BOA-2014-關節(jié)會場英文版

TheOutcomesofPrimaryTotalKneeArthroplastyinObesePatientsZhangXH,ZhangYK,YuZS,LiuL,ZengJZ,GuoT,ZhuX,ZhaoF,ChengWH,GuiQ,PeiZDepartmentofOrthopaedicSurgery,LuheTeachingHospitaloftheCapitalMedicalUniversityObjectiveToinvestigatethemanagementandclinicaloutcomesofprimarytotalkneearthroplasty(TKA)inobesepatientsMaterialandMethodsFromApr.2009toOct.2012,46

obese

patients

whohadundergoneaprimary

TKA

27womenand14menwithameanageof61.8years（51-79y）Bilateral:11casesUnilateral:24cases13inleft,33inrightAllwithposteriorstabilizedPSprosthesisandantibiotic-loadedcementingtechniqueMeanBMI:27.0（26.1-34.9）Pre-andpost-op.HSS&KSS,op.time,incisionlength,bloodloss,earlycomplication,etcDataanalyzedbySPSS11.0andcomparedwithnonobeseones’MaterialandMethodsResults

43patientswithanaverageof38months(24-62)follow-up(3lost)HSS,KSSwereimprovedsignificantlycomparedwithpre-op.ones（HSS:pre-op.36.8vs.post-op.89.2。KSS:pre-op.40.1vs.post-op.91.3）P﹤0.005ResultsPoorerHSSandKSScomparedwithnonobesepatients(nostatisticaldifference)

Earlycomplicationsrate7.5%1case:necrosisofskinedges3cases:fatliquefactionAllwereproperlymanagedwithnodeepinfection.Case1Case1

Case1Pre-op.XrayPost-op.Xray2dpost-op.16mpost-op.Case22/3/202368y,f,severeOAwithvarusKnee2/3/2023Case22/3/2023Case2DiscussionBMI:ameasureofrelativeweightbasedonanindividual‘smassandheight

Pre-op.losingweightgoesagainstperioperativemanagement

ManagementofComorbidities

Hypertension

DiabetesMellitus

CoronaryDisease

LumbarDegenerativeDisease

Angiopathy

DiscussionBMIandarthritishaveacloserelationship：

--

ObesityissufficientlyprovedtobetheriskfactortokneejointOA.

--Long-termoverloadinkneejointleadstochondraldegeneration.DiscussionBMI&EffectofTKA

20yago，patientsover80kgwerecontraindicatedtoproceedwithTKA.Butrecently,clinicalpracticeshaveprovenTKAapplyequallytotheover-weight.DiscussionSolutiontosurgicalproblems:

Makeincisionlongenough

Notinversethepatella

Reducethetensioninsuture

DiscussionPrevention&ManagementofComplications

Pre-op.assessmentofskinandsofttissue

Extendedincisiontoreducethetension

WithoutatourniquetLayeredsuture

NoimpingementtotheMCL

Managementoffatliquefaction

DiscussionPostoperativeRehabilitation

Nottooearly

Professionaltherapist

ExerciseofquadricepsfemorisDiscussionObesepatientsareatahigherriskofdevelopingearlycomplicationsrelatedtopoorsofttissueandsystemicconditionfollowingprimaryTKA.ObesityisnotthecontraindicationtoTKA,properperioperativemanagementwillcontribu