肥満は膝蓋大腿関節形成術後の患者報告された転帰に影響しない

Obesity Does Not Affect Patient-Reported Outcomes following Patellofemoral Arthroplasty.

• Jared C Tishelman
• Abigail Pyne
• Cynthia A Kahlenberg
• Jordan A Gruskay
• Sabrina M Strickland

抄録

膝蓋大腿関節形成術（PFA）は、症状のある孤立性膝蓋大腿関節炎患者のための膝関節全置換術に代わる有効な術式として近年注目を集めている。肥満が再手術の危険因子であることは以前に明らかにされていたが、患者報告アウトカム指標（PROM）に及ぼす影響は評価されていなかった。患者を肥満（O、BMI＞30）または非肥満（NO、BMI：18.5～25）として、ボディマス指数（BMI）によって二分化した。人口統計学的情報、手術情報、およびPROMを収集し、それに応じて分析した。76人の患者（非肥満41人、肥満35人）が同定された。肥満の患者は、膝特有のQOL、身体機能、MHまたは精神的健康に関する術前PROMが有意に悪化していた（膝の損傷と変形性関節症のアウトカムスコアQOL [KOOS QoL], NO: 26.2, O: 14.7, NO: 26.2、O：14.7、=0.019、KOOS PF、NO：38.2、O：50.5、=0.002、Veterans Rand-12メンタルヘルス［VR-12 MH］、NO：54.2、O：47.0、=0.033）。膝機能スコアの改善については、肥満者と非肥満者の間で有意差は認められなかった（KOOS QoL、NO：39.5、O：40.6、=0.898；KOOS PS［身体機能］、NO：-17.8、O：-17.3、=0.945）。さらに、PFA再置換術の施行率に差は認められず、術後合併症の報告もなかった。孤立性PFAを有する肥満患者は、膝蓋大腿関節形成術後の非肥満患者と同様の機能改善が期待できる。本論文は、PFAにおける患者選択の優先順位を強調し、外科医は肥満を理由にPFAを受ける患者を除外すべきであるという考え方に挑戦している。

Patellofemoral arthroplasty (PFA) has garnered attention in recent years as an effective alternative to total knee arthroplasty for patients with symptomatic, isolated patellofemoral joint arthritis. Obesity has previously been identified as a risk factor for revision surgery, but its effect on patient-reported outcome measures (PROMs) has not been evaluated A retrospective review of a consecutive series of PFA surgeries was conducted at a single, specialized orthopedics center in a major urban center. Patients were dichotomized by body mass index (BMI) as obese (O, BMI >30) or nonobese (NO, BMI: 18.5-25). Demographic, surgical information, and PROMs were collected and analyzed accordingly. Seventy-six patients (41 nonobese, 35 obese) were identified. Patients who were obese presented with significantly worse preoperative PROMs regarding knee-specific quality of life, physical function, and MH or mental health (knee injury and osteoarthritis outcome score quality of life [KOOS QoL], NO: 26.2, O: 14.7,  = 0.019; KOOS PF, NO: 38.2, O: 50.5,  = 0.002; Veterans Rand-12 mental health [VR-12 MH], NO: 54.2, O: 47.0,  = 0.033). No significant difference was seen in improvement in knee function scores between patients who were obese or nonobese (KOOS QoL, NO: 39.5, O: 40.6,  = 0.898; KOOS PS [physical function], NO: -17.8, O: -17.3,  = 0.945). Additionally, no difference in the rate of PFA revision was observed and there were no postoperative complications reported. Obese patients with isolated PFA can expect the same improvement in function as nonobese patients following patellofemoral joint arthroplasty. This paper underscores the priority of patient selection in PFA and challenges the notion that surgeons should exclude patients from receiving a PFA on the basis of obesity.

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