Obesity Has a Negative Impact on Clinical Outcome after Total Knee Arthroplasty

Järvenpää, Jaakko; Kettunen, Jukka; Soininvaara, Tarja; Miettinen, Hannu; Kröger, Heikki

doi:10.1177/145749691210100310

Cited by 59 publications

(40 citation statements)

References 23 publications

(20 reference statements)

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“…[6][7][8] Furthermore previous papers have acknowledged that people who are obese have a poorer clinical outcome after hip or knee replacement. 9,10 To address these differences in outcomes and perceived post-operative complications, some arthroplasty candidates have undergone bariatric surgery procedures prior to their total hip (THR) or total knee replacement (TKR). 11 Such procedures have included gastric bypass, sleeve gastrectomy, stomach partition using staples and gastric balloon insertion.…”

Section: Introductionmentioning

confidence: 99%

Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients?

Smith

Aboelmagd

Hing

et al. 2016

The Bone & Joint Journal

124

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Aims: To determine whether, based on the current literature, bariatric surgery prior to total hip (THR) or total knee replacement (TKR) reduces complication rates and improves outcome following arthroplasty. Conclusions: For the majority of peri-operative outcomes, bariatric surgery prior to THR or TKR does not significantly reduce complication rates or improve clinical outcomes. Materials and MethodsClinical Relevance: This study questions the previous notion that bariatric surgery prior to joint replacement may improve clinical outcomes for people who are obese or morbidly obese.

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Section: Introductionmentioning

confidence: 99%

Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients?

Smith

Aboelmagd

Hing

et al. 2016

The Bone & Joint Journal

124

View full text Add to dashboard Cite

show abstract

“…[8][9][10]15,[19][20][21]23,24 While there is a broad consensus that obesity is directly associated with these complications, based on individual studies, it is unclear whether specific BMI cutoffs exist above which patients are placed at a significantly higher risk of developing perioperative complications. 9,15,20 A recent study by Gillespie and Porteous 9 reiterated this point when the authors were not able to identify a significant BMI cutoff to differentiate between high risk and low risk patients.…”

mentioning

confidence: 99%

The Effects of Obesity and Morbid Obesity on Outcomes in TKA

et al. 2013

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The negative effects of obesity following total joint arthroplasty, such as increased morbidity and mortality, have been well documented in literature. However, little is known about whether specific body mass indices can be used as cutoffs to determine which patients are most at risk for having a poor postoperative outcome. We evaluated the effects of differing levels of obesity as measured by body mass index (BMI) on implant survivorship, Knee Society scores, complications, and radiographic outcomes. A systematic review of the literature was performed to identify all studies reporting outcomes of total knee arthroplasty in obese (30 ≤ BMI < 40 kg/m2) and morbidly obese patients (40 ≤ BMI < 50 kg/m2). Twenty-four studies were identified in our literature search. At a mean 5-year follow-up, morbidly obese patients (88%) had significantly lower implant survivorship than obese patients (95%) and nonobese patients (97%). Significantly, lower postoperative mean Knee Society objective and function scores (71 and 60 points) were observed for morbidly obese patients than for nonobese patients (75 and 90 points), but obese patients did not have significantly lower Knee Society objective and function scores than nonobese patients (78 and 84 points). Complication rates for nonobese, obese, and morbidly obese patients were 9, 15, and 22%, respectively, all of which were significantly different. However, no significant difference was observed in the incidence of radiolucent lines that were 12, 19, and 14%, respectively. Thus, we conclude that a BMI greater than 40 kg/m2 may be used as a cutoff to help guide patient education and treatment options for primary total knee arthroplasty.

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“…A recent meta-analysis by Kerkhoffs et al32 that included over 15,000 TKA patients concluded that obesity is associated with higher rates of infection (OR = 1.9), deep infection (OR = 2.4), and revision surgery (OR = 1.3). Obese patients also have significantly higher postsurgical WOMAC scores versus the nonobese 33. Additionally, age and gender are known influencers of acute postoperative pain, clinical outcomes, functional limitations, length of hospital stay, and mortality following knee arthroplasty 34–36.…”

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes and Predictors of Clinical Success with the KineSpring Knee Implant System

London

Smith²,

Miller

et al. 2013

Clin Med�Insights�Arthritis�Musculoskelet Disord

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The purpose of this study was to (1) evaluate joint pain and function in knee osteoarthritis (OA) patients treated with a joint-sparing, extracapsular implant and (2) identify patient characteristics that influenced clinical outcomes. This study included 99 patients with symptomatic medial knee OA refractory to conservative care who were treated with the KineSpring Knee Implant System and followed for a mean of 17 months (range, 1.5 to 48 months). All devices were successfully implanted and activated with no intraoperative complications. Statistically significant mean improvements of 56%, 50%, and 38% were observed for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Function, and Stiffness scales, respectively (all P < 0.001). Regardless of gender, age group, body mass index classification, or disease severity, all WOMAC domain scores significantly improved during the postoperative follow-up period. WOMAC clinical success rates were 77.8% for Pain, 77.8% for Function, and 68.7% for Stiffness. Neither gender, age group, body mass index classification, nor disease severity predicted clinical success in any WOMAC domain. In conclusion, the KineSpring System yields clinically meaningful improvements in joint pain and function in patients with medial knee OA. Additionally, unlike joint-altering procedures such as knee arthroplasty or high tibial osteotomy, patient characteristics had little association with postoperative clinical outcomes.

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Obesity Has a Negative Impact on Clinical Outcome after Total Knee Arthroplasty

Cited by 59 publications

References 23 publications

Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients?

Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients?

The Effects of Obesity and Morbid Obesity on Outcomes in TKA

Midterm Outcomes and Predictors of Clinical Success with the KineSpring Knee Implant System

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