Update on hip and knee arthroplasty: Current state of evidence

Jones, Dina L.; Westby, Marie; Greidanus, Nelson V.; Johanson, Norman A.; Krebs, David E.; Robbins, Laura Pope; Rooks, Daniel; Brander, Victoria A.

doi:10.1002/art.21465

Cited by 72 publications

(45 citation statements)

References 129 publications

(94 reference statements)

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“…TKA can improve the HRQL of patients with knee OA, reducing pain and increasing functional capacity when conservative treatment fails [19]. Some suggest the greatest improvements in pain and function occur during the first 3 to 6 months after surgery [4,14]. However, patient characteristics and surgical factors are important determinants of outcomes in TKA.…”

Section: Introductionmentioning

confidence: 99%

“…Disease-specific instruments focus on issues related to a particular health condition and can be used in therapeutic management [22]. In knee OA, the disease-specific WOMAC (LK 3.0) questionnaire is used for assessing functional outcomes in TKA [1] and often is used after total joint replacement to measure impairment, activity limitations, and participation restrictions [14]. Some studies suggest that condition-or limbspecific instruments are more sensitive to change [5,14,29].…”

Section: Introductionmentioning

confidence: 99%

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Factors Influencing Health-related Quality of Life after TKA in Patients who are Obese

Núñez

Lozano

Núñez

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Although the health-related quality of life (HRQL) for patients who are obese seems to improve after TKA, the magnitude of improvement and the associated factors remain controversial. We previously found body mass index was not associated with changes in HRQL after TKA. Questions/purposes The purposes of this secondary analysis were to determine which patient characteristics and surgical factors were associated with worse health status after TKA in patients who are severe or morbidly obese. Methods We assessed 60 patients (53 females; mean age, 70 years) 12 months after surgery. The mean number of comorbidities was 2.5. Mean lower limb anthropometric index scores were: suprapatellar, 1.6; infrapatellar, 2; and suprapatellar/infrapatellar, 1.2. Intraoperative difficulty (IOD) was Grade 0, 40%; Grade 1, 48%; and Grade 2, 12%. Ten patients (17%) had complications. We measured HRQL using the disease-specific WOMAC questionnaire. Patient characteristics (sociodemographic variables, BMI, comorbidity, lower limb anthropometry) and surgical factors (IOD, complications, postoperative medical data) were collected. Associations between WOMAC dimension scores at 12 months and patient characteristics and surgical factors were analyzed using linear regression models. Results Factors associated with worse WOMAC dimension scores in patients who were obese included the number of comorbidities, an infrapatellar index percentile less than 75, IOD Grade 2, and the number of complications after discharge. Conclusions For patients with knee osteoarthritis who were severe or morbidly obese, various lower limb anthropometric features, degree of IOD, and postoperative complications negatively influenced postoperative WOMAC scores. Level of EvidenceLevel II Prognostic Study. See Guidelines for a complete description of levels of evidence.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors Influencing Health-related Quality of Life after TKA in Patients who are Obese

Núñez

Lozano

Núñez

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…Complications of KR, although rare and preventable, include throm boembolism, infection and prosthesis failure [6] . Many studies have reported how patients' charac teristics such as age, gender and obesity influenced the outcome and prognosis of knee arthroplasty [7,8] . Nonetheless, the importance of these factors on the decision to perform knee arthroplasty is debatable among surgeons [9] .…”

Section: Introductionmentioning

confidence: 99%

Total knee arthroplasty: Effect of obesity and other patients’ characteristics on operative duration and outcome

Turki

Dakhil

Turki

et al. 2015

WJO

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AIM:To examine the effects of patients' characteristics mainly obesity on operative duration and other outcome measures of knee arthroplasty. METHODS:This is a retrospective chart review of 204 patients who had knee arthroplasty within the past five years (2007)(2008)(2009)(2010)(2011) at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia. The data collection form was developed utilizing the literature review to gather all the needed variables. Data were gathered from admission notes, nursing notes, operative reports and discharge summaries. RESULTS:A feasible sample of 204 patients were included in the study. Of those patients, 155 (76%) were females. The mean age was 70.1 years for males (SD ± 9.4) and 62.7 years (SD ± 8) for females. Regarding the type of total knee replacement (TKR), 163 (79.9%) patients had unilateral TKR and 41 (20.1%) had bilateral TKR. Nine patients (4.4%) had a normal body mass index (BMI) (18.5 to < 25). Overweight patients (BMI 25 to < 30) represented 18.1%. Obesity class Ⅰ (BMI 30 to < 35) and obesity class Ⅱ (BMI from 35 to < 40) were present in 23% and 29.9% of the patients, respectively. Morbid obesity (BMI greater than 40) was present in 24.5%. The mean duration of surgery was 126.3 min (SD ± 30.8) for unilateral TKR and 216.6 min (SD ± 55.4) for bilateral TKR.The mean length of stay in the hospital was 12 d (SD ± 4.9). The complications that patients had after the operation included 2 patients (1%) who developed deep venous thrombosis, 2 patients (1%) developed surgical wound infections and none had pulmonary embolism. Patients' characteristics (including age, gender, BMI and co-morbidities) did not have an effect on the operative duration of knee replacement nor the length of hospital stay. CONCLUSION:Our study shows that obesity and other patients' characteristics do not have effect on the operative duration nor the length of hospital stay following TKR. Core tip: Studying the effects of obesity and other patient's characteristics on the outcome and operative duration of knee arthroplasty (KA) is of great value for both patients and physicians. Studies regarding this subject have shown conflicting results, and the importance of these factors on the decision to perform KA is debatable among surgeons. In our study, we demonstrated that higher body mass index values were not associated with longer duration of surgery. We also found that patients' characteristics did not seem to be an important determinant of length of stay.

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“…for knee and hip joints [1][2]. In order to limit time spent during hospitalisation (primarily) and to restore functional ability rapidly (secondarily), several peri-operative training programmes and clinical pathways have been designed in the past [3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Patients with impairment of multiple joints after a total joint replacement benefit from three weeks’ intensive exercise training directly following hospital discharge.

D¹,

Bulthuis²,

E³

et al. 2013

Cureus

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Update on hip and knee arthroplasty: Current state of evidence

Cited by 72 publications

References 129 publications

Factors Influencing Health-related Quality of Life after TKA in Patients who are Obese

Factors Influencing Health-related Quality of Life after TKA in Patients who are Obese

Total knee arthroplasty: Effect of obesity and other patients’ characteristics on operative duration and outcome

Patients with impairment of multiple joints after a total joint replacement benefit from three weeks’ intensive exercise training directly following hospital discharge.

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