目的:全膝关节置换术(TKA)后残余内翻可影响功能预后,在肥胖的情况下可能会恶化。然而,没有研究发现可以比较肥胖患者术后残余轻度内翻或中性的结局.这项研究的目的是比较术后并发症和假体存活率,TKA术后中性或轻度内翻的肥胖患者的膝关节功能结局。
方法:我们回顾性分析了2010年1月至2015年12月在我院接受TKA治疗的188例连续肥胖患者(体重指数≥30kg/m2)。在入院和出院时测量所有患者的机械髋-膝-踝轴角。根据西安大略省和麦克马斯特大学骨关节炎指数(WOMAC)评分对膝关节功能进行回顾性评估,膝关节协会膝关节评分(KS-KS),膝关节社会功能评分(KS-FS),被遗忘的联合得分(FJS),和运动范围(ROM)。使用Studentt检验或方差或Kruskal-Wallis检验的分析,在具有中性或轻度内翻对准的膝盖之间比较连续数据。对于结果的多重比较,我们使用Bonferroni-Dunn方法来调整p值。分类数据使用卡方检验进行比较。
结果:在137名完成平均8.32±1.47年随访的肥胖患者中,有156个膝盖,97个膝盖从内翻矫正为中性,54个膝盖保持轻度残余内翻。轻度内翻的患者有明显的WOMAC(8.25±8.637vs.14.97±14.193,p=0.009)和更好的FJS(86.03±15.607vs.70.22±30.031,p=0.002)。两种类型的膝盖在KS-KS中没有显着差异,KS-FS,或ROM。尽管一名中性膝盖的患者不得不接受翻修手术,两组间差异无统计学意义。
结论:对于患有骨关节炎的肥胖患者,TKA后保留残余内翻对齐可改善功能结局,而不影响假体存活.
OBJECTIVE: Residual varus after total knee arthroplasty (TKA) can affect functional outcomes, which may worsen in the presence of obesity. However, no studies were found to compare the outcomes of obese patients involving postoperative residual mild varus or
neutral. The aim of this study was to compare postoperative complications and prosthesis survival, and functional outcomes for knees of obese patients with
neutral or mild varus after TKA.
METHODS: We retrospectively reviewed 188 consecutive obese patients (body mass index ≥30 kg/m2) at our hospital who underwent TKA due to varus knee osteoarthritis from January 2010 to December 2015. The mechanical hip-knee-ankle axis angle was measured in all patients at admission and discharge. Knee functions were retrospectively assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Knee Score (KS-KS), Knee Society Function Score (KS-FS), Forgotten Joint Score (FJS), and range of motion (ROM). Continuous data were compared between knees with
neutral or mild varus alignment using analysis of Student\'s t test or variance or the Kruskal-Wallis test as appropriate. For multiple comparisons of outcomes, we used Bonferroni-Dunn method to adjust p-values. Categorical data were compared using the chi-squared test.
RESULTS: Of the 156 knees in 137 obese patients who completed follow-up for a mean of 8.32 ± 1.47 years, 97 knees were corrected from varus to
neutral and 54 knees were kept in mild residual varus. Patients with mild varus knees had significantly WOMAC (8.25 ± 8.637 vs. 14.97 ± 14.193, p = 0.009) and better FJS (86.03 ± 15.607 vs. 70.22 ± 30.031, p = 0.002). The two types of knees did not differ significantly in KS-KS, KS-FS, or ROM. Although one patient with a
neutral knee had to undergo revision surgery, there was no significant difference between two groups.
CONCLUSIONS: For obese patients with osteoarthritis, preservation of residual varus alignment after TKA can improve functional outcomes without compromising prosthesis survival.