Relationship between soft tissue envelope thickness of the lower extremity and acute periprosthetic joint infection of the knee.
Arthroplasty
Body mass index
Obesity
Periprosthetic Joint Infection
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
14 Oct 2024
14 Oct 2024
Historique:
received:
08
04
2024
accepted:
03
09
2024
medline:
15
10
2024
pubmed:
15
10
2024
entrez:
14
10
2024
Statut:
aheadofprint
Résumé
The prevalence of obesity is increasing worldwide and it is known to be associated with many postoperative complications, including infection. Patients' body fat distribution may vary and body mass index (BMI) does not provide sufficient information about adipose tissue thickness of the lower extremities. The aim of this study is to investigate the relationship between thigh diameters and early postoperative prosthesis-related joint infections (PJI) in patients who underwent arthroplasty. The study included 76 patients and 114 knees who were operated on by a single surgeon and underwent total knee arthroplasty (TKA) due to primary knee osteoarthritis between May 2022 and September 2023 in a tertiary reference hospital. Circumference of the thickest part of the operated thigh (cm), preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, height, weight, BMI and the presence of early postoperative prosthesis-related joint infections were evaluated. The mean BMI was 32.6 ± 4.2 (kg/m The incidence of acute PJI was found to be significantly higher in patients with larger thigh diameters, whereas no such relationship was observed for BMI. The incorporation of preoperative soft tissue envelope measurements into routine clinical examination may prove beneficial in reducing the risk of PJI.
Sections du résumé
BACKGROUND
BACKGROUND
The prevalence of obesity is increasing worldwide and it is known to be associated with many postoperative complications, including infection. Patients' body fat distribution may vary and body mass index (BMI) does not provide sufficient information about adipose tissue thickness of the lower extremities. The aim of this study is to investigate the relationship between thigh diameters and early postoperative prosthesis-related joint infections (PJI) in patients who underwent arthroplasty.
METHODS
METHODS
The study included 76 patients and 114 knees who were operated on by a single surgeon and underwent total knee arthroplasty (TKA) due to primary knee osteoarthritis between May 2022 and September 2023 in a tertiary reference hospital. Circumference of the thickest part of the operated thigh (cm), preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, height, weight, BMI and the presence of early postoperative prosthesis-related joint infections were evaluated.
RESULTS
RESULTS
The mean BMI was 32.6 ± 4.2 (kg/m
CONCLUSION
CONCLUSIONS
The incidence of acute PJI was found to be significantly higher in patients with larger thigh diameters, whereas no such relationship was observed for BMI. The incorporation of preoperative soft tissue envelope measurements into routine clinical examination may prove beneficial in reducing the risk of PJI.
Identifiants
pubmed: 39402143
doi: 10.1007/s00402-024-05548-3
pii: 10.1007/s00402-024-05548-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL (2016) Trends in obesity among adults in the United States, 2005 to 2014. JAMA 315(21):2284–2291
doi: 10.1001/jama.2016.6458
pubmed: 27272580
pmcid: 11197437
Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M, March L (2008) The impact of obesity on the musculoskeletal system. Int J Obes 32(2):211–222
doi: 10.1038/sj.ijo.0803715
Friedman RJ, Hess S, Berkowitz SD, Homering M (2013) Complication rates after hip or knee arthroplasty in morbidly obese patients. Clin Orthop Relat Res 471(10):3358–66
doi: 10.1007/s11999-013-3049-9
pubmed: 23670675
pmcid: 3773108
Watts CD, Wagner ER, Houdek MT, Lewallen DG, Mabry TM (2015) Morbid obesity: increased risk of failure after aseptic revision TKA. Clin Orthop Relat Res 473(8):2621–7
doi: 10.1007/s11999-015-4283-0
pubmed: 25845948
pmcid: 4488195
Werner BC, Evans CL, Carothers JT, Browne JA (2015) Primary total knee arthroplasty in super-obese patients: dramatically higher postoperative complication rates even compared to revision surgery. J Arthroplasty 30(5):849–853
doi: 10.1016/j.arth.2014.12.016
pubmed: 25577726
Alvi HM, Mednick RE, Krishnan V, Kwasny MJ, Beal MD, Manning DW (2015) The effect of BMI on 30 day outcomes following total joint arthroplasty. J Arthroplasty 30(7):1113–1117. https://doi.org/10.1016/j.arth.2015.01.049
doi: 10.1016/j.arth.2015.01.049
pubmed: 25683294
Samson AJ, Mercer GE, Campbell DG (2010) Total knee replacement in the morbidly obese: a literature review. ANZ J Surg 80(9):595
doi: 10.1111/j.1445-2197.2010.05396.x
pubmed: 20840400
Suleiman LI, Ortega G, Ong’uti SK, Gonzalez DO, Tran DD, Onyike A et al (2012) Does BMI affect perioperative complications following total knee and hip arthroplasty? J Surg Res 174(1):7–11
doi: 10.1016/j.jss.2011.05.057
pubmed: 21816426
Stern SH, Insall JN (1990) Total knee arthroplasty in obese patients. JBJS 72(9):1400–1404
doi: 10.2106/00004623-199072090-00020
Gupta VK, Kejriwal R (2020) Pretubercular subcutaneous thickness is a protective factor for superficial wound complications after total knee arthroplasty in nonmorbidly obese patients. J Arthroplasty 35(1):255–258. https://doi.org/10.1016/j.arth.2019.08.046 . (Epub 2019 Aug 27 PMID: 31558297)
doi: 10.1016/j.arth.2019.08.046
pubmed: 31558297
Pellegrini A, Suardi V, Legnani C (2022) Classification and management options for prosthetic joint infection. Ann Joint 7:3. https://doi.org/10.21037/aoj-20-86
doi: 10.21037/aoj-20-86
Tande AJ, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27(2):302–345. https://doi.org/10.1128/CMR.00111-13
doi: 10.1128/CMR.00111-13
pubmed: 24696437
pmcid: 3993098
Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 33(5):1309-1314.e2. https://doi.org/10.1016/j.arth.2018.02.078
doi: 10.1016/j.arth.2018.02.078
pubmed: 29551303
Chooi YC, Ding C, Magkos F (2019) The epidemiology of obesity. Metabolism 92:6–10
doi: 10.1016/j.metabol.2018.09.005
pubmed: 30253139
George J, Klika AK, Navale SM, Newman JM, Barsoum WK, Higuera CA (2017) Obesity epidemic: is its impact on total joint arthroplasty underestimated? An analysis of national trends. Clin Orthop Relat Res 475(7):1798–806
doi: 10.1007/s11999-016-5222-4
pubmed: 28054327
pmcid: 5449322
George J, Piuzzi NS, Ng M, Sodhi N, Khlopas AA, Mont MA (2018) Association between body mass index and thirty-day complications after total knee arthroplasty. J Arthroplasty 33(3):865–871
doi: 10.1016/j.arth.2017.09.038
pubmed: 29107493
Schwarzkopf R, Thompson SL, Adwar SJ, Liublinska V, Slover JD (2012) Postoperative complication rates in the “super-obese” hip and knee arthroplasty population. J Arthroplasty 27(3):397–401
doi: 10.1016/j.arth.2011.04.017
pubmed: 21676578
Adhikary SD, Liu W-M, Memtsoudis SG, Davis CM, Liu J (2016) Body mass index more than 45 kg/m
doi: 10.1016/j.arth.2015.10.042
pubmed: 26652477
Elkins JM, Simoens KJ, Callaghan JJ (2018) Lower extremity geometry in morbid obesity-considerations for total knee arthroplasty. J Arthroplasty 33(10):3304–3312. https://doi.org/10.1016/j.arth.2018.03.060
doi: 10.1016/j.arth.2018.03.060
pubmed: 29705683
Watts CD, Houdek MT, Wagner ER, Taunton MJ (2016) Subcutaneous fat thickness is associated with early reoperation and infection after total knee arthroplasty in morbidly obese patients. J Arthroplasty 31(8):1788–1791
doi: 10.1016/j.arth.2016.02.008
pubmed: 26989030
Wagner RA, Hogan SP, Burge JR, Bates CM, Sanchez HB (2018) The radiographic prepatellar fat thickness ratio correlates with infection risk after total knee arthroplasty. J Arthroplasty 33(7):2251–2255
doi: 10.1016/j.arth.2018.02.022
pubmed: 29555491
Kozlow JH, Lisiecki J, Terjimanian MN, Rinkinen J, Brownley RC, Agarwal S et al (2014) Cross-sectional area of the abdomen predicts complication incidence in patients undergoing sternal reconstruction. J Surg Res 192(2):670–677
doi: 10.1016/j.jss.2014.05.041
pubmed: 24972736
pmcid: 4631610
Fujii T, Tsutsumi S, Matsumoto A, Fukasawa T, Tabe Y, Yajima R et al (2010) Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery: impact of prediction using preoperative CT. Dig Surg 27(4):331–335
doi: 10.1159/000297521
pubmed: 20689296