Functional Gain and Pain Relief After Total Joint Replacement According to Obesity Status
Functional Gain and Pain Relief After Total Joint Replacement According to Obesity Status
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DOI：
10.2106/jbjs.16.00960
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发表时间：
2017-07-19
影响因子：
5.3
通讯作者：
Franklin, Patricia D.
中科院分区：
文献类型：
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作者：
Li, Wenjun;Ayers, David C.;Franklin, Patricia D.
背景：肥胖与全髋或全膝关节置换术（THR或TKR）前后的功能低下和疼痛增加有关。我们在一个大型的代表性美国队列中检查了术前和术后功能和疼痛之间的变化，以确定是否与肥胖状态有关。方法：术前和术后6个月的功能数据（简表-36身体健康总评[PCS]评分），关节疼痛（髋关节残疾和骨关节炎结局评分和膝关节损伤和骨关节炎结局评分）和体重指数（BMI），2011年5月至2013年3月，040例患者接受了THR，2，964例患者接受了TKR。术前和术后的功能和疼痛进行了评估，根据BMI的状态，定义为正常体重或以下，超重，肥胖，严重肥胖，或病态obesid.Results：接受THR患者的平均年龄为65岁，59%是女性，94%是白色，14%是严重或病态肥胖。基线和术后6个月时，肥胖程度越高，PCS评分越低（越差）。重度和病态肥胖患者的术后功能恢复低于其他BMI组。肥胖程度越高，基线时疼痛越多，但术后疼痛缓解越多，因此平均术后疼痛评分根据BMI状态无显著差异。接受TKR的患者平均年龄为69岁; 61%为女性，93%为白色，25%为重度或病态肥胖。在基线和6个月时，肥胖程度越高，PCS评分越低。术后PCS评分的增加不因BMI水平而异。一个更大的肥胖水平与更严重的疼痛在基线，但更大的疼痛缓解在6个月，所以在6个月的平均疼痛评分是相似的BMI levels.Conclusions：6个月后，全关节置换术（TJR），严重或病态肥胖患者报告优良的疼痛缓解和大量的功能增益，这是类似于其他患者的研究结果。虽然肥胖与早期并发症的风险更大有关，但肥胖本身不应成为接受TJR以缓解症状的障碍。
Background: Obesity has been associated with lower function and more pain before and after total hip or knee replacement (THR or TKR). We examined the changes between preoperative and postoperative function and pain in a large representative U.S. cohort to determine if there was a relationship to obesity status.Methods: Preoperative and 6-month postoperative data on function (Short Form-36 Physical Component Summary [PCS] score), joint pain (Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score), and body mass index (BMI) were collected from a national sample of 2,040 patients who had undergone THR and 2,964 who had undergone TKR from May 2011 to March 2013. Preoperative and postoperative function and pain were evaluated according to BMI status, defined as under or of normal weight, overweight, obese, severely obese, or morbidly obese.Results: Patients undergoing THR were an average of 65 years of age; 59% were women, 94% were white, and 14% were severely or morbidly obese. A greater obesity level was associated with a lower (worse) PCS score at baseline and 6 months postoperatively. Severely and morbidly obese patients had less postoperative functional gain than the other BMI groups. A greater obesity level was associated with more pain at baseline but greater postoperative pain relief, so the average postoperative pain scores did not differ significantly according to BMI status. Patients undergoing TKR had an average age of 69 years; 61% were women, 93% were white, and 25% were severely or morbidly obese. A greater obesity level was associated with a lower PCS score at baseline and 6 months. The postoperative gain in PCS score did not differ by BMI level. A greater obesity level was associated with worse pain at baseline but greater pain relief at 6 months, so the average pain scores at 6 month were similar across the BMI levels.Conclusions: Six months after total joint replacement (TJR), severely or morbidly obese patients reported excellent pain relief and substantial functional gain that was similar to the findings in other patients. While obesity is associated with a greater risk of early complications, obesity in itself should not be a deterrent to undergoing TJR to relieve symptoms.