Hat der Body-Mass-Index Einfluss auf das Ergebnis nach Knieendoprothesenwechseln?

Zusammenfassung

Hintergrund: Knie-Totalendoprothesen-Wechsel (K-TEP-Wechsel) gehören zu den Verfahren mit dem größten Anstieg der Operationszahlen. Inwiefern eine Adipositas oder das Körpergewicht das postoperative Ergebnis beeinflussen, ist wenig untersucht. Die vorliegende Arbeit soll aus diesem Grund den Einfluss des Body-Mass-Index (BMI) und des Körpergewichts auf das klinische Ergebnis mindestens 1 Jahr nach K-TEP-Wechsel evaluieren. Patienten: 75 konsekutive Patienten mit K-TEP-Komplettwechsel-Operationen wurden prospektiv eingeschlossen. Aus dem Gesamtkollektiv wurden 4 Subgruppen gebildet mit einem BMI < bzw. > 30 kg/m² und einem Körpergewicht < bzw. > 90 kg. Analysiert wurden der Verlauf des Knee Society Scores, die OP-Zeit, das Auftreten perioperativer Komplikationen, der perioperative Blutverlust und die Krankenhausverweildauer. Ergebnisse: Bei allen Gruppen fanden sich signifikante Verbesserungen des Knee Society und Knee Function Scores. Es zeigten sich tendenziell bessere klinische Ergebnisse bei einem BMI < 30 kg/m² wie auch für Patienten mit einem Körpergewicht < 90 kg. Signifikante Unterschiede waren insbesondere im Function Score zu ermitteln. Bei der Auswertung der OP-Zeit, der Komplikationsrate, des Blutverlusts und der Krankenhausverweildauer ergaben sich keine Unterschiede zwischen den Gruppen. Schlussfolgerung: Adipositas oder ein generell erhöhtes Körpergewicht stellen per se keine Kontraindikation für einen K-TEP-Wechsel dar und sollte diesen Patienten nicht vorenthalten werden, da eine Funktionsverbesserung und eine Reduktion des Schmerzniveaus auch bei diesen zu erwarten ist. Ein erhöhtes Risiko perioperativer Komplikationen war nicht nachzuweisen, allerdings waren die Ergebnisse bei einem BMI < 30 kg/m² sowie bei einem Körpergewicht < 90 kg tendenziell besser.

Abstract

Background: Revision total knee arthroplasty (TKA) is one of the most demanding as well as increasing orthopaedic operations. The influence of a higher body weight or body mass index (BMI) on the results of revision TKA is not evident so far. We therefore hypothesised that obesity as well as a high body weight could influence the results of revision TKA. Patients: 75 consecutive revision TKA in 75 patients were included and stratified according to a BMI greater or smaller than 30 kg/m² and a body weight greater or smaller than 90 kg. The Knee Society score (KSS), the function and the knee subscales were analysed pre- and postoperatively as well as the pre- to postoperative improvement. The duration of the procedure, the occurrence of complications, the blood loss and the length of hospital stay were collected. Results: All patients showed a significant improvement of the KSS and function score (p < 0.05). There was a tendency to superior results in patients with a smaller BMI and a lower body weight. This tendency was most pronounced in the function subscale which depicted significant differences in favour of a BMI smaller 30 kg/m². No significant differences were observed in the other analysed factors. Conclusion: BMI greater than 30 kg/m² as well as a higher body weight seem to negatively influence the function of revision TKA. However, all patients significantly improved after revision TKA and no differences were found according to the occurence of complications. Therefore, revision TKA should not be refused to obese or heavy patients.

Schlüsselwörter

Endoprothetik - Knie - Body-Mass-Index - Adipositas - Komplikationen - Knie-Totalendoprothesen-Wechsel (K-TEP-Wechsel)

Key words

arthroplasty of knee - body mass index - obesity - complications - revision total knee arthroplasty (TKA)

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