Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis

Abstract

Background: The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. Methods: We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). Results: Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. Conclusion: Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis’s survival.

2023 Evidence-Based Medicine (EBM) Update

“…In a systematic review of 28 studies (10 prospective, 27 retrospective descriptive studies) and meta-analysis of 9 studies with 10 388 patients, Varga et al 42 found significantly higher odds of revision in the obese group compared with the nonobese group (odds ratio [OR] 1.68, confidence interval [CI] 1.44-1.95). However, the odds of overall perioperative complications (OR 1.55, CI 0.50-4.80) and wound complications (OR 1.34, CI 0.29-6.20) were nonsignificantly higher in the obese group.…”