Do patients lose weight after total knee replacement?

Schwartsmann, Carlos Roberto; Borges, Alexandre Moreira; Freitas, Geraldo Luiz Schuck de; Migon, Eduardo Zaniol; Oliveira, Gustavo Kaempf de; Rodrigues, Marcos Wainberg

doi:10.1016/j.rboe.2017.01.003

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…18,24,25 Previous studies have shown that patients undergoing TKA do not experience a significant change in BMI. 26 -29 Our study also found no significant change in BMI before and after TKA. This finding, in addition with previous studies, suggests that the improvements in knee function and pain that can result from TKA may not translate to any significant weight loss in patients.…”

Section: Discussionsupporting

confidence: 46%

The Effect of Total Knee Arthroplasty on Physical Activity and Body Mass Index: An Analysis of the Osteoarthritis Initiative Cohort

Rezzadeh

Behery

Kester

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction:Preliminary analysis of accelerometry measurements has shown physical activity may not increase significantly after total knee arthroplasty (TKA). This study evaluates the effect of TKA on physical activity accelerometry measurements and body mass index (BMI).Methods:Using the multicenter Osteoarthritis Initiative (OAI) database, a cohort of patients with physical activity level accelerometry measurements and BMI before and after TKA was identified. Physical activity levels and BMI were acquired at pre-TKA and post-TKA accelerometry visits 2 years apart. Survey scores pertaining to knee functionality and quality of life were also analyzed before and after knee surgery. Each patient included in the study had a unilateral TKA completed between these 2 accelerometry visits. Accelerometry measurements, BMI of the patients, and survey scores relating to knee functionality and pain relief from before and after TKA were compared using paired samples t tests.Results:Twenty-three patients from the OAI database were identified for the paired analysis. They were evaluated at a mean postoperative follow-up of 15 months. There were no statistically significant differences between the post-TKA group and pre-TKA group for the accelerometry variables and BMI, though patients experienced a significant improvement in knee function and pain relief measures included in this analysis.Discussion:Although TKA can successfully restore function and relieve pain, there remains no good evidence that neither physical activity nor BMI improve postoperatively.Conclusion:No significant differences in physical activity and BMI were observed after TKA in this study.

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Section: Discussionsupporting

confidence: 46%

The Effect of Total Knee Arthroplasty on Physical Activity and Body Mass Index: An Analysis of the Osteoarthritis Initiative Cohort

Rezzadeh

Behery

Kester

et al. 2019

Geriatr Orthop Surg Rehabil

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“…The Framingham Study established a causal relationship between weight and knee OA,10 and that relationship poses a specific challenge for treatment. Total joint replacement, especially of the knee, is not expected to be as successful or complication free in patients who are more obese,34 and total joint recipients often do not lose weight or become more active after replacement, either 35–37. Our results add to the evidence, therefore, that both these epidemics—obesity and OA—are expected to continue and create challenges into the future.…”

Section: Discussionmentioning

confidence: 69%

Medication use and comorbidities in an increasingly younger osteoarthritis population: an 18-year retrospective open-cohort study

Graham¹,

Novosat

Sun

et al. 2023

BMJ Open

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ObjectivesAs understanding of the pathogenesis and treatment strategies for osteoarthritis (OA) evolves, it is important to understand how patient factors are also changing. Our goal was to examine demographics and known risk factors of patients with OA over time.DesignOpen-cohort retrospective study using electronic health records.SettingLarge US integrated health system with 7 hospitals, 2.6 million outpatient clinic visits and 97 300 hospital admissions annually in a mostly rural geographic region.ParticipantsAdult patients with at least two encounters and a diagnosis of OA or OA-relevant surgery between 2001 and 2018. Because of geographic region, over 96% of participants were white/Caucasian.InterventionsNone.Primary and secondary outcome measuresDescriptive statistics were used to examine age, sex, body mass index (BMI), Charlson Comorbidity Index, major comorbidities and OA-relevant prescribing over time.ResultsWe identified 290 897 patients with OA. Prevalence of OA increased significantly from 6.7% to 33.5% and incidence increased 37% (from 3772 to 5142 new cases per 100 000 patients per year) (p<0.0001). Percentage of females declined from 65.3% to 60.8%, and percentage of patients with OA in the youngest age bracket (18–45 years) increased significantly (6.2% to 22.7%, p<0.0001). The percentage of patients with OA with BMI ≥30 remained above 50% over the time period. Patients had low comorbidity overall, but anxiety, depression and gastro-oesophageal reflux disease showed the largest increases in prevalence. Opioid use (tramadol and non-tramadol) showed peaks followed by declines, while most other medications increased slightly in use or remained steady.ConclusionsWe observe increasing OA prevalence and a greater proportion of younger patients over time. With better understanding of how characteristics of patients with OA are changing over time, we can develop better approaches for managing disease burden in the future.

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“…This is potentially important in the light that patients who underwent TKA and lost weight thereafter were reported to have better clinical outcome scores than patients who gained weight in the postoperative period [48]. However, recent literature indicates the patient's bodyweight to be maintained after TKA [49][50][51], suggesting a minor possible impact of weight change on our results. The percentage of patients in obesity class II and III was relatively low, compared to reports in other countries with two-thirds of our patient cohort clustered in the overweight / pre-obese and class I obese categories.…”

Section: Discussionmentioning

confidence: 80%

Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

Giesinger

Hamilton

et al. 2021

BMC Musculoskelet Disord

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Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

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Do patients lose weight after total knee replacement?

Cited by 6 publications

References 27 publications

The Effect of Total Knee Arthroplasty on Physical Activity and Body Mass Index: An Analysis of the Osteoarthritis Initiative Cohort

The Effect of Total Knee Arthroplasty on Physical Activity and Body Mass Index: An Analysis of the Osteoarthritis Initiative Cohort

Medication use and comorbidities in an increasingly younger osteoarthritis population: an 18-year retrospective open-cohort study

Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

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