The effect of obesity on the outcome of hip and knee arthroplasty

Abstract

The aim of this study was to evaluate the outcome of joint arthroplasty in obese and non-obese patients. We reviewed 2,026 consecutive primary total hip and 535 primary total knee arthroplasties performed for osteoarthritis. Patients were separated into two groups according to their body mass index (BMI): non-obese (BMI < 30) and obese (BMI ≥ 30). Their survivorships were compared. Case controlled studies were performed with 134 hip and 50 knee arthroplasties in obese patients. Each was matched individually with a control and their outcome compared. Log rank tests for equality of survival showed no difference in the survival for hip and knee arthroplasty at 11 and ten years, respectively. The obese group had significantly lower postoperative hip and knee scores at latest follow-up, especially in the range of motion. Overall patient satisfaction scores were comparable. There were no significant differences in the radiographic analysis of both hip and knee implants. Revision was used as an end point for the survival analysis. Functional scores (Harris hip score and Hospital for Special Surgery knee score), satisfaction for surgery and radiographic features were used as outcome measures for comparison. The mid-term survival of total hip and knee arthroplasty is not adversely affected by obesity. Despite lower clinical scores, the obese patients were satisfied with the results of their surgery and have an equivalent mid-term survival rate. It would be unreasonable to deny patients arthroplasty surgery purely on the basis of a BMI indicating obesity.

The Impact of Patellar Resurfacing in Two-Stage Revision of the Infected Total Knee Arthroplasty

“…Patients with increased BMI do not achieve the same improvement in outcome scores post primary TKA [29,30]. Although there was a trend towards patients with lower BMI having a better outcome, the difference was not significant.…”

All-Polyethylene Tibial Components in Obese Patients Are Associated With Low Failure at Midterm Followup

“…For most obese patients, as for any patient, TKA results in improved pain and function scores with high satisfaction rates [2,12,26,30,33,37,49]. MBT components and modern APT components both have been shown to be successful in the general population; however, the use of APT components specifically in obese patients has not been well studied.…”

“…Studies focusing on the obese patient population show most patients show improvements in outcome scores and are satisfied with TKA [1,2,12,18,19,24,26,30,33,37,43,44,48,49]. However, high body weight amplifies the magnitude of joint load per step and may adversely affect polyethylene wear performance and the rate of aseptic loosening.…”

Obesity Increases Length of Stay and Direct Medical Costs in Total Hip Arthroplasty

“…Indisputably, more obese patients are undergoing THA today than 10 to 20 years ago [11]. In terms of effectiveness, obese patients seem to benefit from THA as much as their nonobese counterparts despite a slower recovery and lower functional scores [1,7,18,20,25,27,28,41,43,46], yet in terms of adverse outcomes, obese patients undergoing THA are at greater risk for various short-term complications such as infections and dislocations [16, 17, 22-25, 29, 31, 32, 36-38].…”