Gruber Michael Stephan, Schöning Johannes, Bischofreiter Martin, Kindermann Harald, Schulz Arndt-Peter, Hinz Nico, Mayböck Emanuel, Ortmaier Reinhold
Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria.
Medical Faculty, Johannes Kepler University Linz, Altenbergerstraße 69, 4040 Linz, Austria.
J Clin Med. 2024 Dec 13;13(24):7596. doi: 10.3390/jcm13247596.
Short-stem total hip arthroplasty (THA) has gained popularity due to its bone-sparing technique, but its outcomes in patients with obesity remain uncertain. The aim of this study was to investigate the impact of obesity on postoperative subsidence and clinical outcomes after short-stem THA. A retrospective cohort study with a minimum follow-up of 24 months was conducted on 163 patients who underwent short-stem THA with a collarless, triple-tapered, cementless stem achieving fixation in the metaphyseal region. Patients were categorized into obesity (Body Mass Index, BMI ≥ 30 kg/m) and nonobesity (BMI < 30 kg/m) groups. Subsidence rates, clinical outcomes, and complications were analyzed to assess the influence of BMI on the outcome of short stem THA. Regression analysis was performed to assess the influence of the independent variables (BMI, stem size, deviation from planning) on subsidence. The obesity group (mean follow-up 58.6 months) exhibited significantly greater subsidence rates than did the nonobesity group (mean follow-up 38.9 months; 2.6 mm vs. 2.2 mm, = 0.015). After removal of outliers, regression analysis revealed no linear relationship between BMI and subsidence ( = 0.35), but planned stem size was significantly correlated with subsidence ( = 0.005). Moreover, patients with obesity and larger planned stem sizes experienced greater subsidence. Clinical outcomes improved significantly in both groups. Obesity is associated with increased subsidence in short-stem THA, particularly in patients with larger planned stem sizes. Although BMI alone may not predict subsidence, careful selection of stem size and precise imaging techniques are crucial for minimizing subsidence risk in patients with obesity.
短柄全髋关节置换术（THA）因其保骨技术而受到欢迎，但其在肥胖患者中的疗效仍不确定。本研究的目的是调查肥胖对短柄THA术后下沉及临床疗效的影响。对163例行短柄THA的患者进行了一项回顾性队列研究，这些患者使用无领、三锥度、非骨水泥柄，在干骺端区域实现固定，随访时间至少24个月。患者被分为肥胖组（体重指数，BMI≥30kg/m）和非肥胖组（BMI<30kg/m）。分析下沉率、临床疗效和并发症，以评估BMI对短柄THA疗效的影响。进行回归分析以评估自变量（BMI、柄尺寸、与计划的偏差）对下沉的影响。肥胖组（平均随访58.6个月）的下沉率明显高于非肥胖组（平均随访38.9个月；2.6mm对2.2mm，P=0.015）。去除异常值后，回归分析显示BMI与下沉之间无线性关系（P=0.35），但计划的柄尺寸与下沉显著相关（P=0.005）。此外，肥胖且计划柄尺寸较大的患者下沉更明显。两组患者的临床疗效均有显著改善。肥胖与短柄THA下沉增加有关，尤其是计划柄尺寸较大的患者。虽然单独的BMI可能无法预测下沉，但仔细选择柄尺寸和精确的成像技术对于将肥胖患者的下沉风险降至最低至关重要。
