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Huang Z, Wang H, Da Y, Liu S, Zheng W, Li F. Do nutritional assessment tools (PNI, CONUT, GNRI) predict adverse events after spinal surgeries? A systematic review and meta-analysis. J Orthop Surg Res 2024; 19:289. [PMID: 38735935 PMCID: PMC11089772 DOI: 10.1186/s13018-024-04771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Nutritional assessment tools are used to predict outcomes in cancer. However, their utility in patients undergoing spinal surgery is unclear. This review examined if prognostic nutritional index (PNI), controlling nutritional status (CONUT), and geriatric nutritional risk index (GNRI) can predict adverse events after spinal surgeries. METHODS PubMed, CENTRAL, Scopus, and Embase were screened by two reviewers for relevant studies up to 26th January 2024. The primary outcome of interest was total adverse events after spinal surgery. Secondary outcomes were surgical site infections (SSI) and mortality. RESULTS 14 studies were included. Meta-analysis showed that while reduced PNI was not associated with an increased risk of SSI there was a significant association between PNI and higher risk of adverse events. Meta-analysis showed that high CONUT was not associated with an increased risk of complications after spinal surgeries. Pooled analysis showed that low GNRI was associated with an increased risk of both SSI and adverse events. Data on mortality was scarce. CONCLUSIONS The PNI and GNRI can predict adverse outcomes after spinal surgeries. Limited data shows that high CONUT is also associated with a non-significant increased risk of adverse outcomes. High GNRI was predictive of an increased risk of SSI. Data on mortality is too scarce for strong conclusions.
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Affiliation(s)
- Zhi Huang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Hanbo Wang
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Yifeng Da
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Shengxiang Liu
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Wenkai Zheng
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Feng Li
- The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China.
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Kinoshita H, Hongo M, Abe E, Kobayashi T, Kasukawa Y, Kikuchi K, Kudo D, Kimura R, Ono Y, Miyakoshi N. Comparison of Postoperative Results With Prognostic Nutritional Index for Lumbar Disc Herniation. Cureus 2024; 16:e60584. [PMID: 38894769 PMCID: PMC11184540 DOI: 10.7759/cureus.60584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION The prognostic nutritional index (PNI) is an immune-nutritional index simply provided by a blood test. We retrospectively compared the postoperative outcomes of patients with lumbar disc herniation divided into two groups according to the PNI. MATERIALS AND METHODS Seventy-three patients who underwent surgery at our hospital were included in the study. All patients had herniation between one of the L3/4, L4/5, or L5/S intervertebral discs and underwent one posterior lumbar interbody fusion. These patients were divided into two groups: patients with a PNI of <50 (poorly nourished (PN) group) and patients with a PNI of ≥50 (well-nourished (WN) group). Evaluation items included patient background characteristics, operative time, blood loss, postoperative complications, and length of hospital stay. RESULTS The results showed that the body mass index was significantly higher in the WN group than in the PN group (p=0.0221). The rates of collagen disease, steroid use, and postoperative complications were significantly higher (p=0.0475, p=0.0073, and p=0.0211, respectively) and the length of hospital stay was significantly longer (p=0.021) in the PN group than in the WN group. CONCLUSION In conclusion, this study indicates that postoperative complications and the length of hospital stay are significantly worse in PN patients than in WN patients.
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Affiliation(s)
| | - Michio Hongo
- Physical Therapy, Akita University Graduate School of Medicine, Akita, JPN
| | - Eiji Abe
- Orthopedic Surgery, Johto Orthopedic Clinic, Akita, JPN
| | | | - Yuji Kasukawa
- Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Kazuma Kikuchi
- Orthopedic Surgery, Yuri Kumiai General Hospital, Yurihonjo, JPN
| | - Daisuke Kudo
- Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Ryota Kimura
- Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Yuichi Ono
- Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
| | - Naohisa Miyakoshi
- Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
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Li H, Zheng Q, Niu E, Xu J, Chai W, Xu C, Fu J, Hao L, Chen J, Zhang G. Increased risk of periprosthetic joint infection after traumatic injury in joint revision patients. ARTHROPLASTY 2024; 6:8. [PMID: 38311788 PMCID: PMC10840204 DOI: 10.1186/s42836-024-00235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Although some risk factors of PJI were well studied, the association between trauma and PJI remains unknown in revision patients. MATERIALS AND METHODS Between 2015 and 2018, a total of 71 patients with trauma history before revisions (trauma cohort) were propensity score matched (PSM) at a ratio of 1 to 5 with a control cohort of revision patients without a history of trauma. Then, the cumulative incidence rate of PJI within 3 years after operation between the two groups was compared. The secondary endpoints were aseptic revisions within 3 postoperative years, complications up to 30 postoperative days, and readmission up to 90 days. During a minimal 3-year follow-up, the survival was comparatively analyzed between the trauma cohort and the control cohort. RESULTS The cumulative incidence of PJI was 40.85% in patients with trauma history against 27.04% in the controls (P = 0.02). Correspondingly, the cumulative incidence of aseptic re-revisions was 12.68% in patients with trauma history compared with 5.07% in the control cohort (P = 0.028). Cox regression revealed that trauma history was a risk factor of PJI (HR, 1.533 [95%CI, (1.019,2.306)]; P = 0.04) and aseptic re-revisions (HR, 3.285 [95%CI, (1.790,6.028)]; P < 0.0001). CONCLUSIONS Our study demonstrated that revision patients with trauma history carried a higher risk of PJI compared to those without trauma history. Moreover, after revisions, the trauma patients were still at higher risk for treatment failure due to PJI, periprosthetic joint fracture, and mechanical complications.
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Affiliation(s)
- Hao Li
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Qingyuan Zheng
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Erlong Niu
- Department of Orthopedics, Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100039, China
| | - Jiazheng Xu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Wei Chai
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Chi Xu
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jun Fu
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Libo Hao
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jiying Chen
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
| | - Guoqiang Zhang
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
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Hong SW, Rhee KY, Kim TH, Kim SH. Back Muscle Mass as a Predictor of Postoperative Complications in Posterior Lumbar Interbody Fusion Surgery. J Clin Med 2023; 12:5332. [PMID: 37629374 PMCID: PMC10455803 DOI: 10.3390/jcm12165332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND There is a lack of studies on utilising skeletal muscle mass via preoperative lumbar computed tomography or magnetic resonance imaging as a predictor of postoperative complications of posterior lumbar interbody fusion (PLIF) surgery in elderly patients. METHODS Patients aged >65 years who underwent PLIF were enrolled. The sum of the cross-sectional areas of the erector spinae muscles (CSABoth) was presented as the skeletal muscle mass. Postoperative complications were assessed using CSABoth, pulmonary function testing, and prognostic nutritional index (PNI). RESULTS Patients with postoperative complications showed significantly lower values of CSABoth (median 2266.70 (2239.73-2875.10) mm2 vs. 3060.30 (2749.25-3473.30) mm2, p < 0.001), functional vital capacity, forced expiratory volume at 1 s, and PNI. However, multiple logistic regression analysis identified American Society of Anaesthesiologists Physical Status (ASA PS) I (odds ratio 0.307 (95% confidence interval 0.110-0.852), p = 0.023), ASA PS III (4.033 (1.586-10.254), p = 0.003), CSABoth (0.999 (0.999-1.000), p < 0.001), and postoperative red blood cell (RBC) transfusion (1.603 (1.193-2.152), p = 0.002) as risk factors for postoperative complications after PLIF surgery. CONCLUSIONS CSABoth, ASA PS III, and postoperative RBC transfusion might be used as predictors of postoperative complications after PLIF in patients aged >65 years.
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Affiliation(s)
- Seung-Wan Hong
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-W.H.); (K.-Y.R.)
| | - Ka-Young Rhee
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-W.H.); (K.-Y.R.)
| | - Tae-Hoon Kim
- Deparment of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
- Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Seong-Hyop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-W.H.); (K.-Y.R.)
- Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
- Department of Infection and Immunology, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
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Fan MC, Li HT, Sun J, Guan D, Yang ZJ, Feng YG. Preoperative prognostic nutrition index can independently predict the 6-month prognosis of elderly patients undergoing neurosurgical clipping for aneurysmal subarachnoid hemorrhage. Neurosurg Rev 2023; 46:117. [PMID: 37165260 DOI: 10.1007/s10143-023-02021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/16/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023]
Abstract
The number of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) is increasing annually. The prognostic nutritional index (PNI) is used as a novel and valuable prognostic marker for various neoplastic diseases and other critical illnesses. This study aimed to identify the short-term prognostic value of preoperative PNI in elderly patients who underwent neurosurgical clipping for aSAH. This retrospective study included elderly patients with aSAH who underwent neurosurgical clipping from January 2018 to December 2020. Clinical variables and 6-month outcomes were collected and compared. Epidemiological data and effect factors of prognosis were evaluated. Multivariate logistic regression and receiver operating characteristics (ROC) curve analyses were used to evaluate the predictive value of preoperative PNI. Multiple logistic regression was performed to establish a nomogram. A total of 124 elderly patients were enrolled. Multivariate logistic regression analysis showed that preoperative PNI (odds ratio (OR), 0.779; 95% confidence interval (CI), 0.689-0.881; P < 0.001), Hunt-Hess grade (OR, 3.291; 95%CI, 1.816-5.966; P < 0.001), and hydrocephalus (OR, 9.423; 95%CI, 2.696-32.935; P < 0.001) were significant predictors. The area under the ROC curve of PNI was 0.829 (95% CI, 0.755-0.903; P < 0.001) with a sensitivity and specificity of 68.4% and 83.3%, respectively, and the cutoff value was 46.36. Patients with preoperative PNI of < 46.36 had a significantly unfavorable 6-months prognosis (F = 40.768, P < 0.001). Preoperative PNI is independently correlated with the 6-month prognosis in elderly patients who undergo neurosurgical clipping for aSAH.
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Affiliation(s)
- Ming-Chao Fan
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Neurosurgical Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huan-Ting Li
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian Sun
- Department of Neurosurgical Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dong Guan
- Department of Neurosurgery, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), Qingdao, China
| | - Zheng-Jie Yang
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Gong Feng
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China.
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Martín-Fuentes M, Varas de Dios B, Valverde Villar AM, Sánchez Almaraz R, Pérez Torres A, Iglesias Domínguez L, Muñoz García N, Guindal Pérez Y, Aragonés Maza P, Reche Sainz CM, Espina Flores I, Neira Borrajo I, Romero Estarlich V. [Nutritional, bone and body composition assessment of patients with knee and hip arthroplasty]. NUTR HOSP 2023. [PMID: 37073743 DOI: 10.20960/nh.04341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION malnutrition, both due to deficiency and excess of nutrients, is related to the morbidity of the surgical patient. OBJECTIVES to analyze the nutritional status, body composition and bone health of patients undergoing elective knee and hip arthroplasty. METHODS an observational cross-sectional study was carried out evaluating patients undergoing hip and knee replacement surgery from February to September 2019. The Malnutrition Universal Screening Tool (MUST), anthropometry, hand-grip dynamometry, bone densitometry, lumbar spine X-ray and bioimpedance analysis were performed. RESULTS eighty-six patients (61.6 % women) were evaluated, with a mean age of 69.5 ± 9.5 years. The mean body mass index (BMI) was 31.3 ± 4.5. According to MUST, 21.3 % were at risk of malnutrition; 16.9 % had decreased triceps skinfold with respect to p50 and 20 % had a pathological hand-grip dynamometry. In 91.4 %, vitamin D was < 30 pg/ml. In the bioimpedanciometry, the women presented significantly decreased muscle mass values. Age was correlated with a lower presence of fat-free mass, total and appendicular muscle mass. In those over 65 years of age, 52.6 % of men vs 14.3 % of women had a decreased muscle mass index; 58.5 % had low bone mineral density. We observed vertebral bone collapses in 13.9 %. CONCLUSION there is a high prevalence of obesity in patients who are candidates for arthroplasty and this does not exclude the existence of a risk of malnutrition. They may also have decreased muscle mass and strength. Nutritional education and physical exercise recommendations are essential in order to optimize nutritional status for surgery.
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Affiliation(s)
| | | | | | | | | | | | - Nuria Muñoz García
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | - Yolanda Guindal Pérez
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | - Paloma Aragonés Maza
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
| | | | - Irene Espina Flores
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Santa Cristina
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Rodriguez-Merchan EC, Delgado-Martinez AD. Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty. J Clin Med 2022; 11:6128. [PMID: 36294449 PMCID: PMC9605414 DOI: 10.3390/jcm11206128] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 08/29/2023] Open
Abstract
Periprosthetic joint infection (PJI) is a major adverse event of primary total knee arthroplasty (TKA) from the patient's perspective, and it is also costly for health care systems. In 2010, the reported incidence of PJI in the first 2 years after TKA was 1.55%, with an incidence of 0.46% between the second and tenth year. In 2022, it has been published that 1.41% of individuals require revision TKA for PJI. The following risk factors have been related to an increased risk of PJI: male sex, younger age, type II diabetes, obesity class II, hypertension, hypoalbuminemia, preoperative nutritional status as indicated by prognostic nutritional index (PNI) and body mass index, rheumatoid arthritis, post-traumatic osteoarthritis, intra-articular injections prior to TKA, previous multi-ligament knee surgery, previous steroid therapy, current tobacco use, procedure type (bilateral), length of stay over 35 days, patellar resurfacing, prolonged operative time, use of blood transfusions, higher glucose variability in the postoperative phase, and discharge to convalescent care. Other reported independent risk factors for PJI (in diminishing order of importance) are congestive heart failure, chronic pulmonary illness, preoperative anemia, depression, renal illness, pulmonary circulation disorders, psychoses, metastatic tumor, peripheral vascular illness, and valvular illness. Preoperative intravenous tranexamic acid has been reported to diminish the risk of delayed PJI. Knowing the risk factors for PJI after TKA, especially those that are avoidable or controllable, is critical to minimizing (ideally preventing) this complication. These risk factors are outlined in this article.
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Affiliation(s)
- Emerito Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research—IdiPAZ (La Paz University Hospital—Autonomous University of Madrid), 28046 Madrid, Spain
| | - Alberto D. Delgado-Martinez
- Department of Orthopedic Surgery, Hospital Universitario de Jaen, 23007 Jaen, Spain
- Department of Surgery, University of Jaen, 23071 Jaen, Spain
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Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study. Nutrients 2021; 13:nu13113817. [PMID: 34836073 PMCID: PMC8620899 DOI: 10.3390/nu13113817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022] Open
Abstract
Sarcopenic obesity is closely associated with knee osteoarthritis (KOA) and has high risk of total knee replacement (TKR). In addition, poor nutrition status may lead to sarcopenia and physical frailty in KOA and is negatively associated with surgery outcome after TKR. This study investigated the effects of sarcopenic obesity and its confounding factors on recovery in range of motion (ROM) after total knee replacement (TKR) in older adults with KOA. A total of 587 older adults, aged ≥60 years, who had a diagnosis of KOA and underwent TKR, were enrolled in this retrospective cohort study. Sarcopenia and obesity were defined based on cutoff values of appendicular mass index and body mass index for Asian people. Based on the sarcopenia and obesity definitions, patients were classified into three body-composition groups before TKR: sarcopenic-obese, obese, and non-obese. All patients were asked to attend postoperative outpatient follow-up admissions. Knee flexion ROM was measured before and after surgery. A ROM cutoff of 125 degrees was used to identify poor recovery post-surgery. Kaplan-Meier curve analysis was performed to measure the probability of poor ROM recovery among study groups. Cox multivariate regression models were established to calculate the hazard ratios (HRs) of postoperative poor ROM recovery, using potential confounding factors including age, sex, comorbidity, risk of malnutrition, preoperative ROM, and outpatient follow-up duration as covariates. Analyses results showed that patients in the obese and sarcopenic-obese groups had a higher probability of poor ROM recovery compared to the non-obese group (all p < 0.001). Among all body-composition groups, the sarcopenic-obese group yielded the highest risk of postoperative physical difficulty (adjusted HR = 1.63, p = 0.03), independent to the potential confounding factors. Sarcopenic obesity is likely at the high risk of poor ROM outcome following TKR in older individuals with KOA.
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