Billy I Kim, Albert T Anastasio, Colleen M Wixted, James K DeOrio, James A Nunley, Mark E Easley, Samuel B Adams
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引用次数: 0
Abstract
Background: There is limited data evaluating the effect of obesity on outcomes following total ankle arthroplasty (TAA), especially in adequate sample sizes to detect impacts on patient-reported outcomes (PROs). The purpose of this study was to assess the effect of obesity on complication rates and PROs.
Methods: This was a single-institution, retrospective study of 1093 primary TAA performed between 2001 and 2020. Minimum follow-up was 2 years. Patients were stratified by body mass index (BMI) into control (BMI = 18.5-29.9; n = 615), obesity class I (BMI = 30.0-34.9; n = 285), and obesity class II (BMI > 35.0; n = 193) groups. Patient information, intraoperative variables, postoperative complications, and PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (SD: 3.1).
Results: Compared to control and class I, class II patients had the lowest mean age (P = .001), highest mean ASA score (P < .001), and greatest proportion of female sex (P < .001) and Black/African American race (P = .005). There were no statistically significant differences in postoperative complications (infection, implant failure, or impingement) across the BMI classes (P > .05).Preoperatively, class II had lower (worse) mean scores for Foot and Ankle Outcome Score pain and ADL subscales than controls (post hoc pairwise P < .001 for both). At final follow-up, both class II and class I had lower (worse) mean Short Musculoskeletal Function Assessment (post hoc pairwise P < .001 and P = .030, respectively) and 36-Item Short Form Health Survey scores (post hoc pairwise P < .001 and P = .005, respectively) than controls.
Conclusion: At midterm follow-up, obesity was not associated with increased rates of complications after TAA. Patients with obesity reported worse musculoskeletal function and overall quality of life after TAA but there was no differential improvement in PROs across BMI classes. To our knowledge, this is the largest single-institution study to date examining the effect of obesity on outcomes after primary TAA.
Level of evidence: Level III, retrospective comparative study.
背景：评估肥胖对全踝关节置换术（TAA）后疗效影响的数据有限，尤其是在样本量充足的情况下，无法检测肥胖对患者报告疗效（PROs）的影响。本研究旨在评估肥胖对并发症发生率和PROs的影响：这是一项单一机构的回顾性研究，研究对象是 2001 年至 2020 年间进行的 1093 例原发性 TAA。最短随访时间为 2 年。患者按体重指数（BMI）分为对照组（BMI = 18.5-29.9; n = 615）、肥胖 I 级组（BMI = 30.0-34.9; n = 285）和肥胖 II 级组（BMI > 35.0; n = 193）。通过单变量统计比较了各组之间的患者信息、术中变量、术后并发症和 PRO 测量值。采用多变量 Cox 回归评估植入失败的风险。平均随访时间为 5.6 年（SD：3.1）：与对照组和 I 类患者相比，II 类患者的平均年龄最小（P = .001），平均 ASA 评分最高（P P = .005）。术前，与对照组相比，II级患者的足踝结果评分疼痛和ADL分量表平均得分较低（较差）（分别为post hoc pairwise P P = .030），36-Item Short Form Health Survey评分（分别为post hoc pairwise P P = .005）也较低（较差）：结论：在中期随访中，肥胖与TAA术后并发症发生率增加无关。肥胖患者在 TAA 术后的肌肉骨骼功能和整体生活质量较差，但不同 BMI 等级的患者在 PROs 方面的改善程度并无差异。据我们所知，这是迄今为止对肥胖对原发性TAA术后效果的影响进行的最大规模的单机构研究：证据级别：III级，回顾性比较研究。
期刊介绍：
Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers.
The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008.
The journal focuses on the following areas of interest:
• Surgery
• Wound care
• Bone healing
• Pain management
• In-office orthotic systems
• Diabetes
• Sports medicine
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