Effect of Body Mass Index on Reoperation and Complications After Total Knee Arthroplasty

Wagner, Eric R.; Kamath, Atul F.; Fruth, Kristin M.; Harmsen, William S.; Berry, Daniel J.

doi:10.2106/jbjs.16.00093

Cited by 140 publications

(87 citation statements)

References 36 publications

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“…Geriatric patients aged over 85 are signi cantly less likely to receive TKA than their younger counterparts; it may be that among patients who do undergo arthroplasty, increased age re ects the selection process of appropriate surgical candidates rather than being a protective factor, as only patients with limited comorbidities who are likely to experience long term bene ts would be considered for total arthroplasty procedures 6 . Increased BMI in THA was the single patient factor that was consistently positively associated with major complications, including infection, reoperation and readmission which is in accordance with previous studies which showed BMI to have strong associations with dislocation, infection and revision 52,53 . A study using the New Zealand Joint Registry also reported an OR of 3.73 for PJI in patients with BMI >40 compared to patients with BMI <35 54 .…”

Section: Patient Characteristics Associated With Complicationssupporting

confidence: 90%

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

Heo

Harris

Naylor

et al. 2020

Preprint

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Background: Total hip and total knee arthroplasty (THA/TKA) are increasing in incidence annually. While these procedures are effective in improving pain and function, there is a risk of complications. Methods: Using data from an arthroplasty registry, we described complication rates including reasons for reoperation and readmission from the acute period to six months following THA and TKA in an Australian context. Data collection at 6 months was conducted via telephone interview, and included patient-reported complications such as joint stiffness, swelling and paraesthesia. We used logistic regression to identify risk factors for complications. Results: In the 8,444 procedures included for analysis, major complications were reported by 9.5% and 14.4% of THA and TKA patients, respectively, whilst minor complications were reported by 34.0% and 46.6% of THA and TKA patients, respectively. Overall complications rates were 39.7% and 53.6% for THA and TKA patients, respectively. In THA patients, factors associated with increased risk for complications included increased BMI, previous THA and bilateral surgery, whereas in TKA patient factors were heart disease, neurological disease, and pre-operative back pain and arthritis in a separate joint. Female gender and previous TKA were identified as protective factors for minor complications in TKA patients.Conclusion: We found moderate rates of major and high rates of minor postoperative complications following THA and TKA in Australia and have identified several patient factors associated with these complications. Efforts should be focused on identifying patients with higher risk and optimising pre- and post-operative care to reduce the rates of these complications.

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Section: Patient Characteristics Associated With Complicationssupporting

confidence: 90%

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

Heo

Harris

Naylor

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…However, most of the studies report overall risk for revision without detailing reasons for revision. The effect of obesity on revision besides an increased risk for periprosthetic joint infection (PJI) has not been thoroughly discussed in the literature (D'Apuzzo et al 2015, Wagner et al 2016, Jung et al 2017, Roche et al 2018, Boyce et al 2019. There might be a complex relation between weight and height, and TKA outcome.…”

mentioning

confidence: 99%

Weight and height separated provide better understanding than BMI on the risk of revision after total knee arthroplasty: report of 107,228 primary total knee arthroplasties from the Swedish Knee Arthroplasty Register 2009–2017

et al. 2019

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“…Future studies may consider comparing readmissions with standardized chemoprophylaxis, greater coordination of pre-and postsurgical care, and strict adherence to patient selection such as better glycemic control or BMI limits. 42,43 Readmissions following elective TKA are difficult to predict and prevent, and may not be a valid means for determining quality of care. Finally, it is possible that these readmission rates reflect the lower limit of what is acceptable in the current arthroplasty landscape.…”

Section: Discussionmentioning

confidence: 99%

Are Readmissions After Total Knee Arthroplasty Preventable?

Copp

Weinberg

et al. 2019

J Knee Surg

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Readmission within 90 days following total joint arthroplasty has become a central quality measure of reimbursement initiatives; however, the validity of readmission rates as a measure of hospital care quality and the proportion of readmissions that are preventable are unknown. The purpose of this study is to determine if readmissions within 30 and 90 days after total knee arthroplasty (TKA) were related to orthopaedic or medical etiology and identify if these readmissions were preventable. We retrospectively reviewed 1,625 elective TKAs performed between 2011 and 2014 at our institution. Readmissions within 30 and 90 days were categorized into orthopaedic and medical etiologies and an expert research panel determined if readmissions were potentially preventable based on objective criteria from national or peer-reviewed consensus guidelines. Out of the 1,625 TKAs performed during the study period, there were a total of 79 (4.8%) readmissions within 90 days of surgery, of which 17 (22%) were of orthopaedic etiology and 62 (78%) were of medical etiology. Fifty-two (66%) of the 79 readmissions occurred within 30 days, with 11 (21%) of orthopaedic and 41 (80%) of medical etiology. Only 2 of 79 (3%) readmissions within 90 days were deemed potentially preventable, and neither of them were orthopaedic in nature. Hospital readmissions after total joint arthroplasty are inevitable; however, only a small percentage (3%) of readmissions to our health care system was potentially preventable. Orthopaedic readmissions constituted a minority of the proportion of readmissions at 30 or 90 days, and none were deemed preventable.

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Effect of Body Mass Index on Reoperation and Complications After Total Knee Arthroplasty

Abstract: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 140 publications

References 36 publications

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

Weight and height separated provide better understanding than BMI on the risk of revision after total knee arthroplasty: report of 107,228 primary total knee arthroplasties from the Swedish Knee Arthroplasty Register 2009–2017

Are Readmissions After Total Knee Arthroplasty Preventable?

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