Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Abstract

Background Patients with obesity are known to have a higher risk of complications after primary TKA; however, there is a paucity of data regarding the effects of obesity with revision TKAs. Questions/purposes We asked the following questions : (1) Are patients with morbid obesity (BMI C 40 kg/m 2 ) at greater risk for repeat revision, reoperation, or periprosthetic joint infection (PJI) compared with patients without obesity (BMI \ 30 kg/m 2 ) after an index revision TKA performed for aseptic reasons? (2) Do patients who are not obese achieve higher Knee Society pain and function scores after revision TKA for aseptic reasons? Methods We used a retrospective cohort study with 1:1 matching for sex, age (± 3 years) and date of surgery (± 1 year) to compare patients with morbid obesity with patients without obesity with respect to repeat revision, reoperation, and PJI. Using our institution's total joint registry, we identified 1291 index both-component (femoral and tibial) aseptic revision TKAs performed during a 15-year period (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007). Of these, 120 revisions were in patients with morbid obesity (BMI C 40 kg/ m 2 ) and 624 were in patients with a BMI less than 30 kg/ m 2 . We then considered only patients with a minimum 5-year followup, which was available for 77% of patients with morbid obesity and 76% of patients with a BMI less than 30 kg/m 2 (p = 0.84). All patients with morbid obesity who met criteria were included (morbid obesity group: n = 93; average followup, 7.9 years) and compared with a matched cohort of patients with a BMI less than 30 kg/m 2 (nonmorbid obesity group: n = 93; average followup, 7.3 years). Medical records were reviewed to gather details regarding complications and clinical outcomes. Results Overall, patients with morbid obesity had an increased risk of repeat revision (hazard ratio [HR], 3.8; 95% CI, 1.2-16.5; p \ 0.02), reoperation (HR, 2.9; 95% CI, 1.3-7.4; p \ 0.02), and PJI (HR, 6.4; 95% CI, 1.2-119.7; p \ 0.03). Implant survival rates were 96% (95% CI, 92%-100%) and 100% at 5 years, and 81% (95% CI, 70%-92%) and 93% (95% CI, 86%-100%) at 10 years for the patients with morbid obesity and those without morbid obesity, respectively (p = 0.02). At 10 years, The Knee Society pain (90 [95% CI,(88)(89)(90)(91)(92) Conclusion Morbid obesity is associated with increased rates of rerevision, reoperation, and PJI after aseptic revision TKA. As the time-sensitive nature of revision surgery may not always allow for patient or comorbidity optimization, these results emphasize the need for improving our care of patients with morbid obesity earlier on during

Risk of Reinfection after Irrigation and Debridement of Acute Periprosthetic Joint Infection following TKA

“…17,[27][28][29] Obesity has been identified as a possible risk factor for reinfection in the primary and revision TKA settings. 30,31 In this study, we found an association with advanced age and diabetes as a risk factor for reinfection. Our study does have limitations given the inherent challenges of a large database study that relies on accurate coding.…”

Extended Postoperative Prophylactic Antibiotics with First-Generation Cephalosporin Do Not Reduce the Risk of Periprosthetic Joint Infection following Aseptic Revision Total Knee Arthroplasty

“…Obesity has been an important issue not only in primary TKA but also in revision TKA. Watts et al 27 reported that morbidly obese patients (BMI ! 40 kg/m 2 ) had significantly higher rates of repeat revision, reoperation, and PJI after aseptic revision TKA when compared with patients without obesity (BMI < 30 kg/m 2 ).…”

The Use of Stems for Morbid Obesity in Total Knee Arthroplasty

“…40 matched to 120 patients with BMI < 30 and found increased risk of repeat revision and prosthetic joint infection, as well as worse implant survival and Knee Society pain and function scores in the morbidly obese cohort. 36…”