Lovie Jack, Clement Nicholas D, MacDonald Deborah, Ahmed Issaq
Department of Orthopaedics, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
Arch Orthop Trauma Surg. 2025 Jan 11;145(1):124. doi: 10.1007/s00402-024-05704-9.
The combined effect of diabetes mellitus and obesity (Diabesity) on total knee replacement (TKR) outcomes is unclear. This study aimed to assess whether diabesity influenced functional outcomes and complication rate following primary TKR.
This case-controlled study compared the independent effects of obesity, diabetes, and diabesity on TKR outcomes. Data were collected pre-operatively and 12 months post-operatively from a single study centre. Outcomes included Oxford Knee Score (OKS), EuroQol 5-dimensions (Eq. 5D), post-operative satisfaction and complication rate.
There were 2577 TKRs in the cohort, of which 244 (9.5%) had diabesity. Diabesity was independently associated with reduced pre-operative OKS (-1.14 points, 95% CI -1.97 to -0.31, p = 0.007) and OKS improvement (-2.37 points, 95% CI -3.11 to -1.62, p < 0.001). Obesity was also independently associated with worse pre-operative OKS (-0.78 points, 95% CI -1.28 to -0.27, p = 0.003) and OKS improvement (-0.81 points, 95% CI -1.26 to -0.35, p = 0.001). Both diabesity (-0.05 points, 95% CI -0.08 to -0.02, p = 0.003) and obesity (-0.02 points, 95% CI -0.04 to 0.00, p = 0.039) were associated with worse pre-operative Eq. 5D score. Patients with diabesity reported reduced post-operative satisfaction due to obesity independently (OR 0.75, 95% CI 0.56 to 1.00, p = 0.048). Diabesity was not independently associated with post-operative complications.
Diabesity was independently associated with a worse knee-specific function and Eq. 5D score pre-operatively, and diminished joint specific functional improvement following TKR. Patients with diabesity also experienced reduced post-operative satisfaction due to obesity independently.
糖尿病与肥胖症（糖尿病性肥胖）对全膝关节置换术（TKR）疗效的综合影响尚不清楚。本研究旨在评估糖尿病性肥胖是否会影响初次全膝关节置换术后的功能结局和并发症发生率。
本病例对照研究比较了肥胖、糖尿病和糖尿病性肥胖对全膝关节置换术疗效的独立影响。数据在术前及术后12个月从单一研究中心收集。结局指标包括牛津膝关节评分（OKS）、欧洲五维健康量表（Eq. 5D）、术后满意度和并发症发生率。
该队列中有2577例全膝关节置换术，其中244例（9.5%）患有糖尿病性肥胖。糖尿病性肥胖与术前牛津膝关节评分降低（-1.14分，95%置信区间-1.97至-0.31，p = 0.007）及牛津膝关节评分改善值降低（-2.37分，95%置信区间-3.11至-1.62，p < 0.001）独立相关。肥胖也与术前牛津膝关节评分较差（-0.78分，95%置信区间-1.28至-0.27，p = 0.003）及牛津膝关节评分改善值较差（-0.81分，95%置信区间-1.26至-0.35，p = 0.001）独立相关。糖尿病性肥胖（-0.05分，95%置信区间-0.08至-0.02，p = 0.003）和肥胖（-0.02分，95%置信区间-0.04至0.00，p = 0.039）均与术前欧洲五维健康量表评分较差相关。患有糖尿病性肥胖的患者因肥胖独立导致术后满意度降低（比值比0.75，95%置信区间0.56至1.00，p = 0.048）。糖尿病性肥胖与术后并发症无独立相关性。
糖尿病性肥胖与术前较差的膝关节特定功能和欧洲五维健康量表评分独立相关，并且全膝关节置换术后关节特定功能改善减弱。患有糖尿病性肥胖的患者也因肥胖独立导致术后满意度降低。
