■肥胖作为反向肩关节置换术(RSA)后并发症增加的独立危险因素的作用继续引起争论。虽然肩关节置换术没有标准化的体重指数(BMI)截止值,许多外科医生担心高BMI患者的预后不良和活动范围(ROM)下降的可能性.这项研究的目的是比较肥胖和非肥胖患者术前和RSA后短期随访的功能结果。
■对前瞻性维持的,2015年至2019年期间由14名外科医生进行的主要RSAs的多中心数据库,至少随访2年。共有245名患者符合研究标准,包括111名肥胖(BMI>30)和134名非肥胖(BMI<30)患者。比较两组患者报告结果(PRO)和ROM测量值。
■在基线时,肥胖患者的美国肩肘外科医生显着降低(36.6vs.42.0,P=.014),西部安大略省肩关节骨关节炎评分(33.1vs.37.8,P=.043),外旋90°(19°与28°,P=.007),内旋(IR)脊柱水平(L5vs.L4,P=.002),和腹部按压强度(P=0.003)与非肥胖队列相比。2年结局没有统计学差异(PRO,ROM,和力量),而不是低BMI组的IR(脊柱水平)较差(L4与L3,P=.002)。在控制混杂变量的线性回归分析中,BMI的增加与术前外旋(B=-0.591,P=.034)和术前IR脊柱水平(B=0.089,P=.002)呈负相关。BMI的增加与术后90°外旋转无关(B=0.189,P=.490),但与脊柱水平的术后IR恶化有关(B=0.066,P=.043)。
■肥胖患者在RSA之前的基线时,在外部和内部旋转以及美国肩肘外科医生和西部安大略省骨关节炎的肩关节评分方面有更大的限制。然而,肥胖和非肥胖患者之间的术后PRO或ROM测量没有重大差异,除了肥胖组中脊柱水平的活动性IR较差(L4与L3,P=.002)。这项研究表明,RSA程序不需要仅基于BMI进行限制。
UNASSIGNED: The role of obesity as an independent risk factor for increased complications following reverse shoulder arthroplasty (RSA) continues to generate debate. While no standardized body mass index (BMI) cutoff values for shoulder arthroplasty exist, many surgeons are concerned about the potential for poor outcomes and decreased range of motion (ROM) in patients with a high BMI. The purpose of this study was to compare functional outcomes in obese and nonobese patients preoperatively and at short-term follow-up after RSA.
UNASSIGNED: A retrospective review was performed of a prospectively maintained, multicenter database of primary RSAs performed by 14 surgeons between 2015 and 2019 with minimum 2-year follow-up. A total of 245 patients met the study criteria, including 111 obese (BMI >30) and 134 nonobese (BMI <30) patients. Patient-reported outcomes (
PROs) as well as ROM measurements were compared between the 2 groups.
UNASSIGNED: At baseline, obese patients had significantly lower American Shoulder and Elbow Surgeons (36.6 vs. 42.0, P = .014), Western Ontario Osteoarthritis of the Shoulder scores (33.1 vs. 37.8, P = .043), external rotation at 90° (19° vs. 28°, P = .007), internal rotation (IR) spinal level (L5 vs. L4, P = .002), and belly press strength (P = .003) compared to the nonobese cohort. There were no statistical differences in 2-year outcomes (
PROs, ROM, and strength) other than a worse IR (spinal level) in the low BMI group (L4 vs. L3, P = .002). In linear regression analyses controlling for confounding variables, increasing BMI was negatively correlated with preoperative external rotation (B = -0.591, P = .034) and preoperative IR spinal level (B = 0.089, P = .002). Increasing BMI was not correlated with postoperative external rotation at 90° (B = 0.189, P = .490) but was associated with worse postoperative IR by spinal level (B = 0.066, P = .043).
UNASSIGNED: Obese patients have greater restrictions in external and internal rotation as well as American Shoulder and Elbow Surgeons and Western Ontario Osteoarthritis of the Shoulder scores at baseline prior to RSA. However, there are no major differences in postoperative
PROs or ROM measurements between obese and nonobese patients apart from a worse active IR by spinal level in the obese group (L4 vs. L3, P = .002). This study suggests that an RSA procedure does not need to be restricted solely based on BMI.