的重要性。
