Athar Mohammad, Saini Raghav, Chahal Simrun, Siddiqui Rabail, Littlefield Shalyn, Naeem Lahama, Dubois Sacha, Droll Kurt, Marion Travis E, Puskas David, Cullinan Claude
From the Northern Ontario School of Medicine University, Thunder Bay, Ont. (Athar, Saini, Dubois, Droll, Marion, Puskas, Cullinan); the Clinical Research Services Department, Thunder Bay Regional Health Research Institute, Thunder Bay, Ont. (Chahal, Siddiqui, Littlefield, Naeem); the Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. (Droll, Marion, Puskas, Cullinan).
Can J Surg. 2025 May 29;68(3):E214-E220. doi: 10.1503/cjs.008524. Print 2025 May-Jun.
An increasing number of total knee arthroplasties (TKAs) are performed in people with obesity, but TKAs in this population may come with increased risk of perioperative complications and decreased prosthetic survivorship. Given the lack of conclusive evidence on differences in functional outcomes, we aimed to use the Forgotten Joint Score-12 (FJS-12) to see how body mass index (BMI) affected functional outcomes after TKA.
We recruited patients who underwent primary unilateral TKA because of osteoarthritic changes from January 2018 to November 2021. We collected the Forgotten Joint Score-12 (FJS-12) measure of functional outcomes and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) preoperatively and 6- and 12-months postoperatively. We also measured length of stay (LOS), readmission, and emergency department (ED) visits. We compared outcomes by BMI category using linear effects models.
We recruited 351 patients. No differences were found in LOS, readmissions, and ED visits by BMI category. Compared with the preoperative score, we observed significant differences by BMI category for the 6-month FJS-12 (β = -0.66, = 0.007) and 12-month WOMAC (β = -0.34, = 0.02) scores. At 6 months, patients with lower BMI showed a greater change in FJS-12 scores than those with higher BMI. However, by 12 months, all patients appeared to return to similar functional levels regardless of BMI.
Despite a slower return to function, patients with elevated BMI were able to return to similar levels of function as those with a lower BMI by 12 months, with no significant differences in readmission, ED visits, or LOS. This similar return to function justifies candidacy for surgery.
越来越多的肥胖患者接受全膝关节置换术（TKA），但该人群的TKA可能会增加围手术期并发症的风险，并降低假体生存率。鉴于缺乏关于功能结局差异的确凿证据，我们旨在使用遗忘关节评分-12（FJS-12）来观察体重指数（BMI）如何影响TKA后的功能结局。
我们招募了因骨关节炎变化于2018年1月至2021年11月接受初次单侧TKA的患者。我们在术前、术后6个月和12个月收集了功能结局的遗忘关节评分-12（FJS-12）测量值以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）。我们还测量了住院时间（LOS）、再入院情况和急诊就诊次数。我们使用线性效应模型按BMI类别比较结局。
我们招募了351名患者。按BMI类别在LOS、再入院情况和急诊就诊次数方面未发现差异。与术前评分相比，我们观察到按BMI类别在6个月FJS-12（β = -0.66，P = 0.007）和12个月WOMAC（β = -0.34，P = 0.02）评分方面存在显著差异。在6个月时，BMI较低的患者FJS-12评分变化大于BMI较高的患者。然而，到12个月时，无论BMI如何，所有患者似乎都恢复到了相似的功能水平。
尽管恢复功能较慢，但BMI升高的患者在12个月时能够恢复到与BMI较低的患者相似的功能水平，在再入院、急诊就诊或住院时间方面无显著差异。这种相似的功能恢复证明了手术候选资格的合理性。
