Effect of Weight Change on Patient-Reported Outcomes Following Total Joint Arthroplasty

Stock, Laura A; Brennan, Jane C; Turcotte, Justin; King, Paul J.

doi:10.1016/j.arth.2022.04.029

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…Stevens-Lapsley et al ( 35 ) found no relationship between functional recovery and a BMI <40 up to 6 months after TKA. In a retrospective study of 988 patients, Stock et al ( 36 ) confirmed that among patients with low preoperative BMI, the Patient-Reported Outcomes Measurement Information System-Physical Function scores of total hip arthroplasty and TKA patients were significantly improved. To the best of our knowledge, these studies either had a short follow-up period or employed few scoring systems, which may not adequately represent how well patients adapt to the sham knee.…”

Section: Discussionmentioning

confidence: 96%

Effect of body mass index on postoperative mechanical alignment and long-term outcomes after total knee arthroplasty: a retrospective cohort study of 671 knees

Lai¹,

Cao²,

Li³

et al. 2022

Ann Transl Med

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Background: A high body mass index (BMI) is associated with increased rates of complications after total knee arthroplasty (TKA). However, no study has examined the effect of BMI on lower limb alignment using the World Health Organization's (WHO) BMI classification. We believe that the WHO's BMI classification allows a uniform standard worldwide. We sought to investigate the potential association between a high BMI and the incidence of postoperative misalignment. We also evaluated whether a higher BMI is associated with worse clinical function. Methods:We retrospectively reviewed the data of 671 patients who underwent primary TKA for varus osteoarthritis between January 2010 and December 2015. The patients were divided into the following 5 groups based on their BMI: normal weight (<25.0 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), class I obese (30.0-34.9 kg/m 2 ), class II obese (35-39.9 kg/m 2 ), and class III obese (>40 kg/m 2 ). Both weight and height were measured by nurses on admission. Patients' preoperative HKA, gender, age, and side of surgery were collected as baseline. All the patients underwent standing, weight-bearing, full-length radiography before and after surgery to measure the mechanical hip-knee-ankle angle (HKA). We followed up patients by telephone.Among the BMI subgroups, we compared the knee function scores, including the Western Ontario andMcMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society-Knee Score (KS-KS), Knee Society-Function Score (KS-FS), Forgotten Joint Score (FJS), and range of motion (ROM). A multivariate linear regression analysis and a logistic regression was conducted to examine the outcomes. Results:The study had a mean follow-up period of 8.16 years. The multivariate and logistic regression analyses revealed that preoperative alignment (P=0.002) and a higher BMI (P=0.015) were associated with a higher risk of postoperative misalignment. The WOMAC scores were higher in the normal and overweight groups than the other groups (P=0.022). The FJS and KS-KS gradually decreased as BMI increased.Conclusions: A higher BMI is associated with a greater risk of misalignment and worse long-term clinical outcome after TKA. When treating patients with high BMI, we should pay more attention to the adjustment of lower limb alignment intraoperatively.

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Section: Discussionmentioning

confidence: 96%

Effect of body mass index on postoperative mechanical alignment and long-term outcomes after total knee arthroplasty: a retrospective cohort study of 671 knees

Lai¹,

Cao²,

Li³

et al. 2022

Ann Transl Med

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“…Patients were considered to gain or lose weight if they surpassed a ≥5% change in BMI as conventionally reported in the literature [17,20]. If weight change was <5%, they were considered to have had stable weight.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Patients were considered to gain or lose weight if they surpassed a !5% change in BMI as conventionally reported in the literature. 17,20 If weight change was <5%, they were considered to have had stable weight. BMI was captured preoperatively (12 AE 3 months before surgery), at the time of surgery (1 month up to 0 days prior), and postoperatively (12 AE 3 months after surgery).…”

Section: Index [Adi]mentioning

confidence: 99%

“…However, few studies have assessed both preoperative and postoperative weight change [14] and their impact on patient reported outcome measures (PROMs) 1-year after surgery. In the limited available literature, there is conflicting evidence on the impact of postoperative weight change on PROMs [15][16][17]. Confounding variables may play a large role in the reason why there are many inconsistencies between studies [18].…”

Section: Introductionmentioning

confidence: 99%

“…In the limited available literature, there is conflicting evidence on the impact of postoperative weight change on PROMs. [15][16][17] Confounding variables may play a major role in the reason why there are many inconsistencies between studies. 18 With regard to postoperative risks, one study analyzing TKA patients found that losing at least 20 pounds before surgery was associated with a shorter length of stay (LOS) and a lower risk of discharge to a facility.…”

mentioning

confidence: 99%

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Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty

Tidd,

Huffman,

Oyem

et al. 2023

J Knee Surg

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Introduction: As obesity becomes more prevalent, more patients are at risk of lower extremity osteoarthritis and subsequent total knee arthroplasty (TKA). This study aimed to test 1) the association of preoperative weight change with healthcare utilization; and 2) the association of pre- and postoperative weight changes with failure to achieve satisfaction and minimal clinically important difference (MCID) in Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and function (KOOS-PS) 1-year after TKA. Methods: Prospectively collected monocentric data on patients who underwent primary TKA was retrospectively reviewed. Multivariable logistic regression assessed the influence of BMI and weight change on outcomes while controlling for confounding variables. Outcomes included prolonged length of stay (LOS >3 days), non-home discharge, 90-day readmission rate, satisfaction, and achievement of MCID for KOOS-Pain and KOOS-PS. Results: Preoperative weight change had no impact on prolonged LOS (gain, p=0.173; loss, p=0.599). Preoperative weight loss was associated with increased risk of non-home discharge (OR 1.47, p=0.003). There was also increased risk of 90-day readmission with preoperative weight gain (OR 1.27, p=0.047) and decreased risk with weight loss (OR 0.73, p=0.033). There was increased risk of non-home discharge with obesity class II (OR 1.6, p=0.016) and III (OR 2.21, p<0.001). Weight change was not associated with failure to achieve satisfaction, MCID in KOOS-Pain, or MCID in KOOS-PS. Obesity class III patients had decreased risk of failure to reach MCID in KOOS-Pain (OR 0.43, p=0.005) and KOOS-PS (OR 0.7, p=0.007). Conclusion: Pre- and postoperative weight change has little impact on the achievement of satisfaction and clinically relevant differences in pain and function at 1-year. However, preoperative weight gain was associated with a higher risk of 90-day readmissions after TKA. Furthermore, patients categorized in Class III obesity were at increased risk of non-home discharge but experienced a greater likelihood of achieving MCID in KOOS-Pain and KOOS-PS. Our results raise awareness of the dangers of using weight changes and BMI alone as a measure of TKA eligibility.

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Predictors for activity following total and unicompartmental knee arthroplasty

Streck

Hanreich

Cororaton

et al. 2023

Arch Orthop Trauma Surg

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Effect of Weight Change on Patient-Reported Outcomes Following Total Joint Arthroplasty

Cited by 7 publications

References 20 publications

Effect of body mass index on postoperative mechanical alignment and long-term outcomes after total knee arthroplasty: a retrospective cohort study of 671 knees

Effect of body mass index on postoperative mechanical alignment and long-term outcomes after total knee arthroplasty: a retrospective cohort study of 671 knees

Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty

Predictors for activity following total and unicompartmental knee arthroplasty

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