Postoperative Complication Rates in the “Super-Obese” Hip and Knee Arthroplasty Population (original) (raw)
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The effect of obesity on the outcome of hip and knee arthroplasty
International Orthopaedics, 2010
The aim of this study was to evaluate the outcome of joint arthroplasty in obese and non-obese patients. We reviewed 2,026 consecutive primary total hip and 535 primary total knee arthroplasties performed for osteoarthritis. Patients were separated into two groups according to their body mass index (BMI): non-obese (BMI<30) and obese (BMI≥30). Their survivorships were compared. Case controlled studies were performed with 134 hip and 50 knee arthroplasties in obese patients. Each was matched individually with a control and their outcome compared. Log rank tests for equality of survival showed no difference in the survival for hip and knee arthroplasty at 11 and ten years, respectively. The obese group had significantly lower postoperative hip and knee scores at latest follow-up, especially in the range of motion. Overall patient satisfaction scores were comparable. There were no significant differences in the radiographic analysis of both hip and knee implants. Revision was used as an end point for the survival analysis. Functional scores (Harris hip score and Hospital for Special Surgery knee score), satisfaction for surgery and radiographic features were used as outcome measures for comparison. The mid-term survival of total hip and knee arthroplasty is not adversely affected by obesity. Despite lower clinical scores, the obese patients were satisfied with the results of their surgery and have an equivalent mid-term survival rate. It would be unreasonable to deny patients arthroplasty surgery purely on the basis of a BMI indicating obesity.
Association between obesity and inpatient adverse events following primary hip or knee arthroplasty
Osteoarthritis and Cartilage, 2015
Purpose: Obesity is a significant risk factor in the development and progression of osteoarthritis in weight-bearing joints. Obese people (body mass index (BMI) of 30 or greater) make up the majority of hip and knee arthroplasty patients. Nevertheless, there is inconclusive evidence on the association between obesity and outcomes following elective hip or knee arthroplasty. We examined patient data in Alberta to quantify the association between obesity and inpatient adverse events. Methods: We reviewed 9,265 records of patients who had elective primary hip or knee arthroplasty by 68 orthopaedic surgeons during the period from September 2010 to April 2014 in Alberta, Canada. Patient characteristics such as age, gender, procedure type, BMI, co-morbidities and in-hospital adverse events were collected from electronic medical records, operating room information systems, the discharge abstract database, provincial clinical risk grouper data, and provincial surgical site infection surveillance data. We evaluated 12 in-hospital adverse events, which were classified as either Medical Adverse Events (myocardial infarction, pulmonary embolism (PE), deep vein thrombosis, cerebro-vascular accident, illeus, gastro-intestinal bleeding, pneumonia, and complex infection), or Mechanical Adverse Events (fracture, dislocation, fracture after insertion, and other mechanical complications). Deep incisional and organ/space infections were grouped with complex infection. We used logistic regression analyses to compare adverse events for obese (BMI 30) and non-obese patients, and risk-adjusted for age, gender, procedure type, and co-morbidities. The significance level was set at 0.05. Results: Of the 9,265 patients, 59.2% had total knee arthroplasty, 35.3% had total hip arthroplasty, 5.5% had hip resurfacing or partial knee arthroplasty, and 56.2% were obese (BMI 30). Mean age was 66.3 years, 57.7% were female, and mean baseline WOMAC score was 42.3. After controlling for age, gender, procedure type, and co-morbidities, the odds of Medical Adverse Events were 1.4 times higher for obese patients compared to non-obese patients (adjusted odds ratio [OR]¼1.4, 95% confidence interval [CI] [1.1-1.9], p¼0.016). The odds of complex infection were 2.7 times higher for obese patients compared to nonobese patients (adjusted OR¼2.7, 95% CI [1.4-5.2], p¼0.003). Among patients with no history of thromboembolic disease, the odds of PE were 1.7 times higher in the obese cohort (adjusted OR¼1.7, 95% CI [1.2-2.4], p¼0.007). There were no statistically significant differences between the cohorts in Mechanical Adverse Events (adjusted OR¼0.9, 95% CI [0.5-1.7], p¼0.742) during the hospital stay. Conclusions: Obese patients are at significantly elevated risk of inpatient Medical Adverse Events, especially PE and complex infection, but we were unable to detect increased risk of Mechanical Adverse Events. This finding, based on preliminary data in Alberta, suggests continued research is warranted to identify modifiable risk factors within the growing population of obese lower limb arthroplasty patients. The results will provide clinicians with evidence to support the development and implementation of risk-reduction protocols tailored to obese patients. These findings may also reinforce the importance of pre-surgical weight management for patients considering elective hip or knee arthroplasty.
The Journal of Arthroplasty, 2019
Background: The United States is in an obesity epidemic. Obesity has multiple common comorbid conditions, including lower extremity arthritis. We sought to examine the course of treatment for a population with body mass index (BMI) 40 kg/m 2 and osteoarthritis (OA) of the hip or knee. We investigated decision criteria that influenced arthroplasty surgeons to recommend nonoperative management vs total joint arthroplasty (TJA). For those patients who ultimately received TJA, we compared outcomes in this population to those with BMI <40 kg/m 2. Methods: This study retrospectively reviewed 158 new patients with BMI 40 kg/m 2 and moderate/severe OA of the hip or knee. Demographics, comorbidity profiles, and weight loss were compared between groups that underwent TJA and those that did not. The arthroplasty database was used to identify patients who underwent TJA during 2016-2018 (N ¼ 1473). Comorbidities, readmissions, surgical site infections, and overall complications were compared between those with BMI 40 kg/m 2 and BMI <40 kg/m 2. Results: About 51.3% of new patients with BMI 40 kg/m 2 and moderate/severe OA did not return for a second clinic visit. Of those who did return, 42.9% eventually underwent surgery. BMI was higher in single visit patients vs those with multiple visits (49.5 vs 46.3 kg/m 2 , P < .001), no difference in those scheduled on an "as-needed" basis vs a specific return date (P ¼ .18), and did not change significantly during the 2year follow-up (P ¼ .41). Patients who underwent TJA had a lower mean BMI at presentation than their nonoperative counterparts (44.5 vs 47.6 kg/m 2 , P < .01) and demonstrated significant weight loss prior to surgery (44.5 vs 42.6 kg/m 2 , P < .05). When comparing patients with BMI 40 kg/m 2 vs BMI <40 kg/m 2 , overall complications were not higher in the BMI 40 kg/m 2 group, although surgical site infections were higher in those undergoing total hip arthroplasty with BMI 40 kg/m 2 (0.3% vs 3.1%, P < .05). Conclusion: A majority of patients with BMI 40 kg/m 2 and moderate/advanced OA will be lost to orthopedic follow-up. A relatively lower BMI indicates a greater chance of retention in care, and ultimately surgery, but does not influence surgeons' recommendations to continue orthopedic management. Patients who persist in seeking treatment, lose significant weight, and exhaust nonoperative alternatives may be suitable for TJA despite a BMI 40 kg/m 2 , with an overall complication rate of 4.3%. However, only 9% of patients at 2-year follow-up achieved BMI <40 kg/m 2 and only 20% of surgeries were performed on patients who had achieved this proposed cutoff.
Should isolated morbid obesity influence the decision to operate in hip and knee arthroplasty?
Bone & joint open, 2021
Should isolated morbid obesity influence the decision to operate in hip and knee arthroplasty? Aims We studied the outcomes of hip and knee arthroplasties in a high-volume arthroplasty centre to determine if patients with morbid obesity (BMI ≥ 40 kg/m 2) had unacceptably worse outcomes as compared to those with BMI < 40 kg/m 2. Methods In a two-year period, 4,711 patients had either total hip arthroplasty (THA; n = 2,370), total knee arthroplasty (TKA; n = 2,109), or unicompartmental knee arthroplasty (UKA; n = 232). Of these patients, 392 (8.3%) had morbid obesity. We compared duration of operation, anaesthetic time, length of stay (LOS), LOS > three days, out of hours attendance, emergency department attendance, readmission to hospital, return to theatre, and venous thromboembolism up to 90 days. Readmission for wound infection was recorded to one year. Oxford scores were recorded preoperatively and at one year postoperatively. Results On average, the morbidly obese had longer operating times (63 vs 58 minutes), longer anaesthetic times (31 vs 28 minutes), increased LOS (3.7 vs 3.5 days), and significantly more readmissions for wound infection (1.0% vs 0.3%). There were no statistically significant differences in either suspected or confirmed venous thromboembolism. Improvement in Oxford scores were equivalent. Conclusion Although morbidly obese patients had less favourable outcomes, we do not feel that the magnitude of difference is clinically significant when applied to an individual, particularly when improvement in Oxford scores were unrelated to BMI.
Obesity affects a disproportionate proportion of total knee arthroplasty (TKA) patients. Our study explores pre-operative characteristics between obese and non-obese patients undergoing TKA surgery. A cohort of 4718 osteoarthritic patients, undergoing primary TKA, was studied. Patients were stratified according to BMI classes. Each class was compared in terms of age, race, gender, level of education, insurance status, preoperative WOMAC, SF-36, and Elixhauser comorbidities. There was a positive relationship between BMI and female gender, non-white race, Medicaid, private insurance, and self-pay. A negative relationship was observed between BMI and age, Medicare, WOMAC and SF-36. Obese TKA candidates differ from their nonobese counterparts in a number of demographic, socioeconomic, and clinical characteristics.
Overweight and obesity in hip and knee arthroplasty: Evaluation of 6078 cases
World journal of orthopedics, 2015
To evaluate a possible association between the various levels of obesity and peri-operative charac-teristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intra-and perioperative complications increased for such patients. We evaluated all patients with body mass index (BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score (HHS), Hospital for Special Surgery score (HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated. Six thousand and seventy-eight patients w...
Obesity and its effect on outcomes in same-day bilateral total knee arthroplasty
Annals of Translational Medicine
Background: The niche surgery of same-day bilateral total knee arthroplasty (sd-BTKA) continues to create debate amongst specialists in arthroplasty. To date, there is a significant lack of literature on obese patients undergoing sd-BTKA, and no study has evaluated outcomes of this procedure when compared to non-obese patients. Therefore, this study will perform a retrospective analysis to compare (I) incidence, (II) demographics, and (III) complications of sd-BTKA in non-obese, obese, and morbidly obese patients in the United States from 2009 to 2016. Methods: The National Inpatient Sample (NIS) database was queried for all individuals that underwent sd-BTKA from 2009 to 2016. This returned 184,844 non-obese patients, 39,901 obese patients, and 20,394 morbidly obese patients. Analyzed variables included mean age, mean length of stay (LOS), race, payer, age-adjusted Charlson Comorbidity Index score, discharge disposition, hospital charges, hospital costs, and complications. Chi-square analyses and analyses of variance were utilized to assess categorical and continuous variables, respectively. Results: Non-obese patients most commonly underwent sd-BTKA over the course of the study. As weight status increased, mean age decreased and the proportion of females, LOS, hospital charges and costs, and proportion of discharges to skilled nursing facilities increased. Regression analysis demonstrated obese and morbidly obese cohorts were at an overall increased odds for experiencing complications. Specifically, obese patients were at increased risk for pulmonary emboli, periprosthetic joint infections, and respiratory failures, while morbidly obese patients are at increased risk for pulmonary emboli, respiratory failures, and urinary tract infections. Conclusions: Surgeons should thoroughly evaluate the risks and benefits of performing sd-BTKA on obese and morbidly obese patients, as both confer higher overall complication rates and increased length of stay. More research is necessary to characterize the cost analysis of this procedure, as health care models continue to transition to more cost-effective procedures.
Obesity trends over 10 years in primary hip and knee arthroplasty—a study of 12,000 patients
Irish Journal of Medical Science (1971 -)
Objectives/Aims Obesity and its increasing prevalence are global public health concerns. Following joint replacement, there is evidence to support that obese patients are more likely to suffer complications. We examined 10-year trends in BMI of the primary total hip and total knee replacement cohorts in our institution to discern whether the BMI of these patients has changed over time. Methods We examined BMI data of patients who underwent primary hip and knee arthroplasty from our institutional database from January 1, 2010 to December 31, 2019 (n = 12,169). We analysed trends in BMI over this period with respect to (i) surgical procedure, (ii) gender, and (iii) age categories. Results The overall number of surgical procedures increased over the study period which meant more obese patients underwent surgery over time. Average BMI did not change significantly over time; however, there was a statistically significant increase in BMI in females aged < 45 in both arthroplasty groups...
The Journal of arthroplasty, 2014
This study utilized a national database to evaluate 90day postoperative complication rates after total knee arthroplasty (TKA) in super obese (BMI>50kg/m(2)) patients (n=7666) compared to non-obese patients (n=1,212,793), obese patients (n=291,914), morbidly obese patients (n=169,308) and revision TKA patients (n=28,812). Super obese patients had significantly higher rates of local and systemic complications compared to all other BMI groups as well as those undergoing revision TKA with higher rates of venous thromboembolism (VTE), infection, and medical complications. Super obesity is associated with dramatically increased rates of postoperative complications after TKA compared to non-obese, obese, and morbidly obese patients as well as those undergoing revision TKA.
The Impact of Morbid Obesity on Patient Outcomes After Total Knee Arthroplasty
The Journal of Arthroplasty, 2008
Five hundred fifty patients who underwent primary total knee arthroplasty between 1987 and 2004 with a primary diagnosis of osteoarthritis and 1-year outcome data (Western Ontario and McMaster Osteoarthritis Index [WOMAC]) were evaluated. Patients were stratified into body mass index categories based on the World Health Organization classification of obesity. Patients were dichotomized into a class III morbidly obese group and a non-morbidly obese group. Independent t test and multivariable linear regression were used to determine if a difference existed in the 1-year WOMAC outcome between morbidly obese patients and all other patients. Although 1-year outcomes were worse for morbidly obese patients (P b .05), they showed greater improvement in function compared with non-morbidly obese patients. Morbid obesity does not affect 1-year outcomes in patients who have had a total knee arthroplasty.