Preoperative Weight Loss for Morbidly Obese Patients Undergoing Total Knee Arthroplasty

2019 ◽  
Vol 101 (16) ◽  
pp. 1440-1450 ◽  
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

The Rise of Obesity among Total Knee Arthroplasty Patients

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.

The Use of Stems for Morbid Obesity in Total Knee Arthroplasty

2019 ◽  
Vol 32 (07) ◽  
pp. 607-610 ◽  
Author(s):  
Blake J. Schultz ◽  
Malcolm R. DeBaun ◽  
James I. Huddleston
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
High Risk Patient ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Limited Data ◽  
Implant Fixation ◽  
Knee Motion ◽  
Total Knee ◽  
Nonobese Patients

AbstractMorbidly obese patients undergoing total knee arthroplasty have worse functional outcomes and implant survival, and increased revision rates compared with nonobese patients. In addition to increased medical comorbidities and difficult exposure, increased stress on the tibial implant and altered kinematics of knee motion contribute to aseptic loosening and medial collapse. Increased implant fixation, including use of a stemmed tibial implant, may be a way to help avoid these complications. While there is limited data on tibial stems in the morbidly obese patients specifically, cemented stemmed tibial implants should be strongly considered in these patients, especially if bone quality is poor. The initial increased cost of a stemmed implant can be justified in this high-risk patient population to minimize the risk of costly revisions related to compromised tibia component fixation.

Safety of Bilateral Total Knee Arthroplasty in Morbidly Obese Patients

Orthopedics ◽  
2014 ◽  
Vol 37 (3) ◽  
pp. e252-e259 ◽  
Author(s):  
Adam A. Madsen ◽  
Benjamin C. Taylor ◽  
Craig Dimitris ◽  
Dane C. Hansen ◽  
Robert A. Steensen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Bilateral Total Knee Arthroplasty ◽  
Total Knee

Preoperative risk stratification minimizes 90-day complications in morbidly obese patients undergoing primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 45-50
Author(s):  
Yehuda E. Kerbel ◽  
Mitchell A. Johnson ◽  
Stephen R. Barchick ◽  
Jordan S. Cohen ◽  
Kimberly Lola Stevenson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Risk Stratification ◽  
Knee Arthroplasty ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Preoperative Risk ◽  
Rehabilitation Facility ◽  
Significant Difference ◽  
Total Knee ◽  
Preoperative Risk Stratification

Aims It has been shown that the preoperative modification of risk factors associated with obesity may reduce complications after total knee arthroplasty (TKA). However, the optimal method of doing so remains unclear. The aim of this study was to investigate whether a preoperative Risk Stratification Tool (RST) devised in our institution could reduce unexpected intensive care unit (ICU) transfers and 90-day emergency department (ED) visits, readmissions, and reoperations after TKA in obese patients. Methods We retrospectively reviewed 1,614 consecutive patients undergoing primary unilateral TKA. Their mean age was 65.1 years (17.9 to 87.7) and the mean BMI was 34.2 kg/m2 (SD 7.7). All patients underwent perioperative optimization and monitoring using the RST, which is a validated calculation tool that provides a recommendation for postoperative ICU care or increased nursing support. Patients were divided into three groups: non-obese (BMI < 30 kg/m2, n = 512); obese (BMI 30 kg/m2 to 39.9 kg/m2, n = 748); and morbidly obese (BMI > 40 kg/m2, n = 354). Logistic regression analysis was used to evaluate the outcomes among the groups adjusted for age, sex, smoking, and diabetes. Results Obese patients had a significantly increased rate of discharge to a rehabilitation facility compared with non-obese patients (38.7% (426/1,102) vs 26.0% (133/512), respectively; p < 0.001). When stratified by BMI, discharge to a rehabilitation facility remained significantly higher compared with non-obese (26.0% (133)) in both obese (34.2% (256), odds ratio (OR) 1.6) and morbidly obese (48.0% (170), OR 3.1) patients (p < 0.001). However, there was no significant difference in unexpected ICU transfer (0.4% (two) non-obese vs 0.9% (seven) obese (OR 2.5) vs 1.7% (six) morbidly obese (OR 5.4); p = 0.054), visits to the ED (8.6% (44) vs 10.3% (77) (OR 1.3) vs 10.5% (37) (OR 1.2); p = 0.379), readmissions (4.5% (23) vs 4.0% (30) (OR 1.0) vs 5.1% (18) (OR 1.4); p = 0.322), or reoperations (2.5% (13) vs 3.3% (25) (OR 1.2) vs 3.1% (11) (OR 0.9); p = 0.939). Conclusion With the use of a preoperative RST, morbidly obese patients had similar rates of short-term postoperative adverse outcomes after primary TKA as non-obese patients. This supports the assertion that morbidly obese patients can safely undergo TKA with appropriate perioperative optimization and monitoring. Cite this article: Bone Joint J 2021;103-B(6 Supple A):45–50.

Ten-Year Mortality and Revision After Total Knee Arthroplasty in Morbidly Obese Patients

2018 ◽  
Vol 33 (8) ◽  
pp. 2518-2523 ◽  
Author(s):  
Mina Tohidi ◽  
Susan B. Brogly ◽  
Katherine Lajkosz ◽  
Heather J. Grant ◽  
Elizabeth G. VanDenKerkhof ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Total Knee

Insulin Dependence Increases the Risk of Failure After Total Knee Arthroplasty in Morbidly Obese Patients

2016 ◽  
Vol 31 (1) ◽  
pp. 256-259 ◽  
Author(s):  
Chad D. Watts ◽  
Matthew T. Houdek ◽  
Eric R. Wagner ◽  
Matthew P. Abdel ◽  
Michael J. Taunton
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Risk Of Failure ◽  
Insulin Dependence ◽  
Total Knee

Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Achieve Comparable Weight Loss at 1 Year

2012 ◽  
Vol 78 (12) ◽  
pp. 1325-1328 ◽  
Author(s):  
Arezou Yaghoubian ◽  
Amy Tolan ◽  
Bruce E. Stabile ◽  
Amy H. Kaji ◽  
Gary Belzberg ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Excess Weight Loss ◽  
Weight Loss Program ◽  
Excess Weight ◽  
Morbidly Obese ◽  
Preoperative Weight Loss ◽  
Obese Patients ◽  
Laparoscopic Rygb ◽  
Preoperative Weight

Laparoscopic sleeve gastrectomy has gained popularity as a weight loss surgical option for morbidly obese patients. Although initial studies have shown weight loss and comorbidity resolution comparable to those after laparoscopic Roux-en-Y gastric bypass (RYGB), many of these studies are limited by the small patient size. Thus, the purpose of this study was to compare the outcomes of laparoscopic sleeve gastrectomy and laparoscopic RYGB. A retrospective chart review of all morbidly obese patients who underwent laparoscopic RYGB or sleeve gastrectomy between 2007 and 2009 at an HMO hospital was conducted. Data points collected included age, gender, completion of a preoperative weight loss program, initial body mass index (BMI), pre- and postoperative weights, and presence of diabetes mellitus (DM), hypertension (HTN), osteoarthritis, obstructive sleep apnea, and gastroesophageal reflux disease (GERD). Outcomes measures included excess weight loss, resolution of comorbidities, postoperative complications, and mortality. A total of 345 laparoscopic RYGBs and 192 sleeve gastrectomies were performed. On average, the patients who received RYGB were younger (46 vs 48 years, P = 0.05) and had higher BMI (47 vs 43 kg/m2, P < 0.0001). There was a higher incidence of DM in the RYGB group (32 vs 22%, P = 0.01), whereas the incidences of HTN and GERD were similar in both surgical groups. Ninety-three per cent of the patients who underwent RYGB and 90 per cent of the patients who underwent sleeve gastrectomy completed a preoperative weight loss program. The median length of hospital stay for both groups was 3 days. The complication rate in both groups was 9 per cent. The incidence of gastric leak was 1 per cent in both groups. There was only one mortality, which occurred in the RYGB group. The postoperative resolution of DM was comparable in both groups. The RYGB group had greater resolution of HTN (48 vs 34%, P = 0.03) and GERD (73 vs 34%, P < 0.0001). At 12 months, sleeve gastrectomy achieved superior excess weight loss compared with RYGB (72 vs 61%, P = 0.0015). After adjusting for age and BMI, the excess weight loss for RYGB and sleeve gastrectomy was similar at 12 months (t parameter estimate -0.06, P = 0.08). Laparoscopic RYGB and sleeve gastrectomy had comparable postoperative morbidity and mortality rates. At 1 year, sleeve gastrectomy achieved only slightly greater weight loss. The two operations are both legitimate standalone bariatric procedures and their applications need to be based on individual patient characteristics and needs.

scholarly journals Total Knee Arthroplasty in Morbidly Obese Patients Treated With Bariatric Surgery

2012 ◽  
Vol 27 (9) ◽  
pp. 1696-1700 ◽  
Author(s):  
Erik P. Severson ◽  
Jasvinder A. Singh ◽  
James A. Browne ◽  
Robert T. Trousdale ◽  
Michael G. Sarr ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Total Knee
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