Obesity Does Not Affect Outcomes in Hybrid Versus Cemented Total Knee Arthroplasty in Asians (original) (raw)
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The impact of obesity on the mid-term outcome of cementless total knee replacement
The Journal of Bone and Joint Surgery. British volume, 2009
We evaluated 535 consecutive primary cementless total knee replacements (TKR). The mean follow-up was 9.2 years (0.3 to 12.9) and information on implant survival was available for all patients. Patients were divided into two groups: 153 obese patients (BMI ≥ 30) and 382 non-obese (BMI < 30). A case-matched study was performed on the clinical and radiological outcome, comparing 50 knees in each group. We found significantly lower mean improvements in the clinical score (p = 0.044) and lower post-operative total clinical scores in the obese group (p = 0.041). There was no difference in the rate of radiological osteolysis or lucent lines, and no difference in alignment. Log rank test for survival showed no significant differences between the groups (p = 0.167), with a ten-year survival rate of 96.4% (95% confidence interval (CI) 92 to 99) in the obese and 98% (95% CI 96 to 99) in the non-obese. The mid-term survival of TKR in the obese and the non-obese are comparable, but obesity a...
Does Obesity Influence on the Functional Outcomes of a Total Knee Arthroplasty?
Obesity Surgery, 2016
Background The objective of this study was to compare the total knee arthroplasty (TKA) functional outcomes and quality of life of obese and non-obese patients. Methods Prospective comparative study, including all patients underwent TKA in a single centre. Patients were divided into three groups: Group 1 (Gr.1) BMI <30 kg/m 2 , Group 2 (Gr.2) BMI ≥ 30 kg/m 2 and <35 kg/m 2 and Group 3 (Gr.3) BMI ≥35 kg/m 2. The Knee Society score (KSS) and SF-36 scores were obtained preoperatively and at 5 years of follow-up. Results A total of 689 patients were included (72.2 ± 7 years, 76.3 % women). Overall, pre-and post-operative values of SF-36 were lower for the obese group. However the improvement obtained in the three groups was similar in all the subscales of the SF-36 score. KSS values were higher in the nonobese group in both periods. However the improvement obtained in this score in the three groups was similar (Gr.1; 70.21 ± 34.31, Gr.2; 66.53 ± 34.93, Gr.3; 60.94 ± 38.47, n.s.). Conclusions Although non-obese patients obtained better functional and reported quality of life scores than obese patients, there were no differences in the gain of quality of life and knee functionality between both groups at 5-years of follow-up. This is one of the largest series in a single centre published in literature and confirms the results obtained by other authors. Taking into account the different outcomes obtained, surgery should not be denied to patients that are obese, given that they obtained similar benefit than non-obese patients.
Background: Obesity is a significant risk factor for developing knee osteoarthritis, and these cases suffer from complications following Total Knee Arthroplasty (TKA). An association between obesity and outcome after TKA is ambiguous. Knowledge is scarce about a definite relation between the two. This study aims to establish a correlation between obesity and early outcomes of TKA. Methods: This prospective cross-sectional study was done in cases undergoing primary knee arthroplasty between September 2019 to August 2020. Obesity was classified in all cases, and multiple variables like pain, functional status, Range of Motion, knee deformity, and Patient Response Outcome Measures were recorded. Statistical analysis was performed using SPSS Statistical Software version 22.0 and R.3.2.0. The level of statistical significance was taken as p < 0.05. Results: We studied 100 knees (37 bilateral and 26 unilateral) in 63 cases. Pain score decreased maximally in the normal and overweight group and minimal in class III obesity (p < 0.001). KSS, FKSS, and PROMs gradually improved in all, except in morbidly obese (p < 0.001). Although the improvement in all variables was minimum in class III obesity compared to other classes of obesity, the margin of difference from the preoperative period was maximum in class III obese participants. Conclusion: All cases, irrespective of class of obesity, experienced a comparable improvement in their knee function and improved quality of life. In addition, the TKA offered substantial benefits in terms of pain relief, knee stability, walking distance, range of movement of the knee, and stair climbing.
Journal of Arthroplasty, 2021
Background: Operative eligibility thresholds based on body mass index (BMI) alone may risk restricting access to improved pain control, function, and quality of life. This study evaluated the use of BMI-cutoffs to offering TKA in avoiding: 1) 90-day readmission, 2) one-year mortality, and 3) failure to achieve clinically important one-year PROMS improvement (MCID). Methods: A total of 4126 primary elective unilateral TKA patients from 2015 to 2018 were prospectively collected. For specific BMI(kg/m 2) cutoffs: 30, 35, 40, 45, and 50, the positive predictive value (PPV) for 90-day readmission, one-year mortality, and failure to achieve one-year MCID were calculated. The number of patients denied complication-free postoperative courses per averted adverse outcome/failed improvement was estimated. Results: Rates of 90-day readmission and one-year mortality were similar across BMI categories (P > .05, each). PPVs for preventing 90-day readmission and one-year mortality were low across all models of BMI cutoffs. The highest PPV for 90-day readmission and one-year mortality was detected at cutoffs of 45 (6.4%) and 40 (0.87%), respectively. BMI cutoff of 40 would deny 18 patients 90-day readmission-free, and 194 patients one-year mortality-free postoperative courses for each averted 90-day readmission/oneyear mortality. Such cutoff would also deny 11 patients an MCID per avoided failure. Implementing BMI thresholds alone did not influence the rate of improvements in KOOS-PS, KRQOL, or VR-12. Conclusion: Utilizing BMI cutoffs as the sole determinants of TKA ineligibility may deny patients complication-free postoperative courses and clinically important improvements. Shared decisionmaking supported by predictive tools may aid in balancing the potential benefit TKA offers to obese patients with the potentially increased complication risk and cost of care provision.
The Effect of Obesity on Functional Outcome After Total Knee Arthroplasty
2016
Objective: To evaluate the effect of obesity on functional outcome of TKA in terms of range of motion and knee society score. Methods: This is a prospective observational study. We included 350 consecutive patients in whom simultaneous bilateral total knee arthroplasty was done due to knee osteoarthritis from April 2014 to June 2015 by a single surgeon in a single centre. Patients demographic data, weight, height, body mass index, preoperative range of motion and knee society score was taken from Pakistan National Joint Registry. Patients were divided into four groups according to BMI: (1) normal (2) overweight (3) obese and (4) severely obese. At 6 months, detailed assessment of the patients, which included range of motion and calculation of knee society score, was done. We evaluated the effect of obesity on functional outcome after TKR by comparing means and proportions of the outcome variables across these four groups. Results: At the follow-up after 6 months, we found similar i...
Archives of Orthopaedic and Trauma Surgery
Introduction The increasing prevalence of obesity has led to an increase in total knee arthroplasties (TKAs) being undertaken in patients with a higher body mass index (BMI). TKA in morbidly obese patients can be technically challenging due to numerous anatomical factors and patient co-morbidities. The long-term outcomes in this patient group are unclear. This systematic review aims to compare the long-term revision rates, functional outcomes and complication rates of TKAs in morbidly obese versus non-obese patients. Methods A search of PubMed, EMBASE and PubMed Central was conducted to identify studies that reported revision rates in a cohort of morbidly obese patients (BMI ≥ 40 kg/m 2 ) that underwent primary TKA, compared to non-obese patients (BMI ≤ 30 kg/m 2 ). Secondary outcomes included Knee Society Objective Scores (KSOS), Knee Society Functional Scores (KSFS), and complication rates between the two groups. The difference in revision rates was assessed using the Chi-squared test. The Wilcoxon signed-rank test was used to compare pre-operative and post-operative functional scores for each group. KSOS and KSFS for morbidly obese and non-obese patients were compared using the Mann-Whitney test. Statistical significance was defined as p ≤ 0.05. Results Nine studies were included in this review. There were 624 TKAs in morbidly obese patients and 9,449 TKAs in nonobese patients, average BMI values were 45.0 kg/m 2 (range 40-66 kg/m 2 ) and 26.5 kg/m 2 (range 11-30 kg/m 2 ) respectively. The average follow-up time was 4.8 years (range 0.5-14.1) and 5.2 years (range 0.5-13.2) respectively, with a revision rate of 7% and 2% (p < 0.001) respectively. All functional scores improved after TKA (p < 0.001). Pre-and post-operative KSOS and KSFS were poorer in morbidly obese patients, however, mean improvement in KSOS was the same in both groups and comparable between groups for KSFS (p = 0.78). Overall complication rates, including infection, were higher in morbidly obese patients. Conclusions This review suggests an increased mid to long-term revision rate following primary TKA in morbidly obese patients, however, these patients have a functional recovery which is comparable to non-obese individuals. There is also an increased risk of perioperative complications, such as superficial wound infection. Morbidly obese patients should be fully informed of these issues prior to undergoing primary TKA.
Cementless total knee arthroplasty in obese patients. A comparison with a matched control group
The Journal of arthroplasty, 1996
The heaviest 45 patients (50 knees) who underwent cementless total knee arthroplasty were compared with a matched control group of 45 total knee arthroplasty patients (50 knees) with respect to clinical and radiographic data. Surgery was performed over a 10-year period (1980-1989) and follow-up evaluation averaged 7 years (range, 2-11 years). The control group consisted of nonobese patients matched to the obese group with respect to age, sex, diagnosis, preoperative deformity, and length of follow-up evaluation. Clinical evaluation was made using the Knee Society rating scale as well as an analysis of multiple other clinical parameters. Radiographically, each patient was evaluated with long-standing anteroposterior views, lateral and patellar views, and spot fluoroscopic views of the involved knee. This evaluation included an analysis of lucencies, bead shedding, and prosthetic alignment. The final average clinical score in the obese group was 88 points with four revisions, and that...
ANZ Journal of Surgery, 2021
BackgroundObesity is a major public health issue and has considerable implications on outcomes of total knee arthroplasty (TKA). However, there has been conflicting evidence and conclusions on the effects of obesity on TKA. This meta‐analysis compares the outcomes, complications, and peri‐operative parameters of TKA in the obese (body mass index [BMI] ≥ 30 kg/m2) versus non‐obese (BMI < 30 kg/m2) population as well as subgroup analysis of morbidly obese (BMI ≥ 40 kg/m2) versus non‐obese population.MethodsA meta‐analysis was conducted with a multi‐database search according to PRISMA guidelines on 12 September 2019. Data from all published literature meeting inclusion criteria were extracted and analysed.ResultsNinety‐one studies were included, consisting of 917 447 obese and 2 188 834 non‐obese TKA. Obese patients had higher risk of all‐cause revisions (odds ratio [OR] = 1.15, 95% CI: 1.08–1.24, p < 0.0001), all complications (OR = 1.21, 95% CI: 1.06–1.38, p = 0.004), deep infe...
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.