Review Article: Outcome of Total Knee Arthroplasty in Obese Patients

Rodríguez-Merchán, E. Carlos

doi:10.1177/230949901502300124

Cited by 16 publications

(5 citation statements)

References 40 publications

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“…Regarding the impact of BMI on joint awareness, Behrend et al observed a significantly inferior FJS‐12 in the younger obese female patients following TKA [6]. Many systematic reviews also found an inferior outcome, higher complication rate, increased cost, and lower survivorship in obese patients after TKA; however, the findings were relevant to BMI of > 40 kg/m 2 [16, 43]. None of the studies recruited in this meta‐analysis had evaluated this category of patients; hence, selection bias was avoided.…”

Section: Discussionmentioning

confidence: 99%

Joint awareness after unicompartmental knee arthroplasty and total knee arthroplasty: a systematic review and meta-analysis of cohort studies

Trıpathy

Varghese

Srinivasan

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this systematic review and meta-analysis is to evaluate the joint awareness after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). It was hypothesized that patients with UKA could better forget about their artiicial joint in comparison to TKA. Methods A search of major literature databases and bibliographic details revealed 105 studies evaluating forgotten joint score in UKA and TKA. Seven studies found eligible for this review were assessed for risk of bias and quality of evidence using the Newcastle-Ottawa Scale. The forgotten joint score (FJS-12) was assessed at 6 months, 1 year, and 2 years. ResultsThe mean FJS-12 at 2 years was 82.35 in the UKA group and 74.05 in the TKA group. Forest plot analysis of ive studies (n = 930 patients) revealed a mean diference of 7.65 (95% CI: 3.72, 11.57, p = 0.0001; I 2 = 89% with p < 0.0001) in FJS-12 at 2 years. Further sensitivity analysis lowered I 2 heterogeneity to 31% after exclusion of the study by Blevin et al.

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Section: Discussionmentioning

confidence: 99%

Joint awareness after unicompartmental knee arthroplasty and total knee arthroplasty: a systematic review and meta-analysis of cohort studies

Trıpathy

Varghese

Srinivasan

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…The findings of previous studies of obesity and recovery following total knee arthroplasty have been mixed, with some studies suggesting that obesity is associated with worse pain and function and lower satisfaction following total knee arthroplasty, and others finding no association, or even that obese patients are more likely to be satisfied with their surgery [19][20][21][22][23][24]26,37,38 . This variability may be due to differences in the health status of the cohorts or differences in the cutoffs used to define categories of obesity.…”

Section: Discussionmentioning

confidence: 99%

Effect of Obesity on Pain and Functional Recovery Following Total Knee Arthroplasty

Collins

Donnell‐Fink

Yang

et al. 2017

The Journal of Bone and Joint Surgery

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Background: While obesity may be a risk factor for complications following total knee arthroplasty, data remain sparse on the impact of the degree of obesity on patient-reported outcomes following this procedure. Our objective was to determine the extent to which obesity level affects the trajectory of recovery as well as patient-reported pain, function, and satisfaction with surgery following total knee arthroplasty. Methods: We followed a cohort of patients who underwent total knee arthroplasty at 1 of 4 medical centers. Patients were ‡40 years of age with a primary diagnosis of osteoarthritis. We stratified patients into 5 groups according to the World Health Organization classification of body mass index (BMI). We assessed the association between BMI group and pain and function over the time intervals of 0 to 3, 3 to 6, and 6 to 24 months using a piecewise linear model. We also assessed the association between BMI group and patient-reported outcomes at 24 months. Multivariable models adjusted for age, sex, race, diabetes, musculoskeletal functional limitations index, pain medication use, and study site. Results: Of the 633 participants included in our analysis, 19% were normal weight (BMI of <25 kg/m 2), 32% were overweight (BMI of 25 to 29.9 kg/m 2), 27% were class-I obese (BMI of 30 to 34.9 kg/m 2), 12% were class-II obese (BMI of 35 to 39.9 kg/m 2), and 9% were class-III obese (BMI of ‡40 kg/m 2). Study participants with a higher BMI had worse preoperative WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain and function scores and had greater improvement from baseline to 3 months. The mean change in pain and function from 3 to 6 and from 6 to 24 months was similar across all BMI groups. At 24 months, participants in all BMI groups had similar levels of pain, function, and satisfaction. Conclusions: Because of the differential trajectory of recovery in the first 3 months following total knee arthroplasty, the participants in the higher BMI groups were able to attain absolute pain and function scores similar to those in the nonobese and class-I obese groups. These data can help surgeons discuss expectations of pain relief and functional improvement with total knee arthroplasty candidates with higher BMI. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. K nee osteoarthritis is a prevalent, disabling joint disease that affects almost 4% of the global population 1,2. Knee osteoarthritis is more prevalent in obese individuals, and increased body mass index (BMI) has been established as a risk factor for the disease 3,4. The number of obese patients with advanced knee osteoarthritis is expected to increase in the coming decades as the prevalence of obesity among U.S. adults continues to rise 5. Patients who develop advanced knee osteoarthritis are typically offered total knee arthroplasty, a cost-effective procedure for relieving pain and restoring function 6,7. More than 660,000 total knee arthroplasty procedures were ...

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“…Most importantly, studies have not always reported or sub-classified subjects by comorbidities such as diabetes, hypertension, cardiac disease, or sleep apnea, each of which independently impacts surgical infection and complication rates 65,74 . For example, diabetes may double the infection risk independent of obesity 81,83 . This inability to account for comorbidities is identified as a limitation in several of the systematic reviews 44,46,47,75 .…”

Section: Limitations In Current Evidencementioning

confidence: 99%

The EQ-5D-5L Is Superior to the -3L Version in Measuring Health-related Quality of Life in Patients Awaiting THA or TKA

Jin

Sayah

Öhinmaa

et al. 2019

Clin Orthop Relat Res

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2 , particularly in knee arthroplasty, although limitations in the quality and methodology of the research indicate further clarification is necessary. Weight loss before surgery does not decrease infection risk, and there is a lack of information on the impact of extended surgical delays. Using an absolute value of BMI as a cutoff for surgery is not recommended, but shared decision making with the individual patient is strongly recommended, incorporating discussion of risk factors, medical history, disability, and surgical expectations.

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Review Article: Outcome of Total Knee Arthroplasty in Obese Patients

Cited by 16 publications

References 40 publications

Joint awareness after unicompartmental knee arthroplasty and total knee arthroplasty: a systematic review and meta-analysis of cohort studies

Joint awareness after unicompartmental knee arthroplasty and total knee arthroplasty: a systematic review and meta-analysis of cohort studies

Effect of Obesity on Pain and Functional Recovery Following Total Knee Arthroplasty

The EQ-5D-5L Is Superior to the -3L Version in Measuring Health-related Quality of Life in Patients Awaiting THA or TKA

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