FRI0620-HPR Weight Loss Intervention Before Total Knee Arthroplasty – Feasibility and Safety

Liljensøe, Anette; Laursen, Jens Ole; Bliddal, Henning; Søballé, Kjeld; Mechlenburg, Inger

doi:10.1136/annrheumdis-2015-eular.5292

Cited by 2 publications

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“…Of these, eight records passed the initial screening of the title and abstract review (six full-length articles and two abstracts) and were assessed for eligibility (see Fig. 1 ) [ 9 , 25 – 31 ]. A total of four records met the inclusion criteria (two cohort studies, two RCT abstracts).…”

Section: Resultsmentioning

confidence: 99%

“…A total of four records met the inclusion criteria (two cohort studies, two RCT abstracts). The two intervention studies were only available in abstract format at the time of the review [ 30 , 31 ]. We contacted the authors of these abstracts to determine if a full-length article had since been published.…”

Section: Resultsmentioning

confidence: 99%

“…As part of a RCT, researchers initially examined the safety and feasibility of implementing an intensive weight loss programme before surgery in order to reduce pre-operative weight in patients undergoing TKA [ 31 ]. Thirty-eight patients scheduled for TKA with a BMI >30 kg/m 2 and identified as motivated to lose weight were included in the intervention group of the RCT.…”

Section: Resultsmentioning

confidence: 99%

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Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review

2015

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BackgroundOf the more than 104,000 Canadians who underwent elective total joint arthroplasty (TJA) surgery in 2012–2013 for hip and knee osteoarthritis (OA), 40 and 60 %, respectively, were obese. Obesity is associated with increased risks for receiving TJA, post-operative complications and delayed functional recovery. Current guidelines for patients with a body mass index (BMI) of ≥30 kg/m2 are to participate in a weight management programme and to lose weight prior to TJA surgery. As part of a larger project, a rapid review was conducted to examine the effects of short-term non-pharmacological and non-surgical weight loss interventions in adults in the year prior to total hip arthroplasty (THA) and total knee arthroplasty (TKA) on surgical and patient outcomes, and adverse events.MethodsWe performed a rapid review and searched seven electronic databases for English language articles published between 1990 and February 2015. Observational studies evaluating the association between pre-operative weight loss and short- and long-term outcomes, and controlled trials of non-pharmacological and non-surgical weight loss interventions were considered for inclusion. Two reviewers independently screened and selected articles, assessed methodological quality and extracted data.ResultsOf 263 articles identified, a total of four studies met our inclusion criteria. In one of two high-quality retrospective cohort studies, weight loss ≥5 % of body weight in the year prior to TJA and maintained in the year after surgery was associated with a higher likelihood of deep surgical site infection in THA patients and 90-day readmission in TKA patients. No significant differences were reported in incidence of superficial surgical site infections in THA or TKA patients who lost weight pre-operatively compared to those who maintained their weight in either study. Two abstracts of randomized controlled trials were included; however, despite contacting the authors, full-length articles were not available. The limited information from the trials suggested that short-term dietician-supervised weight loss interventions were effective in weight loss prior to TJA.ConclusionsThere is limited evidence to support the recommendation of weight loss in the year prior to TJA and to determine the effectiveness of short-term non-pharmacological, non-surgical weight management interventions on patient and surgical outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review

2015

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“…There are three studies of pre-operative dietary interventions involving some amount of time prior to TJA, though just one measured pre-operative weight loss while the remaining two studies only measured postoperative weight as endpoints. Liljensøe et al randomized 77 participants to a standard care control group or a dietician supervised weight loss group that consisted of nutrition education group sessions and a low calorie (810 kcal/day) diet using formula foods for 8 weeks before surgery, followed by a 1-year maintenance period after surgery [12]. Intervention participants lost an average of 10.7 kg in the 8 weeks before surgery, and the authors concluded that a pre-operative weight loss program shortly before TJA was safe to implement.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite multiple investigations regarding the association between lifestyle interventions and postoperative outcome, there is a dearth of research regarding success of weight loss interventions specifically prior to TJA. Although there are three studies of pre-operative dietary interventions prior to TJA, only one study concluded before surgery and this study did not compare pre-operative weight loss to a control group [12][13][14]. A 2015 review of nonsurgical, non-pharmacologic weight loss interventions in patients with obesity prior to TJA found that there was limited research on the association between weight loss prior to TJA and pre-and post-operative outcomes, and that future studies should address the safety, optimal timing, duration, amount of targeted weight loss, and delivery of pre-TJA interventions [15].…”

Section: Introductionmentioning

confidence: 96%

Weight loss before total joint arthroplasty using a remote dietitian and mobile app: study protocol for a multicenter randomized, controlled trial

et al. 2020

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Background The months prior to elective surgery may present an opportunity for patients to initiate behavior changes that will simultaneously ready them for surgery and improve their overall health status. An upcoming elective total joint arthroplasty (TJA) may serve as motivation for patients with severe obesity (body mass index [BMI]> 40 kg/m2) to lose weight, as it may optimize clinical outcomes following TJA and help them become eligible for TJA since some surgeons use a BMI of 40 kg/m2 as a cut-off for offering surgery in an effort to optimize outcomes. Methods The purpose of this multicenter randomized, controlled trial is to assess the feasibility and efficacy of a 12-week remote dietitian (RD) supervised dietary and physical activity weight loss intervention and mobile app for 60 patients with severe obesity prior to undergoing TJA. Intervention participants will receive access to a smartphone app and connect with an RD who will contact these participants weekly or bi-weekly via video calls for up to nine video calls. Together, participants and RDs will set goals for lifestyle modifications, and RDs will check on progress towards achieving these goals using in-app tools such as food logs and text messages between video calls. All patients will be encouraged to lose at least 20 pounds with a goal BMI < 40 kg/m2 after 12 weeks. Individuals randomized to the control group will receive clinical standard of care, such as nutritionist and/or physical therapy referrals. Outcome and demographic data will be collected from blood serology, chart review, mobile app user data, pre- and postintervention surveys, and phone interviews. The primary outcome measure will be weight change from baseline. Secondary outcome measures will include percentage of patients eligible to undergo TJA, number of sessions completed with dietitians, self-reported global health status (PROMIS Global Health scale), self-reported joint-specific pain and function (Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS)), and serologies such as hemoglobin A1c, total lymphocyte count, albumin, and transferrin. Qualitative responses transcribed from phone interviews about the intervention will also be analyzed. Discussion This will be the first study to assess pre-operative weight loss in patients with severe obesity anticipating orthopaedic surgery using an RD and mobile app intervention aimed at helping patients become eligible for TJA. Trial registration Registered on 1 April 2020 at Clincialtrials.gov. Trial number is NCT04330391.

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FRI0620-HPR Weight Loss Intervention Before Total Knee Arthroplasty – Feasibility and Safety

Cited by 2 publications

References 0 publications

Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review

Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review

Weight loss before total joint arthroplasty using a remote dietitian and mobile app: study protocol for a multicenter randomized, controlled trial

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