Preoperative Weight Loss and Postoperative Weight Gain Independently Increase Risk for Revision After Primary Total Knee Arthroplasty

Kim, Billy; Cochrane, Niall H.; O’Donnell, Jeffrey; Wu, Mark; Wellman, Samuel S.; Ryan, Sean P.; Seyler, Thorsten M.

doi:10.1016/j.arth.2021.12.003

Cited by 19 publications

(10 citation statements)

References 35 publications

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“…Use of policies that require patients to lose weight before accessing surgery should be based in evidence, yet there is currently no strong evidence that pre-surgical weight loss improves surgical outcomes. Indeed, short-term pre-surgical weight loss raises concerns of deconditioning and post-surgical rebounds in weight in arthroplasty patients [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Access to hip and knee arthroplasty in England: commissioners’ policies for body mass index and smoking status and implications for integrated care systems

McLaughlin

Elsey

Kipping

et al. 2023

BMC Health Serv Res

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Background Commissioning policies are in place in England that alter access to hip and knee arthroplasty based on patients’ body mass index and smoking status. Our objectives were to ascertain the prevalence, trend and nature of these policies, and consider the implications for new integrated care systems (ICSs). Methods Policy data were obtained from an internet search for all current and historic clinical commissioning group (CCG) hip and knee arthroplasty policies and use of Freedom of Information (FOI) requests to each CCG. Descriptive analyses of policy type, explicit threshold criteria and geography are reported. Estimates were made of the uptake of policies by ICSs based on the modal policy type of their constituent CCGs. Results There were 106 current and 143 historic CCGs in England at the time of the search in June 2021. Policy information was available online for 56.2% (140/249) CCGs. With the addition of information from FOIs, complete policy information was available for 94.4% (235/249) of CCGs. Prevalence and severity of policies have increased over time. For current CCGs, 67.9% (72/106) had a policy for body mass index (BMI) and 75.5% (80/106) had a policy for smoking status for hip or knee arthroplasty. Where BMI policies were in place, 61.1% (44/72) introduced extra waiting time before surgery or restricted access to surgery based on BMI thresholds (modal threshold: BMI of 40 kg/m2, range 30–45). In contrast, where smoking status policies were in place, most offered patients advice or optional smoking cessation support and only 15% (12/80) introduced extra waiting time or mandatory cessation before surgery. It is estimated that 40% of ICSs may adopt a BMI policy restrictive to access to arthroplasty. Conclusions Access policies to arthroplasty based on BMI and smoking status are widespread in England, have increased in prevalence since 2013, and persist within new ICSs. The high variation in policy stringency on BMI between regions is likely to cause inequality in access to arthroplasty and to specialist support for affected patients. Further work should determine the impact of different types of policy on access to surgery and health inequalities.

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Section: Discussionmentioning

confidence: 99%

Access to hip and knee arthroplasty in England: commissioners’ policies for body mass index and smoking status and implications for integrated care systems

McLaughlin

Elsey

Kipping

et al. 2023

BMC Health Serv Res

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“…Previous studies have recommended preoperative weight loss for obese patients prior to undergoing either total knee or hip arthroplasty owing to relatively unfavorable outcomes [41][42][43]. However, there has been recent studies that suggest the contrary-that weight loss prior to total joint arthroplasty may not necessarily be as beneficial as previously thought [23,32,35,44].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Weight Loss Prior To Total Joint Arthroplasty

Andrawis¹,

George²

2022

Prog Orthop Sci

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“…of discharge to a facility [19]. Another study indicated that preoperative weight loss may increase the risk for all-cause revisions [14]. A different study again offered conflicting results, stating the risk of surgical site infection and readmission were not different in those who gained or lost weight compared to those who had no change in weight [20].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty

Tidd,

Huffman,

Oyem

et al. 2023

J Knee Surg

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Introduction: As obesity becomes more prevalent, more patients are at risk of lower extremity osteoarthritis and subsequent total knee arthroplasty (TKA). This study aimed to test 1) the association of preoperative weight change with healthcare utilization; and 2) the association of pre- and postoperative weight changes with failure to achieve satisfaction and minimal clinically important difference (MCID) in Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and function (KOOS-PS) 1-year after TKA. Methods: Prospectively collected monocentric data on patients who underwent primary TKA was retrospectively reviewed. Multivariable logistic regression assessed the influence of BMI and weight change on outcomes while controlling for confounding variables. Outcomes included prolonged length of stay (LOS >3 days), non-home discharge, 90-day readmission rate, satisfaction, and achievement of MCID for KOOS-Pain and KOOS-PS. Results: Preoperative weight change had no impact on prolonged LOS (gain, p=0.173; loss, p=0.599). Preoperative weight loss was associated with increased risk of non-home discharge (OR 1.47, p=0.003). There was also increased risk of 90-day readmission with preoperative weight gain (OR 1.27, p=0.047) and decreased risk with weight loss (OR 0.73, p=0.033). There was increased risk of non-home discharge with obesity class II (OR 1.6, p=0.016) and III (OR 2.21, p<0.001). Weight change was not associated with failure to achieve satisfaction, MCID in KOOS-Pain, or MCID in KOOS-PS. Obesity class III patients had decreased risk of failure to reach MCID in KOOS-Pain (OR 0.43, p=0.005) and KOOS-PS (OR 0.7, p=0.007). Conclusion: Pre- and postoperative weight change has little impact on the achievement of satisfaction and clinically relevant differences in pain and function at 1-year. However, preoperative weight gain was associated with a higher risk of 90-day readmissions after TKA. Furthermore, patients categorized in Class III obesity were at increased risk of non-home discharge but experienced a greater likelihood of achieving MCID in KOOS-Pain and KOOS-PS. Our results raise awareness of the dangers of using weight changes and BMI alone as a measure of TKA eligibility.

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Preoperative Weight Loss and Postoperative Weight Gain Independently Increase Risk for Revision After Primary Total Knee Arthroplasty

Cited by 19 publications

References 35 publications

Access to hip and knee arthroplasty in England: commissioners’ policies for body mass index and smoking status and implications for integrated care systems

Access to hip and knee arthroplasty in England: commissioners’ policies for body mass index and smoking status and implications for integrated care systems

Preoperative Weight Loss Prior To Total Joint Arthroplasty

Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty

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