Elevated Body Mass Index Is Associated With Early Total Knee Revision for Infection

Electricwala, Ali J.; Jethanandani, Rishabh; Narkbunnam, Rapeepat; Huddleston, James I.; Maloney, William J.; Goodman, Stuart B.; Amanatullah, Derek F.

doi:10.1016/j.arth.2016.05.071

Cited by 37 publications

(30 citation statements)

References 27 publications

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“…However, weight loss was not associated with better outcome scores despite seeing better outcome scores in total hip arthroplasty patients with weight loss. Additionally, many studies have demonstrated that weight gain after TKA was associated with higher incidence of complications and shorter time to revision [30, 35, 36]. Given the evidence presented above, orthopedic surgeons should counsel patients to avoid weight gain after TKA to reduce the adverse influences of weight gain on the clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Weight changes after total knee arthroplasty in Chinese patients: a matched cohort study regarding predictors and outcomes

et al. 2019

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Background The purpose of this study was to compare 2-year BMI changes between patients undergoing simultaneous bilateral total knee arthroplasty (TKA), staged bilateral TKA, and unilateral TKA. We also sought to determine the predictors of weight change and whether clinically meaningful weight changes affected outcomes. Patients and methods This retrospective, single-institution study included 202 Chinese patients who received simultaneously bilateral TKA, staged bilateral TKA, or unilateral TKA from 2008 to 2015. There were 49 simultaneous bilateral TKAs, 52 staged bilateral TKAs, and a matched 101 unilateral TKAs. Results 66.8% (135/202) of patients lost weight after TKA surgery. However, 20.7% (42/202) of patients experienced clinically meaningful weight loss (a BMI decrease of more than 5%). Paired t test showed that 2-year BMI was significantly lower than preoperative BMI ( p < 0.001). Weight loss was significantly different between the surgical strategy ( p < 0.001). Preoperative BMI and age were predictive of clinically significant weight loss or gain ( p < 0.05). Multiple linear regression showed that post-operative weight loss was associated with better Western Ontario and McMaster Universities Osteoarthritis Index and SF-36 scores ( p < 0.001). Conclusion Patients after TKA experience weight loss. Age and preoperative BMI predict clinically meaningful weight change. Simultaneous bilateral TKA is associated with higher likelihood of weight loss. Clinically meaningful weight loss experiences better patient-reported outcomes.

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Section: Discussionmentioning

confidence: 99%

Weight changes after total knee arthroplasty in Chinese patients: a matched cohort study regarding predictors and outcomes

et al. 2019

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“…Electricwala et al. (2017) found aseptic loosening to be the 3rd highest reason for revision after infection and instability. They also found that not only obese patients but also overweight patients had a higher risk of revision.…”

Section: Discussionmentioning

confidence: 99%

“…2015, Electricwala et al. 2017), as well as increased load on the prosthesis–bone junction, leading to increased risk of bone or ligament insufficiency and migration (Astephen Wilson et al. 2010).…”

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confidence: 99%

Weight affects survival of primary total knee arthroplasty: study based on the Danish Knee Arthroplasty Register with 67,810 patients and a median follow-up time of 5 years

Gøttsche

Gromov

Viborg³

et al. 2018

Acta Orthopaedica

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Background and purpose — Obesity is a rising issue worldwide and growing evidence supports poor outcome amongst obese patients following total knee arthroplasty (TKA). Using nationwide registries we investigated the association between bodyweight and risk of revision of primary TKA.Patients and methods — All primary TKA performed during 1997–2015, weight at time of primary TKA and subsequent TKA revisions were identified in the Danish Knee Arthroplasty Register (DKR). Data on comorbidities and a priori selected confounding variables were collected from nationwide registries. The association between weight and 1st time TKA revision was calculated as both crude and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) using Cox regression.Results — Of 67,810 identified primary TKAs, 4.8% were revised within a median follow-up time of 5.4 years. No association between weight and risk of any revision in patients aged 18–54 and 55–70 years was found. Increased risk of any revision was seen in patients >70 years, 80–89 kg (aHR =1.5, CI 1.2–1.8), 90–99 kg (aHR =1.7, CI 1.3–2.1) and patients >99 kg (aHR =1.6, CI 1.3–2.1), as well as those weighing 45–60 kg (aHR =1.4, CI 1.1–1.9) compared with same aged patients weighing 70–79 kg.Interpretation — We found a complex association between weight and knee arthroplasty survival. There was an increased risk of any revision in patients older than 70 years of age weighing <60 kg and >80 kg. Patients aged 18–55 years weighing 60–69 kg had a lower risk of revision compared with all other weight groups, whereas weight was not found to affect risk of any revision in patients aged 55–70 years.

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“…18 Morbid obesity is a risk factor for adverse outcomes of TKA, including implant revision and infection. 19,20 The best approaches for decreasing TKA-PJI risk in this patient cohort have not been well defined. Inabathula et al have reported successful reduction in 90-day postoperative infection rates among high risk patients who received an extended course of oral antibiotic treatment following either THA or TKA.…”

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confidence: 99%

Dual Antibiotic Prophylaxis in Primary Total Knee Arthroplasty—No Benefit for Extremely Obese Patients

Lane

Keeney

2021

J Knee Surg

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We performed this study to assess the effectiveness of multimodal total knee arthroplasty prosthetic joint infection (TKA-PJI) prophylaxis including “on-time” dual-antibiotic prophylaxis, and the influence of body mass index (BMI) on prophylaxis effectiveness. After obtaining Institutional Review Board approval, we assessed 1,802 primary TKAs (1,496 patients) who received cefazolin alone or cefazolin combined with vancomycin for TKA-PJI prophylaxis. A detailed chart review was performed to determine patient demographic features (age, gender, BMI, American Society of Anesthesiologists Score), antibiotic selection, vancomycin administration timing, and 1-year PJI rates. Statistical assessment was accomplished using a two-sided Student's t-test or Fisher's exact test. Patients who received dual-antibiotic prophylaxis with “on time” vancomycin infusion (Group CVt) had significantly lower infection rates than other TKA patients (0.8 vs. 2.7%, p < 0.01). “On Time” vancomycin administration was associated with a lower TKA-PJI rate for patients with a BMI < 45 kg/m2 (0.5 vs. 2.6%, p < 0.01) with no infections in 120 TKA patients with a BMI between 40 and 44.9 kg/m2 (p < 0.01). No difference was noted for patients with a BMI ≥ 45 kg/m2 (3.3 vs. 2.6%, p = 0.71). There were no infections in 150 TKA patients with a normal BMI (18–25 kg/m2) in any PJI-prophylaxis treatment group. Adoption of a dual-antibiotic prophylaxis approach can successfully reduce TKA-PJI rates among overweight and moderately obese patients. The approach does not appear to influence outcomes for low risk patients with a normal BMI (18–25 kg/m2) or for higher risk patients with a BMI > 45 kg/m2.

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Elevated Body Mass Index Is Associated With Early Total Knee Revision for Infection

Cited by 37 publications

References 27 publications

Weight changes after total knee arthroplasty in Chinese patients: a matched cohort study regarding predictors and outcomes

Weight changes after total knee arthroplasty in Chinese patients: a matched cohort study regarding predictors and outcomes

Weight affects survival of primary total knee arthroplasty: study based on the Danish Knee Arthroplasty Register with 67,810 patients and a median follow-up time of 5 years

Dual Antibiotic Prophylaxis in Primary Total Knee Arthroplasty—No Benefit for Extremely Obese Patients

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