골관절염 노인에서 근감소성 비만과 슬관절전치환술 후 하지기능과의 관계

Abstract

This retrospective study aimed to investigate the prevalence of obesity,sarcopenia, and sarcopenic obesity in elderly patients with osteoarthritis, todetermine the relationship between obesity, sarcopenia, sarcopenic obesity, andlower limb function in these patients after total knee arthroplasty, and toprovide basic data for the development of nursing intervention for therehabilitation of lower limb function in the elderly who had undergone totalknee arthroplasty.This study analyzed the data obtained from the medical records of 986patients who underwent total knee arthroplasty and rehabilitation treatmentfor knee osteoarthritis in a university hospital with >600 beds between June2014 and December 2019. We excluded 329 patients who underwent total kneearthroplasty on both knees at the same time and 397 patients who were notevaluated before or after surgery. Altogether, the medical records of 260patients were reviewed for data analysisThe collected data were analyzed using the SPSS 23.0 program. Weperformed χ2-test and covariance analysis (ANCOVA) to examine thedifferences in obesity, sarcopenia, sarcopenic obesity, and lower limb functionafter total knee arthroplasty. Analysis of covariance (ANCOVA) was used toexamine the relationship between obesity, sarcopenia, sarcopenic obesity, andlower limb function after total knee arthroplasty. Post-test was used formultiple comparisons using the Bonferroni correction.The results of this study are as follows1) The patients' average age was 72.7(±4.59) years, and most of the patientswere female(n=225, 86.5%). The average Number of diagnosed diseases was4.18(±1.76), and the number of drugs during hospitalization was 8.00(±2.98),with 87.3% of the patients taking ≥5 drugs per day.2) The prevalence of obesity was 51.2%, with 23.1% of the patients beingoverweight and 11.2% having extremity obesity. The prevalence of sarcopeniaand sarcopenic obesity was 15.4% and 6.2%.3) When comparing the prevalence of obesity, sarcopenia, and sarcopenicobesity characteristics of the participants and disease-related characteristics,type of insurance(χ2=8.39, p=.020) and education(χ2=17.57, p=.007) werestatistically significantly different among patients classified according to thedegree of obesity. age(χ2=9.97, p=.002), gender(χ2=4.88, p=.027), Cohabitant(χ2=7.57, p=.006), type of insurance(χ2=6.68, p=.023), and education(χ2=17.46,p<.001) were significantly different between patients with and withoutsarcopenia. Age(χ2=5.87, p=.015) and education(χ2=15.31, p<.001) weresignificantly different between patients with and without sarcopenic obesity.4) When comparing the lower limb function after total knee arthroplastyaccording to characteristics of the participants among their disease-relatedcharacteristics, the flexion angle was statistically significantly different amongpatients classified according to the number of drugs(F=4.47, p=.004) duringhospitalization. isometric knee flexor and extensor strength was significantlydifferent among patients stratified by gender(F=11.05, p=.001; F=10.54, p=.001)and job(F=9.56, p=.002; F=11.65, p=.001). TUG was statistically significantlydifferent among patients stratified by age(F=4.66, p=.032), education(F=7.15,p=.001), Kellgren Lawrence grade(F=7.19, p=.008), and Number of paindrugs(F=4.51, p=.035) during hospitalization. The time to stairs ascending aftertotal knee arthroplasty was statistically significantly different amongcharacteristics of the participants, job(F=8.55, p=.004), type of insurance(F=4.92,p=.027) and education(F=5.14, p=.007). as well as according to theirdisease-related characteristics, Kellgren Lawrence grade(F=5.22, p=.023) andNumber of diagnosed diseases(F=2.80, p=.041). The time to stairs descendingafter total knee arthroplasty was significantly different among characteristicsof the participants age(F=4.65, p=.032), job(F=8.75, p=.003), education(F=5.47,p=.005), Kellgren Lawrence grade(F=6.95, p=.009), Number of diagnoseddiseases(F=3.75, p=.012), and number of drugs(F=3.15, p=.026) duringhospitalization.There was a statistically significant difference 6MWT before total kneearthroplasty among characteristics of the participants gender(F=10.14, p=.002),job(F=4.89, p=.028), education(F=7.32, p=.001), and among disease-relatedcharacteristics number of diagnosed diseases(F=4.44, p=.005). The gait speed wasstatistically significantly different among characteristics of the participantsaccording to gender(F=4.46, p=.036), job(F=7.78, p=.006), and education(F=5.40,p=.005). There was no statistically significant difference in the K-WOMACamong characteristics of the participants and disease-related characteristics.There was a significant difference in the pain score among of the participantsdisease-related characteristics according to the number of drugs(F=3.44,p=.017) during hospitalization.5) Among the lower limb functions after total knee arthroplasty Knee JointRange of Motion extension angle(F=4.50, p=.004), stairs ascending(F=2.73,p=.045) and stairs descending(F=2.74, p=.044), 6MWT(F=5.02, p=.002) werestatistically significantly different according to the degree of obesity.6) Among the lower limb functions after total knee arthroplasty Knee JointRange of Motion flexion angle(F=5.143, p=.024), isometric knee extensorstrength(F=4.522, p=.034), and stairs descending(F=6.089, p=.014) werestatistically significantly different between patients with and withoutsarcopenia.7) Among the lower limb functions after total knee arthroplasty, isometricknee flexor strength(F=3.97, p=.047), TUG(F=5.83, p=.016), stairsascending(F=6.98, p=.009) and stairs descending(F=8.96, p=.003) werestatistically significantly different between patients with and withoutsarcopenic obesityIn summary, the prevalence of obesity, sarcopenia, and sarcopenic obesitywas high in women and elderly patients. obesity, sarcopenia, and sarcopeniawere all identified as variables that negatively affect the lower limb functionof elderly patients with osteoarthritis who had undergone total kneearthroplasty. For the elderly with obesity, sarcopenia, or sarcopenic obesity,the risk of complications after total knee arthroplasty is high, and there maybe a high risk of physical function limitations and falling, along with delayedrecovery of lower limb function. Thus, comprehensive assessment andmanagement, including evaluation of risk factors for obesity, sarcopenia, andsarcopenic obesity, should be considered in elderly patients with osteoarthritiswho are scheduled to undergo total knee arthroplasty. In addition, to reducethe risk of complications after total knee arthroplasty and to promote therecovery of lower limb function in elderly patients with obesity, sarcopenia,and sarcopenic obesity, it is necessary to provide long-term comprehensiveexercise interventions pre operatively until 1 year postoperatively.