scholarly journals Early functional results of total knee arthroplasty in patients with alimentary obesity

2018 ◽  
Vol 25 (3-4) ◽  
pp. 30-35
Author(s):  
M. D Helo ◽  
I. F Akhtiamov ◽  
F. M Said ◽  
I. Sh Gilmutdinov ◽  
A. I Yousef ◽  
...  

Introduction. Total knee replacement has become a standard planned intervention at specialized clinics. The study of surgical results is not as urgent as the follow up of the patients with concomitant pathology because various complications are most often registered in this group. Purpose: to evaluate the efficacy of total knee arthroplasty in patients with increased body mass index at early rehabilitation steps. Patients and methods. Open prospective comparative study included 75 patients with III-IV stages of gonarthrosis by Kellgren-Lawrence. Mean age of the patients made up 63.8±6.87 years. Main group included 48 patients with excessive body mass and alimentary-constitutional obesity of different degree, the control group - 27 patients with normal body mass index. The duration of intervention, volume of blood loss intraoperatively and drainages was assessed. Evaluation of clinical functional results was performed OKS, KSS and visual analog scale (VAS) before surgery, at discharge, 3 months and 1 year after surgical intervention. Results. In comparison to the patients with normal body mass index the patients from the main group showed slightly higher duration of the intervention and intraoperative blood loss - by 13.05% (p=0.027) and 12.8% (p=0.003), respectively. In the main group the severity of pain syndrome by VAS decreased from 90.4±14.4 to 9.6±0.4 mm (p=0.0001), evaluation of clinical functional results by KSS increased from 47.39±1.63 to 88.02±2.01 points, by OKS - from27.3±4.3 to 43.2±6.5 points (p=0.001). In the control group the severity of pain syndrome by VAS within 1 year follow up decreased from 86.2±2.4 to 3.8±0.7 mm (p=0.002) and clinical functional indices by KSS increased from 52.2±10.1 to 93.8±1.3 points (p=0.001), by OKS - from28.4±1.6 to 44.7±1.9 points (p=0,001). Conclusion. The study results demonstrate the high potentialities of arthroplasty in patients with alimentary obesity and confirm the necessity of its performance for the improvement of the patients’ future quality of life.

2017 ◽  
Vol 8 (2) ◽  
pp. 71-77 ◽  
Author(s):  
Tomas Sveikata ◽  
Narunas Porvaneckas ◽  
Paulius Kanopa ◽  
Alma Molyte ◽  
Dalius Klimas ◽  
...  

Introduction: Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis. Patient-reported outcome after TKA is influenced by multiple patient-related factors. The aim of this study was to prospectively evaluate preoperative patient-related factors and to compare the self-reported outcomes 1 year after TKA among groups differing by age, sex, body mass index (BMI), education, and social support level. Methods: 314 patients, who underwent TKA in Vilnius Republican University Hospital between the end of 2012 and the middle of 2014, were included in a study. The preoperative and 12-month follow-up measurements were obtained using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-12 (SF-12). Differences between patient groups according to gender, age, BMI, level of education, and level of social support were analyzed. Results: At 12-month follow-up men demonstrated better results than women in WOMAC ( P = .003) and SF-12 both domains ( P < .05). Patients with a higher social support demonstrated higher scores in physical function according to SF-12 ( P = .008). Better preoperative WOMAC and SF-12 scores were a predictor of better outcome 1 year after surgery. There was no difference in postoperative scores in different age, BMI, and education groups according to WOMAC and SF-12. Conclusion: There is no difference in self-reported functional outcome between patient groups differing in age, BMI, and education. Men and socially supported patients demonstrate better postoperative functional results 12 months after TKA. Better preoperative knee function and overall physical and mental function are predictors of better outcome 1 year after TKA. Age and obesity should not be limiting factors when considering who should receive this surgery.


2018 ◽  
Vol 49 (2) ◽  
Author(s):  
Zorislava Bajić ◽  
Nela Rašeta ◽  
Nenad Ponorac

Introduction: Bone formation marker osteocalcin (OC) and bone resorption marker C-terminal telopeptide of type 1 collagen (CTX) can be used to detect or to monitor the early responses of the skeleton to physical activity. Literature suggests that it is likely that higher body mass index (BMI) has positive effect on bones and can postpone onset of osteoporosis.Aim of the Study: The aim of this study is to:1.Determine the effect of aerobic physical acitivity on OC and CTX in young women2.Investigate correlation of OC, CTX and BMI in young women engaged into structured aerobic excerciseMaterial and methods: Study included 64 healthy young women, aged 19 to 25 years, devided into two groups: intervention group (n=32) and control group (n=32). The study duration was six weeks with follow-up period of four weeks. The intervention group underwent structured aerobic physical activity program for six weeks, but the control group did not receive such program. Level of OC, CTX and BMI were measured at baseline, after 6-week aerobic program, and after 4-week follow up (only intervention group).Results: There was significant increase of OC level after 6-week aerobic program, while level of CTX did not changed. OC level was at its maximum immediately after finishing the program in the participants with normal BMI (p<0.001). There was no statistically significant interaction of BMI and CTX level.Conclusion: Aerobic physical activity increases level of osteocalcin, suggesting that it has positive influence on bone formation in young women, primarily in women with normal BMI.


Kinesiology ◽  
2016 ◽  
Vol 48 (1) ◽  
pp. 132-141 ◽  
Author(s):  
Alberto Grao-Cruces ◽  
Rafael Ruiz-López ◽  
José-Enrique Moral-García ◽  
Alberto Ruiz-Ariza ◽  
Emilio J. Martínez-López

The aim of the study was to assess the effects that a steps/day programme may have on body mass index (BMI) among primary education students (11.37±0.48 years). A six-week controlled trial with a follow-up was completed with an experimental group (N=66, pedometer + steps/day programme + reinforcement programme in their physical education (PE) marks + weekly follow-up in PE), and a control group (N=76). Omron HJ-152-E2 pedometers were used. Normoweight students complied with programme requirements to a greater extent than their overweight counterparts (72.7 vs 59.1%). The programmed minimum number of 12,000 steps/day for boys and 10,000 for girls was exceeded by 83% of boys and 60% of girls. The differences in the number of steps/day between boys (14,274) and girls (10,626) were significant across all the measured periods (p&lt;.05). The results show that the teenagers who complied with the programme requirements reduced their BMI significantly after the intervention (p&lt;.001) and this reduction persisted for six weeks after the programme (p&lt;.001). In conclusion, the six-week programme of 12,000 steps/day for boys and 10,000 for girls, jointly with a reinforcement programme in their PE marks and weekly follow-up by their PE teacher, reduces BMI significantly in 11-12-year-old schoolchildren. Monitored steps/day programmes in the PE curriculum increase out-of-school physical activity and reduce BMI in 11-12-year-old schoolchildren.


Author(s):  
Matthew A. Siegel ◽  
Michael J. Patetta ◽  
Angie M. Fuentes ◽  
Armaan S. Haleem ◽  
Craig W. Forsthoefel ◽  
...  

AbstractKnee range of motion (ROM) is an important postoperative measure of total knee arthroplasty (TKA). There is conflicting literature whether patients who are obese have worse absolute ROM outcomes than patients who are not obese. This study analyzed whether preoperative body mass index (BMI) influences knee ROM after patients' primary TKA. A retrospective investigation was performed on patients, who underwent primary TKA at an academic institution, by one of three fellowship-trained adult reconstruction surgeons. Patients were stratified according to their preoperative BMI into nonobese (BMI < 30.0 kg/m2) and obese (BMI ≥ 30.0 kg/m2) classifications. Passive ROM was assessed preoperatively as well as postoperatively at patients' most recent follow-up visit that was greater than 2 years. Mann–Whitney U tests were performed to determine statistical significance at p-value <0.05 for ROM outcomes. No statistically significant differences were observed when ROM in the nonobese group was compared with ROM in the obese group both preoperatively (105.73 ± 11.58 vs. 104.14 ± 13.58 degrees, p-value = 0.417) and postoperatively (105.83 ± 14.19 vs. 104.49 ± 13.52 degrees, p-value = 0.777). Mean follow-up time for all patients was 4.49 ± 1.92 years. In conclusion, long-term postoperative ROM outcomes were similar between patients who were nonobese and patients who were obese.


2020 ◽  
Vol 48 (7) ◽  
pp. 1625-1635
Author(s):  
David R. Maldonado ◽  
Jeffery W. Chen ◽  
Mitchell J. Yelton ◽  
Philip J. Rosinsky ◽  
Jacob Shapira ◽  
...  

Background: Association among generalized ligamentous laxity (GLL), hip microinstability, and patient-reported outcomes (PROs) after hip arthroscopy has yet to be completely established. Purposes: (1) To report minimum 2-year PROs in patients with GLL who underwent hip arthroscopy in the setting of symptomatic labral tears and femoroacetabular impingement syndrome and (2) to compare clinical results with a matched-pair control group without GLL. Study Design: Cohort study; Level of evidence, 3. Methods: Data from a prospectively collected database were retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain (VAS). From the sample population, 2 groups were created: the GLL group (Beighton score ≥4) and the control group (Beighton score <4). Patients were matched in a 1:2 ratio via propensity score matching according to age, sex, body mass index, Tönnis grade, and preoperative lateral center-edge angle. Patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS, Hip Outcome Score–Sports Specific Scale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12) were calculated. Results: A total of 57 patients with GLL were matched to 88 control patients. Age, sex, body mass index, and follow-up times were not different between groups ( P > .05). Preoperative radiographic measurements demonstrated no difference between groups. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving a greater percentage of capsular plications ( P = .04). At minimum 2-year follow-up, both groups showed significant improvement in PROs and VAS ( P < .001). Furthermore, the postoperative PROs at minimum 2-year follow-up and the magnitude of improvement (delta value) were similar between groups for mHHS, NAHS, HOS-SSS, and VAS ( P > .05). Moreover, groups reached comparable rates of MCID and PASS for mHHS, HOS-SSS, and iHOT-12. Conclusion: Patients with GLL after hip arthroscopy for symptomatic femoroacetabular impingement and labral tears may expect favorable outcomes with appropriate labral and capsular management at minimum 2-year follow-up. When compared with a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, and VAS and reached PASS and/or MCID for mHHS, HOS-SSS, and iHOT-12.


Author(s):  
Nagendra Gowtham Rayudu Yelamarthi ◽  
Raghu Yelavarthi ◽  
Rajashekhar Tati

<p class="abstract"><strong>Background:</strong> Obesity is associated with an increased risk of osteoarthritis, and the incidence of obese patients requiring a total knee replacement (TKR) has increased in recent years. A high body mass index (BMI) may influence post‐TKR rehabilitation outcomes. The aim of the present study was to assess the effects of obesity on functional mobility outcomes following post‐TKR rehabilitation in Asian patients where BMI was not as high as those reported in similar studies performed other countries other than Asian.</p><p class="abstract"><strong>Methods:</strong> A total of 100 patients were categorized as normal weight (n=11), overweight (n=10), class I obese (n=28), or class II obese (n=32), class III obese (n=19). Patients were retrospectively followed up for 6 months after undergoing TKR followed by 2 months of active rehabilitation. Outcome measures were recorded at baseline and at the 2‐month and 6‐month follow-up assessments and included the Western Ontario and McMaster Universities Osteoarthritis Index and the following tests: functional reach, single‐leg stance, ten‐meter walk, timed up and go, chair rise, and stair climbing.<strong></strong></p><p class="abstract"><strong>Results:</strong> A 4×3 (group×time) repeated‐measures analysis of variance showed significant improvement in all of the outcome measures for all of the BMI groups at the 2‐month and 6‐month follow-up assessments (p&lt;0.05 for all). No significant intergroup differences at the 2‐month and 6‐month follow-up assessments were observed for any of the mobility measures except the functional reach and single‐leg stance (p&lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Patients with class II/III obesity benefit from early post‐TKR outpatient rehabilitation and respond well. Also, the patients with lower BMIs showed significant improvements and patients with a high BMI might require additional balance-based exercises in their post-TKR rehabilitation protocols.</p>


2021 ◽  
Vol 11 (4(42)) ◽  
pp. 28-33
Author(s):  
A. Borshuliak ◽  
O. Andriets ◽  
A. Andriets ◽  
A. Semeniak

Іntroduction. Today, a quarter of the population of economically developed countries has a body weight that is 15% larger than the norm. According to various authors, the timely onset of menarche in women with various forms of obesity and reproductive dysfunction is observed in 31% of cases only. Obesity results in insulin resistance, which in its turn results in hyperinsulinemia. The main reason of the connection of insulin resistance with reproductive function disorders consists in the specific influence of insulin on ovaries. Insulin suppresses apoptosis, binding to receptors of various growth factors that promotes long existence of atresizing follicles. In the pathogenesis of the metabolic syndrome, along with the development of hyperinsulinemia and insulin resistance, a significant role belongs to the imbalance of adipocytokines, one of which is adiponectin. The aim is to analyze metabolic processes in the formation of menstrual dysfunction in adolescent girls with obesity to improve diagnostic methods of menstrual disorders. Material and methods. Clinical and laboratory examination of adolescent girls aged 12-18 years was held, among which 79 had obesity and complaints about menstrual dysfunction (the main group); 31 with normal body weight and regular menstrual cycle (the control group). Research methods: general clinical, biochemical (indicators of lipid and carbohydrate metabolism were determined), instrumental (ultrasound), statistical. Results. It was found that 53.3% of the girls from the main group had the beginning of the first menstruation after 14 years, delayed menstruation from 42 days to 6 days, duration 2.1 ± 0.05 days, which was significantly shorter, the volume of 10.2 ± 0.05; 0.4 points (average 1-2 pads per day) was significantly lower (p <0.05). Ultrasound showed uterine hypoplasia in almost every second girl in the main group - 36 (45.46%). Hyperleptinemia and leptin resistance was found in obesity of the first degree 34.8 ± 1.75, in obesity of the second degree 37.15 ± 2.12, in obesity of the third degree 40.64 ± 2.0. It was 14.35 ng / ml in the control group, p<0,01. Hyperleptinemia in the main group was accompanied by hyperinsulinemia in 26% of cases and insulin resistance. The relationship between low values of adiponectin and elevated body mass index in patients of the main group was established, which was confirmed by the results of correlation analysis (adiponectin & body mass index: ρ = -0.74). Analysis of the results revealed a decrease of A/L level in the main group by 4.3 times. Based on our own results, the A/L and HOMA-AD models can be considered more accurate for determining insulin resistance. Conclusions. 1. Changes of the menstrual cycle in overweight girls were found. The association of adipokines secretion disorders is characterized by hyperleptinemia, leptin resistance, decreased Adiponectin / Leptin index and hypoadiponectinemia, which, in combination with insulin resistance, indicates the participation of adipokines in the genesis of oligomenorrhea. The algorithm of adolescents’ treatment with menstrual dysfunction on the background of obesity must include the calculation of Adiponectin/Leptin and HOMA-AD, which will make it possible to avoid overdiagnosis of insulin resistance.


2016 ◽  
Vol 22 (2) ◽  
pp. 66-69
Author(s):  
Veronika S. Pshennova ◽  
O. V Aleksandrov

The article presents the results of study demonstrating that though evident symptoms of pulmonary hypertension were absent (maximal systolic tension was within standards both in males and females of main group) reliable increasing of blood pressure in pulmonary artery in comparison with control group under increasing of body mass index, waist volume and index waist/hips. At that, in males of main group under obesity degree I and II average blood pressure exceeded limits of standards.


Author(s):  
A. I. Gorbatenko ◽  
N. O. Kostyanaya

Efficacy of platelet-rich autoplasma (PRA) in treatment of osteoarthrosis was evaluated. Prospective study included 120 patients (83 females, 37 males, mean age 52.8±4.5 years) with clinical and roentgenologic diagnosis of II-IV stage osteoarthrosis by Kellgren-Lawrence classification. The patients from the main group (n=60) were on courses of PRA intraarticular injections (3 injections with 1-2 weeks interval). In the control group the patients received nonsteroidal anti-inflammatory drugs (NSAIDs) and periodically injections of glucocorticoids when indicated. Results were assessed by the verbal efficacy scale, Lequesne index and the pain visual analog scale. Follow up period made up 6 months. Use of PRA enabled to eliminate pain syndrome and improve knee joint function without adverse effects. In 6 months the number of patients who noted the efficacy of treatment was 31% higher in the main group than in the control one. The obtained results allow recommending PRA use for knee osteoarthrosis treatment as an alternative to NSAIDs especially in contraindications to the latter.


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