Poilvache Hervé, Elmenawi Khaled A, Hannon Charles P, Abdel Matthew P, Bedard Nicholas A
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2025 May 29. doi: 10.1016/j.arth.2025.05.061.
Obesity is a known risk factor for complications following primary total knee arthroplasty (TKA), yet its impact on the outcomes of aseptic revision TKA remains less defined. This study evaluates the influence of body mass index (BMI) on revision, reoperation, and infection outcomes following aseptic revision TKA.
A retrospective cohort of 2,836 first-time aseptic revision TKAs performed at a single academic institution from 2000 to 2022 was analyzed. Patient demographics, including BMI, were collected. The mean age was 69 years, the mean BMI was 33, and 42% were men. The main causes for the initial revisions were aseptic loosening (37%), instability (29%), and wear or osteolysis (13%). Kaplan-Meier survivorship, univariate Cox regression analyses, and multivariate Cox regression analyses adjusted for age, sex, indication for revision, and Charlson Comorbidity Index were used to assess the impact of BMI on the risks of revision, reoperation, and infection. The mean follow-up was seven years (range, two to 22).
The 5-year survivorships free from revision for periprosthetic joint infection (PJI), reoperation for PJI, any revision, and any reoperation were 96, 96, 89, and 85%. Univariate analyses showed that a BMI > 40 correlated with a trend toward increased reoperation for PJI (hazard ratio: 1.4, P = 0.05) and a higher risk of reoperation for any reason (hazard ratio: 1.3, P = 0.04). However, these findings did not remain significant when controlling for confounding factors with multivariate analysis.
Although a BMI greater than 40 did impact the risk of subsequent reoperation following revision TKA on univariate analyses, these findings did not persist when accounting for confounding factors. These results suggest that the indication for revision plays a much larger role in outcomes following revision TKA for aseptic indications than BMI alone.
IV (retrospective study).
肥胖是初次全膝关节置换术（TKA）后出现并发症的已知风险因素，但其对无菌性翻修TKA结局的影响仍不太明确。本研究评估体重指数（BMI）对无菌性翻修TKA后翻修、再次手术和感染结局的影响。
对2000年至2022年在单一学术机构进行的2836例初次无菌性翻修TKA的回顾性队列进行分析。收集患者人口统计学资料，包括BMI。平均年龄为69岁，平均BMI为33，42%为男性。初次翻修的主要原因是无菌性松动（37%）、不稳定（29%）和磨损或骨溶解（13%）。采用Kaplan-Meier生存率、单因素Cox回归分析和多因素Cox回归分析，并对年龄、性别、翻修指征和Charlson合并症指数进行校正，以评估BMI对翻修、再次手术和感染风险的影响。平均随访时间为7年（范围为2至22年）。
假体周围关节感染（PJI）翻修、PJI再次手术、任何翻修和任何再次手术的5年无翻修生存率分别为96%、96%、89%和85%。单因素分析显示，BMI>40与PJI再次手术增加的趋势相关（风险比：1.4，P = 0.05），以及任何原因导致的再次手术风险更高（风险比：1.3，P = 0.04）。然而，在多因素分析中控制混杂因素后，这些结果不再显著。
虽然在单因素分析中BMI大于40确实影响翻修TKA后随后再次手术的风险，但在考虑混杂因素时这些结果并不持续。这些结果表明，对于无菌性指征的翻修TKA，翻修指征在结局中所起的作用比单独的BMI大得多。
IV（回顾性研究）
