Cemented versus Cementless Total Knee Arthroplasty in Obese Patients with BMI ≥35: A Contemporary Analysis of 812 Patients

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

Download Full-text

Total knee arthroplasty in obese patients

Current Orthopaedic Practice ◽

10.1097/bco.0b013e3282f54080 ◽

2008 ◽

Vol 19 (2) ◽

pp. 170-173

Author(s):

Stephen R Thompson ◽

Robert S Sterling ◽

Michael J OʼBrien

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Obese Patients ◽

Total Knee

Download Full-text

The influence of obesity on functional outcome and quality of life after total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b5.bjj-2017-1263.r1 ◽

2018 ◽

Vol 100-B (5) ◽

pp. 579-583 ◽

Cited By ~ 16

Author(s):

S. Xu ◽

J. Y. Chen ◽

N. N. Lo ◽

S. L. Chia ◽

D. K. J. Tay ◽

...

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Functional Outcome ◽

Knee Arthroplasty ◽

Obese Group ◽

Control Group ◽

Obese Patients ◽

Knee Score ◽

Total Knee

AimsThis study investigated the influence of body mass index (BMI) on patients’ function and quality of life ten years after total knee arthroplasty (TKA).Patients and MethodsA total of 126 patients who underwent unilateral TKA in 2006 were prospectively included in this retrospective study. They were categorized into two groups based on BMI: < 30 kg/m2(control) and ≥ 30 kg/m2(obese). Functional outcome was assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), and Oxford Knee Score (OKS). Quality of life was assessed using the Physical (PCS) and Mental Component Scores (MCS) of the 36-Item Short-Form Health Survey.ResultsPatients in the obese group underwent TKA at a younger age (mean, 63.0 years, sd 8.0) compared with the control group (mean, 65.6 years, sd 7.6; p = 0.03). Preoperatively, both groups had comparable functional and quality-of-life scores. Ten years postoperatively, the control group had significantly higher OKS and MCS compared with the obese group (OKS, mean 18 (sd 5) vs mean 22 (sd 10), p = 0.03; MCS, mean 56 (sd 10) vs mean 50 (sd 11), p = 0.01). After applying multiple linear regression with the various outcomes scores as dependent variables and age, gender, and Charlson Comorbidity Index as independent variables, there was a clear association between obesity and poorer outcome in KSFS, OKS, and MCS at ten years postoperatively (p < 0.01 in both KSFS and OKS, and p = 0.03 in MCS). Both groups had a high satisfaction rate (97.8% in the control group vs 87.9% in the obese group, p = 0.11) and fulfillment of expectations at ten years (98.9% in the control group vs 100% in the obese group, p = 0.32).ConclusionAlthough both obese and non-obese patients have significant improvements in function and quality of life postoperatively, obese patients tend to have smaller improvements in the OKS and MCS ten years postoperatively. It is important to counsel patients on the importance of weight management to achieve a more sustained outcome after TKA. Cite this article: Bone Joint J 2018;100-B:579–83.

Download Full-text

Economic Considerations for Obese Patients Undergoing Total Knee Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.16.00907 ◽

2016 ◽

Vol 98 (24) ◽

pp. e113 ◽

Cited By ~ 2

Author(s):

Ronald E. Delanois ◽

Nirav K. Patel ◽

Jaydev B. Mistry ◽

Michael A. Mont

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Obese Patients ◽

Total Knee ◽

Economic Considerations

Download Full-text

Preoperative Weight Loss for Morbidly Obese Patients Undergoing Total Knee Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.18.01136 ◽

2019 ◽

Vol 101 (16) ◽

pp. 1440-1450 ◽

Cited By ~ 10

Author(s):

Benjamin J. Keeney ◽

Daniel C. Austin ◽

David S. Jevsevar

Keyword(s):

Weight Loss ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Morbidly Obese ◽

Preoperative Weight Loss ◽

Obese Patients ◽

Total Knee ◽

Preoperative Weight

Download Full-text

The Rise of Obesity among Total Knee Arthroplasty Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1710566 ◽

2020 ◽

Author(s):

Nequesha S. Mohamed ◽

Wayne A. Wilkie ◽

Ethan A. Remily ◽

Iciar M. Dávila Castrodad ◽

Mirlande Jean-Pierre ◽

...

Keyword(s):

Morbid Obesity ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

The United States ◽

National Database ◽

Categorical Variables ◽

Morbidly Obese ◽

Obese Patients ◽

Total Knee ◽

Nonobese Patients

AbstractIn the United States, one-third of adults are considered obese, and demand for total knee arthroplasty (TKA) is expected to rise in these patients. Surgeons are reluctant to operate on obese patients, but it is important to understand how obesity has affected TKA utilization. This study utilizes a national database to evaluate incidence, demographics, outcomes, charges, and cost in nonobese, overweight, nonmorbidly obese, and morbidly obese TKA patients. We queried the National Inpatient Sample from 2009 to 2016 for primary TKA patients identifying 4,053,037 nonobese patients, 40,077 overweight patients, 809,649 nonmorbidly obese patients, and 428,647 morbidly obese patients. Chi-square was used to analyze categorical variables, and one-way analysis of variance was used to analyze continuous variables. Nonmorbidly obese and morbidly obese patients represented 23.2% of all TKAs. TKA utilization increased 4.1% for nonobese patients, 121.6% for overweight patients, 73.6% for nonmorbidly obese patients, and 83.9% for morbidly obese patients. Morbidly obese patients were younger (p < 0.001), female (p < 0.001), Black (p < 0.001), poor (p < 0.001), and utilized private insurance (p < 0.001). They also had the longest length of stay (p < 0.001) and the highest mortality rate (p < 0.001). More morbidly obese patients were discharged to other facilities (p < 0.001), and they had the highest rate of complications (p < 0.001). Patients with morbid obesity had the highest charges (p < 0.001), but overweight patients had the highest costs (p < 0.001). The results of this study demonstrate the rise in obese and morbidly obese patients seeking TKAs, which may be reflection of the obesity epidemic in America. Although TKA utilization has increased for morbidly obese patients, this body mass index (BMI) category also has the highest rates of charges and complications, suggesting morbid obesity to be a modifiable risk factor leading to worse surgical and economic outcomes. Obese patients undergoing TKA may benefit from preoperative optimization of their weight, in an effort to reduce the risk of adverse outcomes.

Download Full-text