The influence of obesity on achievement of a ‘forgotten joint’ following total knee arthroplasty

Singh, Vivek; Yeroushalmi, David; Lygrisse, Katherine A.; Simcox, Trevor; Long, William J.; Schwarzkopf, Ran

doi:10.1007/s00402-021-03840-0

Cited by 9 publications

(11 citation statements)

References 51 publications

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“…Another finding of particular interest was that patients in both obesity and sarcopenic obesity groups experienced an inpatient stay approximately one day longer than the non-obese peers did. Our results were consistent with previous studies demonstrating that obese patients (BMI ≥ 30 kg/m 2 ) expended a significantly longer time period of hospital stay than those with BMIs < 30 kg/m 2 did (p < 0.001) after total knee or hip arthroplasty [7,[85][86][87]. Additionally, a higher comorbidity score along with a longer period of inpatient stay was noted in our obese patients compared with the referent peers and such findings were consistent with prior results [7,85].…”

Section: Demographics and Characteristics In The Study Cohortsupporting

confidence: 92%

“…Our results were consistent with previous studies demonstrating that obese patients (BMI ≥ 30 kg/m 2 ) expended a significantly longer time period of hospital stay than those with BMIs < 30 kg/m 2 did (p < 0.001) after total knee or hip arthroplasty [7,[85][86][87]. Additionally, a higher comorbidity score along with a longer period of inpatient stay was noted in our obese patients compared with the referent peers and such findings were consistent with prior results [7,85]. Such obese patients who have higher BMIs along with higher comorbidity scores are expected to experience a longer period of hospital stay since BMI and comorbidities predict length of hospital stay after TKR [87,88].…”

Section: Demographics and Characteristics In The Study Cohortsupporting

confidence: 92%

“…In addition, obese patients in this study tended to be significantly younger than the non-obese patients. Similar results concerning effects of obesity on surgery outcome following TKR have been reported in prior literatures [7,8,85].…”

Section: Demographics and Characteristics In The Study Cohortsupporting

confidence: 89%

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Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study

Liao

Huang

et al. 2021

Nutrients

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Sarcopenic obesity is closely associated with knee osteoarthritis (KOA) and has high risk of total knee replacement (TKR). In addition, poor nutrition status may lead to sarcopenia and physical frailty in KOA and is negatively associated with surgery outcome after TKR. This study investigated the effects of sarcopenic obesity and its confounding factors on recovery in range of motion (ROM) after total knee replacement (TKR) in older adults with KOA. A total of 587 older adults, aged ≥60 years, who had a diagnosis of KOA and underwent TKR, were enrolled in this retrospective cohort study. Sarcopenia and obesity were defined based on cutoff values of appendicular mass index and body mass index for Asian people. Based on the sarcopenia and obesity definitions, patients were classified into three body-composition groups before TKR: sarcopenic-obese, obese, and non-obese. All patients were asked to attend postoperative outpatient follow-up admissions. Knee flexion ROM was measured before and after surgery. A ROM cutoff of 125 degrees was used to identify poor recovery post-surgery. Kaplan-Meier curve analysis was performed to measure the probability of poor ROM recovery among study groups. Cox multivariate regression models were established to calculate the hazard ratios (HRs) of postoperative poor ROM recovery, using potential confounding factors including age, sex, comorbidity, risk of malnutrition, preoperative ROM, and outpatient follow-up duration as covariates. Analyses results showed that patients in the obese and sarcopenic-obese groups had a higher probability of poor ROM recovery compared to the non-obese group (all p < 0.001). Among all body-composition groups, the sarcopenic-obese group yielded the highest risk of postoperative physical difficulty (adjusted HR = 1.63, p = 0.03), independent to the potential confounding factors. Sarcopenic obesity is likely at the high risk of poor ROM outcome following TKR in older individuals with KOA.

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Section: Demographics and Characteristics In The Study Cohortsupporting

confidence: 92%

Section: Demographics and Characteristics In The Study Cohortsupporting

confidence: 92%

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Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study

Liao

Huang

et al. 2021

Nutrients

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“…Singh et al found that BMI had no effect on the postoperative joint perception, and all classes of obesity experienced similar functional outcomes following TKA [12]. We noticed a difference in the functional outcome in the immediate, intermediate, and late postoperative period but the nal functional outcome after one year from the surgery was the same in all obesity classes (Table 4 and Fig.…”

Section: Discussionmentioning

confidence: 55%

Effect of Body Mass Index on the outcomes of primary Total Knee Arthroplasty up to one year- a prospective cohort study

Mishra

Vaish

Vaishya

2021

Preprint

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Background Obesity is an important risk factor in development of knee osteoarthritis, and these cases suffer from complications following Total Knee Arthroplasty (TKA). The association between obesity and outcomes after TKA is ambiguous. Knowledge is scarce about a definite relation between the two. This study aims to establish a correlation between obesity and early outcomes of TKA. Methods This prospective cross-sectional study was done in cases undergoing primary knee arthroplasty between September 2019 to August 2020. Obesity was classified in all cases, and multiple variables like pain, functional status, Range of Motion, knee deformity, and Patient Response Outcome Measures were recorded. Statistical analysis was performed using SPSS Statistical Software version 22.0 and R.3.2.0. The level of statistical significance was taken as p < 0.05. Results We studied 100 knees (37 bilateral and 26 unilateral) in 63 cases. Pain score decreased maximally in the normal and overweight group and minimal in class III obesity (p < 0.001). KSS, FKSS, and PROMs gradually improved in all, except in morbidly obese (p < 0.001). Although the improvement in all variables was minimum in class III obesity compared to other classes of obesity, the margin of difference from the preoperative period was maximum in class III obese participants. Conclusion All cases, irrespective of class of obesity, experienced a comparable improvement in their knee function and improved quality of life. In addition, the TKA offered substantial benefits in terms of range of movement of the knee, pain relief, knee stability, walking distance, and stairs climbing.

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“…FJS-12 has been proven to be simple, valid and reliable in original and translated versions [ 3 , 17 , 20 , 54 – 56 ]. A study in New York found that although patients who were obese (BMI ≥ 30 kg/m 2 ) and received primary TKA provided lower post-surgery FJS-12 scores, statistical significance was not found [ 57 ]. That means FJS-12 is able to accurately reflect patients’ outcome undergoing conservative or operative treatment of the knee, regardless of the patient’s BMI.…”

Section: Discussionmentioning

confidence: 99%

Traditional Chinese-Hong Kong version of Forgotten Joint Score-12 (FJS-12) for patients with osteoarthritis of the knee underwent joint replacement surgery: cross-cultural and sub-cultural adaptation, and validation

Chau

Lau

et al. 2022

BMC Musculoskelet Disord

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Background A patient-reported outcome (PRO) tool which reflects the outcomes of patients underwent total knee arthroplasty (TKA) are important to be “ceiling effect free” which commonly used PRO tools face. Forgotten joint score-12 (FJS-12) has been proved to reduce or even free from ceiling effect. FJS-12 has been translated to different languages. The objectives of this study are to validate FJS-12 in Traditional Chinese-Hong Kong language and look for the goodness of FJS-12 still exist in this language adapted FJS-12 version. Methods FJS-12 was administered to 75 patients whose majority was obese underwent TKA between September 2019 and March 2020. Patients completed 3 sets of questionnaires (FJS-12, Oxford Knee Score (OKS), and Numeric Rating Scale (NRS)) twice, 2 weeks apart. Reliability, internal consistency, responsiveness, test–retest agreement and discriminant validity were evaluated. Results Reliability of FJS-12 showed moderate to excellent internal consistency (Cronbach’s α = 0.870). Test–retest reliability of FJS-12 was good (ICC = 0.769). Bland–Altman plot showed good test–retest agreement. Construct validity in terms of correlations between FJS-12 and OKS, and FJS-12 and NRS were moderate at baseline (Pearson’s coefficient r = 0.598) and good at follow-up (r = 0.879). Smallest detectable change (Responsiveness) was higher than MIC. Floor effect was none observed, and ceiling effect was low. Discriminant validity was found to have no significance. BMI (obesity) did not affect FJS-12 outcomes. Conclusions The Traditional Chinese-Hong Kong version of FJS-12 showed good test–retest reliability, validity, responsiveness, BMI non-specific, with no floor and low ceiling effects for patients who underwent TKA. Sub-culture differences in individual PRO tools should be considered in certain ethnicities and languages.

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The influence of obesity on achievement of a ‘forgotten joint’ following total knee arthroplasty

Cited by 9 publications

References 51 publications

Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study

Effects of Sarcopenic Obesity and Its Confounders on Knee Range of Motion Outcome after Total Knee Replacement in Older Adults with Knee Osteoarthritis: A Retrospective Study

Effect of Body Mass Index on the outcomes of primary Total Knee Arthroplasty up to one year- a prospective cohort study

Traditional Chinese-Hong Kong version of Forgotten Joint Score-12 (FJS-12) for patients with osteoarthritis of the knee underwent joint replacement surgery: cross-cultural and sub-cultural adaptation, and validation

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