Can obesity and physical activity predict outcomes of elective knee or hip surgery due to osteoarthritis? A meta-analysis of cohort studies

Abstract

ObjectiveThe aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis.DesignSystematic review and meta-analysis.Data source and eligibility criteriaA systematic search was performed on the Medline, CINAHL, EMBASE and Web of Science electronic databases. Longitudinal cohort studies were included in the review. To be included, studies needed to have assessed the association between obesity or physical activity participation measured at baseline and clinical outcomes (ie, pain, disability and adverse events) following hip or knee arthroplasty.Data extractionTwo independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications.Results62 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that compared to obese participants, non-obese participants report less pain at both short term (standardised mean difference (SMD) −0.43; 95% CI −0.67 to −0.19; P<0.001) and long term post-surgery (SMD −0.36; 95% CI −0.47 to −0.24; P<0.001), as well as less disability at long term post-surgery (SMD −0.32; 95% CI −0.36 to −0.28; P<0.001). They also report fewer postsurgical complications at short term (OR 0.48; 95% CI 0.25 to 0.91; P<0.001) and long term (OR 0.55; 95% CI 0.41 to 0.74; P<0.001) along with less postsurgical infections after hip arthroplasty (OR 0.33; 95% CI 0.18 to 0.59; P<0.001), and knee arthroplasty (OR 0.42; 95% CI 0.23 to 0.78; P=0.006).ConclusionsPresurgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed.PROSPERO registration numberCRD42016032711.

Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading

“…showed that obese patients undergoing TKR experienced less improvement in physical function compared to non-obese patients [ 129 ]. Patients with obesity are also at higher risk of developing post-surgical complications, including deep vein thrombosis, dislocation and infection, which may compromise implant survival and outcome [ 130 ].…”

Effect of morbid obesity on patient-reported outcomes in total joint arthroplasty: a minimum of 1-year follow-up

“…The impact of obesity in lower extremity TJA, particularly total knee arthroplasty (TKA), has been widely established. This includes higher rates of post-operative complications, such as infection [10], [11], [12], all-cause revision surgery [12], and mortality [2]. Obesity is also associated with increased operative time, hospital length of stay, and readmission rates [13], [14].…”

“…Obesity is also associated with increased operative time, hospital length of stay, and readmission rates [13], [14]. However, when it comes to patient-reported outcome (PRO) measures, the impact of obesity becomes less clear due to conflicting reports [3], [4], [11], [15], [16] likely reflecting geographic variations, outcome measures used, research methodology, and severity of obesity (all obese patients vs morbidly obese). In addition, most previous studies have focused on TKA, leaving limited information on the effect of obesity on PROs following total hip arthroplasty (THA).…”

Health systems should be publicly funded and publicly provided

“…In the UK, some ISTCs achieved better outcomes than NHS facilities for elective surgery, but the differences were marginal even though they had healthier, more affluent patients 34. Moreover, outcomes were not adjusted for key influences such as BMI 35. ISTCs also provide poorer training environments,36 reduce communication across institutional boundaries,37 and, in an example where surgery was transferred from a NHS hospital to a nearby ISTC, reduce overall activity 38…”