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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2015

01-06-2015 | Knee

The influence of body mass index on the outcomes of primary total knee arthroplasty

Authors: Hai-bo Si, Yi Zeng, Bin Shen, Jing Yang, Zong-ke Zhou, Peng-de Kang, Fu-xing Pei

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2015

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Abstract

Purpose

The body mass index (BMI) is widely recognized as a prognostic factor in multiple operations; however, the relationship between the BMI and outcomes following total knee arthroplasty (TKA) is extensively debated. We aimed to evaluate the effect of the BMI at different cutoff values on the outcomes following primary TKA.

Methods

Electronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for studies investigating the association between the BMI and outcomes following primary TKA. Two investigators independently reviewed studies for eligibility, assessed the study quality using the Newcastle-Ottawa Scale and extracted the data. A meta-analysis was performed using Review Manager software.

Results

Twenty-eight articles including a total of 20,988 TKAs were identified. The postoperative Knee Society Score appeared to trend lower in obese (BMI ≥ 30 kg/m2) patients than in non-obese (BMI < 30 kg/m2) patients. The meta-analysis showed that revision with follow-up ≥5 years, any infection, superficial infection and deep vein thrombosis occurred statistically more frequently in obese patients, whereas a deep infection occurred statistically more frequently in morbidly obese (BMI ≥ 40 kg/m2) patients than in non-obese patients. No differences in aseptic loosening with follow-up ≥5 years, pulmonary embolism and perioperative mortality rates were found between obese and non-obese patients.

Conclusions

Patients with a BMI ≥ 30 kg/m2 are at a higher risk of lower functional scores and developing complications following primary TKA. It appears reasonable to encourage obese patients to lose weight before selective TKA.

Level of evidence

Prognostic study, Level III.
Literature
1.
Amin AK, Clayton RAE, Patton JT, Gaston M, Cook RE, Brenkel IJ (2006) Total knee replacement in morbidly obese patients: results of a prospective, matched study. J Bone Joint Surg Br 88(10):1321–1326CrossRefPubMed
2.
Amin AK, Patton JT, Cook RE, Brenkel IJ (2006) Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br 88(3):335–340CrossRefPubMed
3.
Bellocco R, Jia C, Ye W, Lagerros YT (2010) Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the swedish national march cohort. Eur J Epidemiol 25(11):777–788CrossRefPubMed
4.
Benjamin J, Tucker T, Ballesteros P (2001) Is obesity a contraindication to bilateral total knee arthroplasties under one anesthetic? Clin Orthop Relat Res 392:190–195CrossRefPubMed
5.
Bordini B, Stea S, Cremonini S, Viceconti M, De Palma R, Toni A (2009) Relationship between obesity and early failure of total knee prostheses. BMC Musculoskelet Disord 10:29CrossRefPubMedCentralPubMed
6.
Bourne RB, McCalden RW, MacDonald SJ, Mokete L, Guerin J (2007) Influence of patient factors on TKA outcomes at 5 to 11 years followup. Clin Orthop Relat Res 464:27–31PubMed
7.
Chesney D, Sales J, Elton R, Brenkel IJ (2008) Infection after knee arthroplasty—a prospective study of 1509 cases. J Arthroplasty 23(3):355–359CrossRefPubMed
8.
Collins RA, Walmsley PJ, Amin AK, Brenkel IJ, Clayton RA (2012) Does obesity influence clinical outcome at nine years following total knee replacement? J Bone Joint Surg Br 94(10):1351–1355CrossRefPubMed
9.
Deshmukh RG, Hayes JH, Pinder IM (2002) Does body weight influence outcome after total knee arthroplasty? A 1-year analysis. J Arthroplasty 17(3):315–319CrossRefPubMed
10.
Dewan A, Bertolusso R, Karastinos A, Conditt M, Noble PC, Parsley BS (2009) Implant durability and knee function after total knee arthroplasty in the morbidly obese patient. J Arthroplasty 24(6 Suppl):89–94CrossRefPubMed
11.
Dowsey MM, Choong PF (2009) Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res 467(6):1577–1581CrossRefPubMedCentralPubMed
12.
Dowsey MM, Liew D, Stoney JD, Choong PF (2010) The impact of pre-operative obesity on weight change and outcome in total knee replacement: a prospective study of 529 consecutive patients. J Bone Joint Surg Br 92(4):513–520CrossRefPubMed
13.
Ersozlu S, Akkaya T, Ozgur AF, Sahin O, Senturk I, Tandogan R (2008) Bilateral staged total knee arthroplasty in obese patients. Arch Orthop Trauma Surg 128(2):143–148CrossRefPubMed
14.
Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH (2007) The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty 22(6 Suppl 2):71–76CrossRefPubMed
15.
Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS (2004) The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am 86-A 8:1609–1615
16.
Foran JR, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford DS (2004) Total knee arthroplasty in obese patients: a comparison with a matched control group. J Arthroplasty 19(7):817–824CrossRefPubMed
17.
Griffin FM, Scuderi GR, Insall JN, Colizza W (1998) Total knee arthroplasty in patients who were obese with 10 years followup. Clin Orthop Relat Res 356:28–33CrossRefPubMed
18.
Hamoui N, Kantor S, Vince K, Crookes PF (2006) Long-term outcome of total knee replacement: does obesity matter? Obes Surg 16(1):35–38CrossRefPubMed
19.
20.
21.
Issa K, Pivec R, Kapadia BH, Shah T, Harwin SF, Delanois RE, Mont MA (2013) Does obesity affect the outcomes of primary total knee arthroplasty? J Knee Surg 26(2):89–94CrossRefPubMed
22.
Jackson MP, Sexton SA, Walter WL, Walter WK, Zicat BA (2009) The impact of obesity on the mid-term outcome of cementless total knee replacement. J Bone Joint Surg Br 91(8):1044–1048CrossRefPubMed
23.
Jarvenpaa J, Kettunen J, Kroger H, Miettinen H (2010) Obesity may impair the early outcome of total knee arthroplasty. Scand J Surg 99(1):45–49PubMed
24.
Jarvenpaa J, Kettunen J, Soininvaara T, Miettinen H, Kroger H (2012) Obesity has a negative impact on clinical outcome after total knee arthroplasty. Scand J Surg 101(3):198–203CrossRefPubMed
25.
Jiang L, Tian W, Wang Y, Rong J, Bao C, Liu Y, Zhao Y, Wang C (2012) Body mass index and susceptibility to knee osteoarthritis: a systematic review and meta-analysis. Joint Bone Spine 79(3):291–297CrossRefPubMed
26.
Kerkhoffs GMMJ, Servien E, Dunn W, Dahm D, Bramer JAM, Haverkamp D (2012) The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 94(20):1839–1844CrossRefPubMedCentralPubMed
27.
Krushell RJ, Fingeroth RJ (2007) Primary total knee arthroplasty in morbidly obese patients: a 5-to 14-year follow-up study. J Arthroplasty 22(6 Suppl 2):77–80CrossRefPubMed
28.
Miric A, Lim M, Kahn B, Rozenthal T, Bombick D, Sculco TP (2002) Perioperative morbidity following total knee arthroplasty among obese patients. J Knee Surg 15(2):77–83PubMed
29.
Mont MA, Mathur SK, Krackow KA, Loewy JW, Hungerford DS (1996) Cementless total knee arthroplasty in obese patients: a comparison with a matched control group. J Arthroplasty 11(2):153–156CrossRefPubMed
30.
Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 20(7 Suppl 3):46–50CrossRefPubMed
31.
Parvizi J, Trousdale RT, Sarr MG (2000) Total joint arthroplasty in patients surgically treated for morbid obesity. J Arthroplasty 15(8):1003–1008CrossRefPubMed
32.
Paulis WD, Silva S, Koes BW, van Middelkoop M (2014) Overweight and obesity are associated with musculoskeletal complaints as early as childhood: a systematic review. Obes Rev 15(1):52–67CrossRefPubMed
33.
Razak HRB, Chong HC, Tan AHC (2013) Obesity does not imply poor outcomes in Asians after total knee arthroplasty. Clin Orthop Relat Res 471(6):1957–1963CrossRef
34.
Richmond SA, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA (2013) Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? a systematic review. J Orthop Sports Phys Ther 43(8):515–524CrossRefPubMed
35.
Severson EP, Singh JA, Browne JA, Trousdale RT, Sarr MG, Lewallen DG (2012) Total knee arthroplasty in morbidly obese patients treated with bariatric surgery: a comparative study. J Arthroplasty 27(9):1696–1700CrossRefPubMedCentralPubMed
36.
Spicer DDM, Pomeroy DL, Badenhausen WE, Schaper LA, Curry JI, Suthers KE, Smith MW (2001) Body mass index as a predictor of outcome in total knee replacement. Int Orthop 25(4):246–249CrossRefPubMedCentralPubMed
37.
Vazquez-Vela Johnson G, Worland RL, Keenan J, Norambuena N (2003) Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br 85(1):52–56CrossRefPubMed
38.
Walter SD, Yao X (2007) Effect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews. J Clin Epidemiol 60(8):849–852CrossRefPubMed
39.
WHO (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i–xii, 1–253
40.
Workgroup of the American Association of Hip and Knee Surgeons (AAHKS) Evidence Based Committee (2013) Obesity and total joint arthroplasty: a literature based review. J Arthroplasty 28(5):714–721CrossRef
41.
Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg Am 85-A(1):1–3PubMed
42.
Metadata
Title
The influence of body mass index on the outcomes of primary total knee arthroplasty
Authors
Hai-bo Si
Yi Zeng
Bin Shen
Jing Yang
Zong-ke Zhou
Peng-de Kang
Fu-xing Pei
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3301-1

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