Lower Extremity Geometry in Morbid Obesity—Considerations for Total Knee Arthroplasty

Elkins, Jacob M.; Simoens, Kevin J.; Callaghan, John J.

doi:10.1016/j.arth.2018.03.060

Cited by 13 publications

(9 citation statements)

References 31 publications

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“…The mechanisms of aseptic loosening of tibial implants in obese patients are likely due to increased stress on the tibial implant and abnormal kinematics of the knee with catastrophic varus collapse. 14,31,32 Preoperative weight loss, the use of a larger tibial component, and a tibial stem extension can reduce stress on the proximal tibia. Because the size of the tibial component is limited by anatomy, efforts to reduce tibial stress may depend primarily on the preoperative weight loss and the use of tibial stem extensions.…”

Section: Discussionmentioning

confidence: 99%

Stemmed Versus Nonstemmed Tibia in Primary Total Knee Arthroplasty: A Similar Pattern of Aseptic Tibial Loosening in Obese Patients with Moderate Varus. 5-Year Outcomes of a Randomized Controlled Trial

Mohammad

Elesh²,

El-Desouky

2022

J Knee Surg

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Obesity is linked to early tibial tray failure after primary total knee arthroplasty (TKA) for osteoarthritis (OA), especially in patients with preoperative varus. This study compared standard and stemmed tibiae TKAs in patients with class I and II obesity with varus deformity. Between April 2013 and June 2020, a prospective study was conducted including patients with end-stage OA, body mass index between 30 and 40 kg/m2, and varus <15 degrees. Patients were randomly assigned to TKAs with either standard or long-stemmed tibiae and evaluated 5 years after surgery using the Knee Society Scoring (KSS). The knee society and modified radiographic evaluation systems were used for radiological evaluation. In total, 264 TKAs were performed in 264 patients (134 in the standard group and 130 in the stemmed group). The mean preoperative hip–knee–ankle angles for the standard and stemmed groups were 8.2 ± 3.2 degrees/varus and 9 ± 2.9 degrees/varus, respectively (p = 0.2), which improved to 5.1 ± 3 degrees/valgus and 5 ± 3.5 degrees/valgus after surgery (p = 0.52). There was no statistically significant difference between the objective KSS (92 vs. 92.9; p = 0.84) and the functioning KSS (73.4 vs. 74.8; p = 0.28). There were no aseptic loosening cases or radiographic differences. In-group analysis revealed significant outcomes differences in both groups if preoperative varus was >10 degrees irrespective of the stem design (p < 0.0001). Complications occurred in two patients; one with a late infection and one had a stem-related tibial fracture. Standard tibia TKAs yielded comparable results in obese patients to long-stemmed tibias. No aseptic tibial loosening was observed regardless of stem type, and worse clinical outcomes were associated with greater varus. Clinical trial registry: registered at http://www.researchregistry.com (researchregistry5717).Level of Evidence II; a prospective randomized trial.

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Section: Discussionmentioning

confidence: 99%

Stemmed Versus Nonstemmed Tibia in Primary Total Knee Arthroplasty: A Similar Pattern of Aseptic Tibial Loosening in Obese Patients with Moderate Varus. 5-Year Outcomes of a Randomized Controlled Trial

Mohammad

Elesh²,

El-Desouky

2022

J Knee Surg

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“…Additionally, we restricted our analysis to patients undergoing TKA with conventional instrumentation and controlled for multiple factors that might influence operating time, such as the use of cruciate-retaining or posterior-stabilized implants and surgeon volume, allowing a robust assessment of the effect of BMI on surgical duration. Second, an elevated BMI does not always correlate with adiposity around the knee [3], and other local factors such as patella baja may inhibit exposure and prolong operative time [5]. However, BMI is a routinely recorded variable in patients undergoing TKA, and a previous study suggested BMI was a better predictor of operative duration than local measures of adiposity [22].…”

Section: Discussionmentioning

confidence: 99%

Do TKAs in Patients with Higher BMI Take Longer, and is the Difference Associated with Surgeon Volume? A Large-database Study from a National Arthroplasty Registry

Quayle

Klasan

Frampton

et al. 2021

Clin Orthop Relat Res

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“…Anthropomorphic information regarding patterns of adipose tissue deposition in obese patients is limited; however, girth in both coronal and sagittal planes along the lower extremity from hip to ankle does appear to correlate with BMI. 13 In a case-control analysis of 116 primary TKAs, Callanan et al showed the depth of subcutaneous fat overlying the patella and tibial tubercle is correlated with reoperation and perhaps a stronger predictor of complication than BMI, however, did not correlate subcutaneous fat with component positioning. 10 Thus, it remains largely unknown if obesity itself affects the position of the tibial component.…”

Section: Discussionmentioning

confidence: 99%

Extramedullary Guide Alignment Is not Affected by Obesity in Primary Total Knee Arthroplasty

et al. 2020

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Coronal alignment of the tibial implant correlates with survivorship of total knee arthroplasty (TKA), especially in obese patients. The purpose of this study was to determine if obesity affects coronal plane alignment of the tibial component when utilizing standard extramedullary tibial guide instrumentation during primary TKA. A retrospective review from June 2017 to February 2018 identified 142 patients (162 primary TKAs). There were 88 patients (100 knees) with body mass index (BMI) < 35 kg/m2 and 54 patients (62 knees) with BMI ≥ 35.0 kg/m2. The cohorts did not differ in age (p = 0.37), gender (p = 0.61), or Charlson's comorbidity index (p = 0.54). Four independent reviewers measured the angle between the base of the tibial component and the mechanical axis of the tibia on the anteroposterior view of long-leg film at first postoperative clinic visit. Outliers were defined as patients with greater than 5 degrees of varus or valgus alignment (n = 0). Reoperations and complications were recorded to 90 days postoperatively. There was no significant difference in mean tibial coronal alignment between the two groups (control alignment 90.8 ± 1.2 degree versus obese alignment 90.8 ± 1.2 degree, p = 0.91). There was no difference in varus versus valgus alignment (p = 0.19). There was no difference in the number of outliers (two in each group, p = 0.73). There was no difference in rate of reoperation (p = 1.0) or complication (p = 0.51). Obesity did not affect coronal plane alignment of the tibial component when using an extramedullary guide during primary TKA in our population.

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Lower Extremity Geometry in Morbid Obesity—Considerations for Total Knee Arthroplasty

Cited by 13 publications

References 31 publications

Stemmed Versus Nonstemmed Tibia in Primary Total Knee Arthroplasty: A Similar Pattern of Aseptic Tibial Loosening in Obese Patients with Moderate Varus. 5-Year Outcomes of a Randomized Controlled Trial

Stemmed Versus Nonstemmed Tibia in Primary Total Knee Arthroplasty: A Similar Pattern of Aseptic Tibial Loosening in Obese Patients with Moderate Varus. 5-Year Outcomes of a Randomized Controlled Trial

Do TKAs in Patients with Higher BMI Take Longer, and is the Difference Associated with Surgeon Volume? A Large-database Study from a National Arthroplasty Registry

Extramedullary Guide Alignment Is not Affected by Obesity in Primary Total Knee Arthroplasty

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