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Ishimoto R, Mutsuzaki H, Shimizu Y, Yoshikawa K, Koseki K, Takeuchi R, Matsumoto S, Hada Y. Association between Obesity and Short-Term Patient-Reported Outcomes following Total Knee Arthroplasty: A Retrospective Cohort Study in Japan. J Clin Med 2024; 13:1291. [PMID: 38592115 PMCID: PMC10932041 DOI: 10.3390/jcm13051291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: This study investigated the association between obesity and short-term patient-reported outcomes after total knee arthroplasty (TKA). Methods: The primary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index's (WOMAC) pain and function scores. Data were collected preoperatively and 2 and 4 weeks after surgery. Patients were stratified into three groups based on body mass index (BMI): normal weight (BMI < 24.99 kg/m2), overweight (25 ≤ BMI < 29.99 kg/m2), and obese (BMI ≥ 30 kg/m2). The associations between BMI and the WOMAC pain and function scores were assessed using generalized linear mixed models. Results: Among the 102 patients (median age: 75.0, women [85.3%]), 29.4%, 48.0%, and 22.5% were normal weight, overweight, and obese, respectively. The mean pain and function scores at baseline were similar across the BMI-stratified groups (p = 0.727 and 0.277, respectively). The pain score significantly improved 2 weeks post-surgery (p = 0.001). The function score improved significantly 4 weeks post-surgery (p < 0.001). The group and group-by-time interaction effects lacked statistical significance. Conclusions: All patients statistically and clinically showed relevant pain reduction and functional improvement shortly after TKA, irrespective of their obesity status. These data may help healthcare professionals discuss the expectations of pain amelioration and functional improvement with TKA candidates.
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Affiliation(s)
- Ryu Ishimoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan;
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Ryoko Takeuchi
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
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Akar B. Is there an indication for simultaneous bilateral knee arthroplasty in morbidly obese patients? Should the patients' request for simultaneous operation be considered? PLoS One 2023; 18:e0287021. [PMID: 37878579 PMCID: PMC10599534 DOI: 10.1371/journal.pone.0287021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 05/30/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE This study aimed to analyse the safety of simultaneous bilateral total knee arthroplasty (SBTKA) surgery by comparing morbidly obese (MO) patients with obese patients. METHODS SBTKA was performed to 494 patients by a single surgeon in a single center between 2014-2020. The patients followed for a mean of 26 months. They were divided into two groups according to body mass index (BMI) as MO (BMI> 40 kg/m2, n = 65) and obese(O) (BMI = 30-39.9 kg/m2, n = 429 patients). The groups were compared in terms of wound healing problems (WHP), mobilization time (MT), operation time (OT), prosthesis infection, aseptic loosening (AL), early complications, revision, and length of hospitalization using univariate and multivariate logistic regression analyses. RESULTS Logistic regression analysis revealed significant differences in the clinical outcomes and complications between MO and O patients. Parameters such as length of stay, OT, MT, WHP, debridement, medial retinaculum detachment (MRD) and AL, and short-term complications such as acute kidney injury (AKI), and pulmonary embolism (PE) incidence were significantly higher in the MO group. Among the MO patients, the clinical outcomes were worse than those among the O patients, and the complication incidence was higher. CONCLUSION We do not find SBTKA surgery feasible in morbidly obese patients due to the high complication rate and unsatisfactory clinical outcomes. We suggest that the patient's request to undergo SBTKA should not be taken into account, and that staged surgery be preferred.
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Affiliation(s)
- Bedrettin Akar
- Deparmant of Orthopedics and Traumatology, Sakarya Yenikent State Hospital, Sakarya, Turkey
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Pavlovic N, Harris IA, Boland R, Brady B, Genel F, Naylor J. The effect of body mass index and preoperative weight loss in people with obesity on postoperative outcomes to 6 months following total hip or knee arthroplasty: a retrospective study. ARTHROPLASTY 2023; 5:48. [PMID: 37777817 PMCID: PMC10544191 DOI: 10.1186/s42836-023-00203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Few studies have investigated the association between obesity, preoperative weight loss and postoperative outcomes beyond 30- and 90-days post-arthroplasty. This study investigated whether body mass index (BMI) and preoperative weight loss in people with obesity predict postoperative complications and patient-reported outcomes 6 months following total knee or hip arthroplasty. METHODS Two independent, prospectively collected datasets of people undergoing primary total knee or hip arthroplasty for osteoarthritis between January 2013 and June 2018 at two public hospitals were merged. First, the sample was grouped into BMI categories, < 35 kg/m2 and ≥ 35 kg/m2. Subgroup analysis was completed separately for hips and knees. Second, a sample of people with BMI ≥ 30 kg/m2 was stratified into participants who did or did not lose ≥ 5% of their baseline weight preoperatively. The presence of postoperative complications, Oxford Hip Score, Oxford Knee Score, EuroQol Visual Analogue Scale and patient-rated improvement 6 months post-surgery were compared using unadjusted and adjusted techniques. RESULTS From 3,552 and 9,562 patients identified from the datasets, 1,337 were included in the analysis after merging. After adjustment for covariates, there was no difference in postoperative complication rate to 6 months post-surgery according to BMI category (OR 1.0, 95%CI 0.8-1.4, P = 0.8) or preoperative weight loss (OR 1.1, 95%CI 0.7-1.8, P = 0.7). There was no between-group difference according to BMI or preoperative weight change for any patient-reported outcomes 6 months post-surgery. CONCLUSION Preoperative BMI or a 5% reduction in preoperative BMI in people with obesity was not associated with postoperative outcomes to 6 months following total knee or hip arthroplasty.
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Affiliation(s)
- Natalie Pavlovic
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia.
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, NSW, 2176, Australia.
| | - Ian A Harris
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Robert Boland
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, NSW, 2176, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Bernadette Brady
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, 2170, Australia
- School of Health Sciences, Western Sydney University, Sydney, NSW, 2560, Australia
| | - Furkan Genel
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- Faculty of Medicine and Health, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, 2217, Australia
| | - Justine Naylor
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
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Li S, Si H, Zhang S, Xu J, Liu Y, Shen B. Does diabetes mellitus impair the clinical results of total knee arthroplasty under enhanced recovery after surgery? J Orthop Surg Res 2023; 18:490. [PMID: 37430329 DOI: 10.1186/s13018-023-03982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) and osteoarthritis (OA) are common diseases that are predicted to increase in prevalence, and DM is a risk factor for OA progression and has a negative impact on the outcome. However, the evidence remains unclear on how it affects patients' clinical results of total knee arthroplasty (TKA) under enhanced recovery after surgery (ERAS). METHODS A retrospective single-center study was conducted comparing diabetic and non-diabetic patients who underwent TKA in West China Hospital of Sichuan University between September 2016 to December 2017 under ERAS. Consecutive propensity score matching (PSM) was conducted by 1:1 (DM: non-DM) matching analysis with all baselines as covariates. The primary clinical results were the improvement of knee joint function, the incidence of postoperative complications, and the FJS-12 sensory results 5 years after the operation between DM and Non-DM groups. The secondary clinical results were the postoperative length of stay (LOS), postoperative blood test and total blood loss (TBL). RESULT After PSM, the final analysis included 84 diabetic patients and 84 non-diabetic patients. Diabetic patients were more likely to experience early postoperative complications (21.4% vs. 4.8%, P = 0.003), of which wound complications are the most significant (10.7% vs. 1.2%, P = 0.022). Diabetic patients experienced longer postoperative LOS with a significant increase in patients with LOS exceeding 3 days (66.7% vs. 50%, P = 0.028) and showed less postoperative range of motion (ROM) (106.43 ± 7.88 vs. 109.50 ± 6.33 degrees, P = 0. 011). Diabetic patients also reported lower Forgotten joint score (FJS-12) than non-diabetic patients (68.16 + 12.16 vs. 71.57 + 10.75, P = 0.020) in the 5-year follow-up and were less likely to achieve a forgotten knee joint (10.7% vs. 1.2%, P = 0.022). In additional, Compared with non-diabetics, diabetic patients showed lower hemoglobin (Hb) (P < 0.001) and hematocrit (HCT) (P < 0.001) and were more likely to suffer from hypertension before TKA (P < 0.001). CONCLUSION Diabetic patients show increased risk for postoperative complications, and have lower lower postoperative ROM and lower FJS-12 compared with non-diabetic patients after TKA under ERAS. More perioperative protocols are still needed to be investigated and optimized for diabetic patients.
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Affiliation(s)
- Shuai Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Haibo Si
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Shaoyun Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Jiawen Xu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yuan Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
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Meert L, Mertens MG, Meeus M, Vervullens S, Baert I, Beckwée D, Verdonk P, Smeets RJEM. Identification of Metabolic Factors and Inflammatory Markers Predictive of Outcome after Total Knee Arthroplasty in Patients with Knee Osteoarthritis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105796. [PMID: 37239524 DOI: 10.3390/ijerph20105796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To identify metabolic factors and inflammatory markers that are predictive of postoperative total knee arthroplasty (TKA) outcome. METHOD A systematic search of the existing literature was performed using the electronic databases PubMed, Web of Science and Embase until the 1st of August 2022. Studies that evaluated the influence of metabolic or inflammatory markers (I) on postsurgical outcome (O) in end-stage knee osteoarthritis patients awaiting primary TKA (P) were included in this review. RESULTS In total, 49 studies were included. Risk of bias of the included studies was low for one study, moderate for 10 studies and high for the remaining 38 studies. Conflicting evidence was found for the influence of body mass index, diabetes, cytokine levels and dyslipidaemia on pain, function, satisfaction and quality of life at more than six months after TKA. CONCLUSIONS Several limitations such as not taking into account known confounding factors, the use of many different outcome measures and a widely varying follow-up period made it challenging to draw firm conclusions and clinical implications. Therefore large-scaled longitudinal studies assessing the predictive value of metabolic and inflammatory factors pre-surgery in addition to the already evidenced risk factors with follow-up of one year after TKA are warranted.
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Affiliation(s)
- Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, 2610 Wilrijk, Belgium
- Pain in Motion, International Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, 2610 Wilrijk, Belgium
- Pain in Motion, International Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, 2610 Wilrijk, Belgium
- Pain in Motion, International Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, 2610 Wilrijk, Belgium
- Pain in Motion, International Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Isabel Baert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, 2610 Wilrijk, Belgium
- Pain in Motion, International Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - David Beckwée
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, 2610 Wilrijk, Belgium
- Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Peter Verdonk
- Antwerp Orthopaedic Center, AZ Monica Hospitals, 2018 Antwerp, Belgium
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University and CIR Revalidatie, 5628 WB Eindhoven, The Netherlands
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Sane RM, Samant PD. Influence of body mass index on early post-operative functional outcomes after total knee arthroplasty: A prospective, clinical and observational study. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2023. [DOI: 10.1177/22104917231161834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Background/Purpose: The evidence on the influence of body mass index (BMI) on functional outcomes following total knee arthroplasty (TKA) is conflicting. This study assessed and compared the effect of BMI on early mobility and function after TKA. Methods: Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA) who received unilateral TKA were recruited and then divided into normal, overweight and obese groups. The pain and functional outcomes of pre/post-TKA were examined using visual analogue scale (VAS) and Lysholm Knee Scale (LKS), respectively. Results: At 3 and 6 weeks post-TKA, LKS score was significantly higher in normal BMI group compared to overweight and obese. Lower BMI gained early improvement in functional outcome than higher BMI groups. However, patients showed considerable functional improvement at 6 months post-TKA, regardless of BMI category. Conclusion: Although BMI levels influence postoperative early functional improvement in TKA patients, the functional benefits after TKA at 6 months were similar regardless of BMI class.
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Affiliation(s)
- Rohit M Sane
- Department of Orthopaedics, D.Y. Patil University – School of Medicine, Navi Mumbai, India
| | - Prakash D Samant
- Department of Orthopaedics, D.Y. Patil University – School of Medicine, Navi Mumbai, India
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Palanne R, Rantasalo M, Vakkuri A, Olkkola KT, Vahlberg T, Skants N. Fat tissue is a poor predictor of 1 year outcomes after total knee arthroplasty: A secondary analysis of a randomized clinical trial. Scand J Surg 2023; 112:22-32. [PMID: 36510351 DOI: 10.1177/14574969221139722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Obesity may increase the risk of adverse events after total knee arthroplasty (TKA). Although body mass index (BMI) is commonly used in categorizing obesity, its accuracy is limited. Body fat percentage (BFP) might indicate adiposity status and predict arthroplasty-related outcomes better than BMI. We investigated whether BFP is predictive of TKA-related outcomes. METHODS In this secondary analysis, BFP was measured preoperatively from 294 participants of a randomized trial that investigated the effects of tourniquet and anesthesia methods on TKA. Data concerning in-hospital assessments and events were collected. Knee range of motion (ROM) was measured, the Brief Pain Inventory-short form and Oxford Knee Score questionnaires were used to collect data on patient-reported pain and function, and the 15-dimensional health-related questionnaire was used to assess quality of life preoperatively and 3 and 12 months postoperatively. The patients reported satisfaction to TKA 3 and 12 months postoperatively. Data concerning infectious and thromboembolic events within 90 postoperative days and revision surgery, manipulation under anesthesia, and mortality within 1 year were collected. A separate post hoc analysis was performed for 399 participants to assess the effects of BMI on the respective outcomes. RESULTS A 1-unit increase in BFP affected the ROM by -0.37° (95% confidence interval (CI) = -0.60 to -0.13) 12 months after surgery. BFP was not significantly associated with the operation time or adverse events. However, the number of most adverse events remained too low for adjusted analysis. A 1-unit increase in BMI increased the operation time by 0.57 min (95% CI = 0.10 to 1.04) and affected the ROM by -0.47° (95% CI = -0.74 to -0.20) 12 months postoperatively. Neither BFP nor BMI was significantly associated with acute pain, pain management, length of stay, or with pain, function, quality of life, or satisfaction to TKA at 12 months after surgery. CONCLUSIONS BFP seems to be a poor predictor of in-hospital results and of patient-reported outcomes 1 year after TKA. TWITTER HANDLE In this secondary analysis of a randomized trial, body fat percentage was poorly predictive of clinical outcomes during hospital stay and of patient-reported outcomes 1 year after TKA.
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Affiliation(s)
- Riku Palanne
- Department of Anesthesiology and Intensive Care Central Finland Hospital Nova Hoitajantie 3 40620 Jyväskylä Finland
- Department of Anesthesiology Intensive Care and Pain Medicine Peijas Hospital University of Helsinki and HUS Helsinki University Hospital Vantaa Finland
| | - Mikko Rantasalo
- Department of Orthopedics and Traumatology, Peijas Hospital and Arthroplasty Center, University of Helsinki and HUS Helsinki University Hospital, Vantaa, Finland
| | - Anne Vakkuri
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Klaus T Olkkola
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine and Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora Skants
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, University of Helsinki and HUS Helsinki University Hospital, Vantaa, Finland
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Baum G, Jacobs H, Lazovic D, Maus U, Hoffmann F, Seeber GH. The influence of obesity on functional outcomes and patient satisfaction 8 weeks after total knee arthroplasty: results of the prospective FInGK study. BMC Musculoskelet Disord 2022; 23:949. [PMID: 36324114 PMCID: PMC9630069 DOI: 10.1186/s12891-022-05874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To investigate obese versus non-obese subjects´ knee joint function, stiffness, pain, expectations, and outcome satisfaction before and two months after total knee arthroplasty (TKA). METHODS This study is a secondary analysis of data retrieved via a prospective single-centre cohort study investigating knee joint function and health care services utilization in patients undergoing TKA (FInGK Study). For the primary study, elective TKA patients were consecutively recruited between December 2019 and May 2021. Preoperative expectations, Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), surgery outcome satisfaction, and sociodemographic variables were assessed via self-reported questionnaires. In the current study, obese (Body Mass Index (BMI) ≥ 30 kg/m²) versus non-obese (BMI < 30 kg/m²) subjects' data were exploratively compared before and two months after TKA. Multivariable logistic regression assessed factors associated with TKA satisfaction two months postoperatively. Linear regression evaluated factors associated with higher WOMAC change two months postoperatively. RESULTS A total of 241 subjects participated (response: 85.2%). Eighty-seven were non-obese (mean age: 70.7 years, 63.2% female) and 154 were obese (mean age: 67.1 years, 57.8% female). Obese subjects reported inferior pre- and postoperative pain and knee joint function compared to non-obese subjects. Yet, WOMAC scores of obese and non-obese subjects significantly improved from preoperative means of 52.6 and 46.8 to 32.3 and 24.4 after surgery, respectively. The only significant TKA satisfaction predictor was subjects' smoking status. Non-obesity and worse preoperative WOMAC scores were predictive of higher WOMAC change scores after two months. CONCLUSION Both obese and non-obese subjects reported significant symptom improvements. However, as obese subjects' short-term outcomes were still inferior, more research on TKA rehabilitation measures adapted to the needs of this growing patient group is warranted to maximize their benefits from TKA.
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Affiliation(s)
- Gesa Baum
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany.
| | - Hannes Jacobs
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany
| | - Djordje Lazovic
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Uwe Maus
- Department of Orthopaedics and Trauma Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 114-118, 26129, Oldenburg, Germany
| | - Gesine H Seeber
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany.,Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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9
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Abbas Z, Hafeez S, Naseem A, Habib Y, Mumtaz H. Effect of body mass index on duration of total knee replacement surgery: A prospective cross sectional study. Ann Med Surg (Lond) 2022; 82:104637. [PMID: 36268351 PMCID: PMC9577639 DOI: 10.1016/j.amsu.2022.104637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Obesity and increased BMI has raised concerns throughout the globe. As obesity is often associated with many serious medical conditions. Obesity, older age and gender are major contributing factors for knee replacement surgeries. We aimed to compare the mean duration of surgery in obese and non-obese patients undergoing total knee replacement. Methods A Cross-sectional study is conducted at the orthopedic department at Shifa international hospital, Islamabad during June 2021–Dec 2021. Study is conducted to assess the effect of BMI on duration of total knee arthroplasty. Sample size was calculated to be 105 with 95% confidence limit. Data will be analyzed using SPSS version 22. Quantitative variables like age, BMI and duration of surgery were presented as mean and standard deviation. Qualitative variables like gender, laterality (unilateral/bilateral), and ASA were presented as frequency and percentage. Results There were more females undergoing the procedure than males. The predominant age group was found to be 56–65 years. On BMI classification scale, a far greater number of individuals were found to be obese constituting more than ⅗ of the study population and almost ⅕ of the patients were overweight. The Association of BMI Classification & Duration of Surgery has a significant p value of 0.00. Conclusion A linear and direct relation was observed between body mass index and duration of surgery. There may be other contributing factors and will need more data and research. The body mass index (BMI) is widely recognized as a prognostic factor in multiple operations. High body mass index (BMI) is associated with increased rates of complications after total knee arthroplasty. Our study finds a strong association of Age, Gender & ASA Grade with BMI.
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Affiliation(s)
- Zamin Abbas
- Shifa International Hospital, Islamabad, Pakistan
| | | | - Ali Naseem
- Shifa International Hospital, Islamabad, Pakistan
| | - Yasir Habib
- Shifa International Hospital, Islamabad, Pakistan
| | - Hassan Mumtaz
- Health Services Academy, Islamabad, Pakistan
- Corresponding author.
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10
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Muertizha M, Cai X, Ji B, Aimaiti A, Cao L. Factors contributing to 1-year dissatisfaction after total knee arthroplasty: a nomogram prediction model. J Orthop Surg Res 2022; 17:367. [PMID: 35902950 PMCID: PMC9330701 DOI: 10.1186/s13018-022-03205-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Identifying risk factors and early intervention are critical for improving the satisfaction rate of total knee arthroplasty (TKA). Our study aimed to identify patient-specific variables and establish a nomogram model to predict dissatisfaction at 1 year after TKA. Methods This prospective cohort study involved 208 consecutive primary TKA patients with end-stage arthritis who completed self-reported measures preoperatively and at 1 year postoperatively. All participants were randomized into a training cohort (n = 154) and validation cohort (n = 54). Multiple regression models with preoperative and postoperative factors were used to establish the nomogram model for dissatisfaction at 1 year postoperatively. The least absolute shrinkage and selection operator method was used to screen the suitable and effective risk factors (demographic variables, preoperative variables, surgical variable, and postoperative variables) collected. These variables were compared between the satisfied and dissatisfied groups in the training cohort. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis were used to validate the discrimination, calibration, and clinical usefulness of the model. Results were evaluated by internal validation of the validation cohort. Results The overall satisfaction rate 1 year after TKA was 77.8%. The nomogram prediction model included the following risk factors: gender; primary diagnosis; postoperative residual pain; poor postoperative range of motion; wound healing; and the rate of change in the degree of coronal lower limb alignment (hip–knee–ankle angle, HKA).The ROC curves of the training and validation cohorts were 0.9206 (95% confidence interval [CI], 0.8785–0.9627) and 0.9662 (0.9231, 1.0000) (95% CI, 0.9231, 1.0000), respectively. The Hosmer–Lemeshow test showed good calibration of the nomogram (training cohort, p = 0.218; validation cohort, p = 0.103). Conclusion This study developed a prediction nomogram model based on partially modifiable risk factors for predicting dissatisfaction 1 year after TKA. This model demonstrated good discriminative capacity for identifying those at greatest risk for dissatisfaction and may help surgeons and patients identify and evaluate the risk factors for dissatisfaction and optimize TKA outcomes.
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Affiliation(s)
- Mieralimu Muertizha
- Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, 137th South LiYuShan Road, Urumqi, 830054, Xinjiang, China
| | - XinTian Cai
- Xinjiang Medical University Urumqi, People's Republic of China, 137th South LiYuShan Road, Urumqi, Xinjiang, China
| | - Baochao Ji
- Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, 137th South LiYuShan Road, Urumqi, 830054, Xinjiang, China
| | - Abudousaimi Aimaiti
- Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, 137th South LiYuShan Road, Urumqi, 830054, Xinjiang, China
| | - Li Cao
- Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, 137th South LiYuShan Road, Urumqi, 830054, Xinjiang, China.
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11
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Comparison of joint awareness after medial unicompartmental knee arthroplasty and high tibial osteotomy: a retrospective multicenter study. Arch Orthop Trauma Surg 2022; 142:1133-1140. [PMID: 34269892 DOI: 10.1007/s00402-021-03994-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are established treatments for medial compartment osteoarthritis (OA) or osteonecrosis (ON) of the knee joint, and the predominance of either procedure is inconclusive. We compared the awareness of the knee after UKA and HTO using the Forgotten joint score-12 (FJS). MATERIALS AND METHODS This was a retrospective, multicenter study. Ninety-six knees of 90 patients who received UKA or HTO and were followed-up for at least 1 year were analyzed. Postoperative FJS was compared between the two groups and evaluated for the effect of patient-related factors and clinical outcomes. Multiple linear regression analysis was performed to predict FJS. RESULTS There was no significant difference in the FJS between the UKA and HTO groups (p = 0.24). FJS did not correlate with any of the patient-related factors. There was a correlation between the FJS and each item of the Knee Injury and Osteoarthritis Outcome Scores (KOOS) and Lysholm Knee Scoring Scale (LKS). In multiple linear regression analysis, lower BMI, the diagnosis of OA Kellgren-Lawrence (KL) grade ≥ 3, and ON were significant predictors of better FJS. In both groups, FJS was correlated with each item of the KOOS and LKS. Internal consistency in terms of Cronbach's alpha was excellent. CONCLUSIONS There was no significant difference in FJS between patients who underwent UKA and HTO. Lower BMI, the diagnosis of OA KL grade ≥ 3, and ON were significant predictors of better FJS.
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12
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Elcock KL, Carter TH, Yapp LZ, MacDonald DJ, Howie CR, Stoddart A, Berg G, Clement ND, Scott CEH. Total knee arthroplasty in patients with severe obesity provides value for money despite increased complications. Bone Joint J 2022; 104-B:452-463. [PMID: 35360945 DOI: 10.1302/0301-620x.104b4.bjj-2021-0353.r3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m2). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m2 to examine whether this is supported. METHODS This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m2) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m2 (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m2 in a 1:1 ratio. Demographic data, comorbidities, and complications to one year were recorded. Preoperative and one-year patient-reported outcome measures (PROMs) were completed: EuroQol five-dimension three-level questionnaire (EQ-5D-3L), OKS, pain, and satisfaction. Using national life expectancy data with obesity correction and the 2020 NHS National Tariff, QALYs (discounted at 3.5%), and direct medical costs accrued over a patient's lifetime, were calculated. Probabilistic sensitivity analysis (PSA) was used to model variation in cost/QALY for each cohort across 1,000 simulations. RESULTS All PROMs improved significantly (p < 0.05) in both groups without differences between groups. Early complications were higher in BMI ≥ 40 kg/m2: 34/169 versus 52/169 (p = 0.050). A total of 16 (9.5%) patients with a BMI ≥ 40 kg/m2 were readmitted within one year with six reoperations (3.6%) including three (1.2%) revisions for infection. Assuming reduced life expectancy in severe obesity and revision costs, TKA in patients with a BMI ≥ 40 kg/m2 costs a mean of £1,013/QALY (95% confidence interval £678 to 1,409) more over a lifetime than TKA in patients with BMI < 40 kg/m2. In PSA replicates, the maximum cost/QALY was £3,921 in patients with a BMI < 40 kg/m2 and £5,275 in patients with a BMI ≥ 40 kg/m2. CONCLUSION Higher complication rates following TKA in severely obese patients result in a lifetime cost/QALY that is £1,013 greater than that for patients with BMI < 40 kg/m2, suggesting that TKA remains a cost-effective use of healthcare resources in severely obese patients where the surgeon considers it appropriate. Cite this article: Bone Joint J 2022;104-B(4):452-463.
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Affiliation(s)
| | - Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Liam Z Yapp
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Colin R Howie
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Andrew Stoddart
- Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Guy Berg
- Healthcare Improvement Scotland, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
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Bily W, Jauker J, Nics H, Grote V, Pirchl M, Fischer MJ. Associations between Patient-Reported and Clinician-Reported Outcome Measures in Patients after Traumatic Injuries of the Lower Limb. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053140. [PMID: 35270830 PMCID: PMC8910334 DOI: 10.3390/ijerph19053140] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/09/2023]
Abstract
Both clinician-reported outcome measures (CROMs) measures and patient-reported outcome measures (PROMs) are applied to evaluate outcomes in rehabilitation settings. The previous data show only a low to moderate correlation between these measures. Relationships between functional performance measures (Clinician-Reported Outcome Measures, CROMs) and Patient-Reported Outcome Measures (PROMs) were analysed in rehabilitation patients with traumatic injuries of the lower limb. A cohort of 315 patients with 3 subgroups (127 hip, 101 knee and 87 ankle region) was analysed before and after 3 weeks of inpatient rehabilitation. All three groups showed significant improvements in PROMs with low to moderate effect sizes. Moderate to high effect sizes were found for CROMs. Correlation coefficients between CROMs and PROMs were low to moderate. The performance consistency between PROMs and CROMs ranged from 56.7% to 64.1%. In this cohort of rehabilitation patients with traumatic injuries, CROMs showed higher effect sizes than PROMs. When used in combination, patient-reported outcome and performance measures contribute to collecting complementary information, enabling the practitioner to make a more accurate clinical evaluation of the patient’s condition.
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Affiliation(s)
- Walter Bily
- Department of Physical Medicine and Rehabilitation, Ottakring Clinic, Vienna Health Association, A-1160 Vienna, Austria; (W.B.); (J.J.)
| | - Jakob Jauker
- Department of Physical Medicine and Rehabilitation, Ottakring Clinic, Vienna Health Association, A-1160 Vienna, Austria; (W.B.); (J.J.)
| | - Helena Nics
- Department of Physical Medicine and Rehabilitation, Floridsdorf Clinic, Vienna Health Association, A-1210 Vienna, Austria;
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1140 Vienna, Austria; (M.P.); (M.J.F.)
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, A-1090 Vienna, Austria
- Correspondence: ; Tel.: +43-680-2199422
| | - Michael Pirchl
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1140 Vienna, Austria; (M.P.); (M.J.F.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1140 Vienna, Austria; (M.P.); (M.J.F.)
- Vamed Rehabilitation Center Kitzbühel, A-6370 Kitzbühel, Austria
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14
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Shohat N, Heller S, Sudya D, Small I, Khawalde K, Khatib M, Yassin M. Mild radiographic osteoarthritis is associated with increased pain and dissatisfaction following total knee arthroplasty when compared with severe osteoarthritis: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:965-981. [PMID: 33604736 DOI: 10.1007/s00167-021-06487-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The association between severity of radiographic osteoarthritis with patient pain, function, and satisfaction following total knee arthroplasty has been disputed. The discrepancies in current literature prompt us to further examine this association in a systematic review and meta-analysis. METHODS The OVID-Medline, Embase, and Web of Science databases were searched from their inception up to Mar 2020. The main independent variable was osteoarthritis severity as defined by preoperative radiographs. The outcomes measured were pain, function and satisfaction following total knee arthroplasty. A minimum of three studies assessing the same patient-reported outcome measures were included in the meta-analysis, as well as those separating patients by chronic pain or dissatisfaction. RESULTS 29 studies were included in this study. Significant heterogeneity was seen between radiographic evaluation and reported outcomes. Patients with only mild radiographic osteoarthritis were more likely to suffer from chronic pain (odds ratio = 2.45, 95% CI = 1.80-3.34, p < 0.001) and dissatisfaction (odds ratio = 2.43, 95% CI = 1.79-3.31, p < 0.001) compared to patients with severe osteoarthritis. A significant association was found between mild radiographic severity and lower total Western Ontario and McMaster Universities Osteoarthritis scores (95% CI = - 0.37-0.06, p = 0.006) as well as Knee Society Scores (CI: - 0.54-0.16, p < 0.001). CONCLUSION Patients with mild radiographic osteoarthritis are anticipated to gain less from total knee arthroplasty compared to those with severe osteoarthritis. They are also at risk for chronic pain and dissatisfaction and should be consulted about this risk prior to surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Noam Shohat
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Snir Heller
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Dan Sudya
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Ilan Small
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Kefah Khawalde
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Muhammad Khatib
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Mustafa Yassin
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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15
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Singh V, Yeroushalmi D, Lygrisse KA, Simcox T, Long WJ, Schwarzkopf R. The influence of obesity on achievement of a 'forgotten joint' following total knee arthroplasty. Arch Orthop Trauma Surg 2022; 142:491-499. [PMID: 33661386 DOI: 10.1007/s00402-021-03840-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Obesity has been associated with poorer outcomes following total knee arthroplasty (TKA); however, data remain sparse on its impact on patients' joint awareness following surgery. This study aims to investigate the impact of body mass index (BMI) on improvement in outcomes following TKA as assessed by the Forgotten Joint Score-12 (FJS-12). MATERIALS AND METHODS We retrospectively reviewed 1075 patients who underwent primary TKA from 2017 to 2020 with available postoperative FJS-12 scores. Patients were stratified based on their BMI (kg/m2): < 30, 30.0-34.9 (obese class I), 35.0-39.9 (obese class II), and ≥ 40 (obese class III). FJS-12 and KOOS, JR scores were collected at various time points. Demographic differences were assessed with Chi-square and ANOVA tests. Mean scores between BMI groups were compared using univariate ANCOVA, controlling for observed demographic differences. RESULTS Of the 1075 patients included, there were 457 with a BMI < 30, 331 who were obese class I, 162 obese class II, and 125 obese class III. There were no statistical differences in FJS-12 scores between the BMI groups at 3 months (27.24 vs. 25.33 vs. 23.57 vs. 22.48; p = 0.99), 1 year (45.07 vs. 41.86 vs. 40.51 vs. 36.22; p = 0.92) and 2 years (51.31 vs. 52.86 vs. 46.17 vs. 44.97; p = 0.94). Preoperative KOOS, JR scores significantly differed between the various BMI categories (49.33 vs. 46.63 vs. 44.24 vs. 39.33; p < 0.01); however, 3-month (p = 0.20) and 1-year (p = 0.13) scores were not statistically significant. Mean improvement in FJS-12 scores from 3 months to 2 years was statistically greatest for obese class I patients and lowest for obese class III patients (24.07 vs. 27.53 vs. 22.60 vs. 22.49; p = 0.01). KOOS, JR score improvement from baseline to 1 year was statistically greatest for obese class III patients and lowest for non-obese patients (22.34 vs. 25.49 vs. 23.77 vs. 27.58; p < 0.01). CONCLUSION While all groups demonstrated postoperative improvement, those with higher BMI reported lower mean FJS-12 scores but these differences were not found to be significant. Our study showed no significant impact of BMI on postoperative joint awareness, which implies that obese patients, in all obesity classes, experience similar functional improvement following TKA. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - David Yeroushalmi
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Katherine A Lygrisse
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Trevor Simcox
- Department of Orthopedic Surgery, NYU Langone Hospital Long Island, 259 1st St, Mineola, NY, 11501, USA
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
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16
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Baghbani-Naghadehi F, Armijo-Olivo S, Prado CM, Gramlich L, Woodhouse LJ. Does obesity affect patient-reported outcomes following total knee arthroplasty? BMC Musculoskelet Disord 2022; 23:55. [PMID: 35039019 PMCID: PMC8764810 DOI: 10.1186/s12891-022-04997-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is an existing perception that obesity has a negative impact on complications following total knee arthroplasty (TKA). However, data on the impact of obesity levels on patient-reported outcomes (PROMs) is sparse. We investigated the association between different obesity classes with PROMs among patients who underwent TKA. Methods We performed retrospective secondary analyses on data extracted from the total joint replacement data repository (Alberta, Canada) managed by the Alberta Bone and Joint Health Institute (ABJHI). Patients had WOMAC and EQ5D scores measured at baseline in addition to 3 and/or 12 months following TKA. Patients were stratified according to the World Health Organization (WHO) classification, into five body mass index (BMI) groups of normal, overweight, BMI class I, BMI class II, and BMI class III. The association between BMI and mean changes in WOMAC subscales (pain, function, and stiffness) and EQ-5D-5L index over the time intervals of baseline to 3 months and 3 to 12 months following TKA was assessed. Linear mixed-effects models were used, and the models were adjusted for age, sex, length of surgery, comorbidities, year of surgery, and geographical zone where the surgery was performed. Results Mean age was 65.5 years (SD = 8.7). Postoperatively, there was a significant improvement (p < 0.001) in WOMAC subscales of patient-reported pain, function, and stiffness, as well as EQ-5D-5L regardless of BMI group. Although, patients in BMI class II and class III reported significantly improved pain 3 months after TKA compared to those with normal BMI, all BMI groups attained similar level of pain reduction at 12 months after TKA. The greatest improvement in all WOMAC subscales, as well as EQ5D index, occurred between baseline and 3 months (adjusted p < 0.0001). Conclusion The findings indicate that patients reported improved pain, function, and stiffness across all BMI groups following TKA. Patients with BMI classified as obese reported similar benefits to those with BMI classified as normal weight. These results may help health care providers to discuss expectations regarding the TKA recovery in terms of pain, function, and quality of life improvements with their TKA candidates. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-04997-4.
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Affiliation(s)
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Business and Social Sciences, University of Applied Sciences, Osnabrück, Germany.,Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carla M Prado
- Faculty of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Leah Gramlich
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Linda J Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Tufts University, School of Medicine, Department of Public Health & Community Medicine, Division of Physical Therapy, Boston, Massachusetts, USA
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17
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Zeh A, Gehler V, Gutteck N, Beckmann J, Brill R, Wohlrab D. Superior clinical results and higher satisfaction after customized compared with conventional TKA. Acta Orthop Belg 2021; 87:649-658. [PMID: 35172432 DOI: 10.52628/87.4.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Investigation of functional outcome and patient`s satisfaction after implantation of a customized versus conventional TKA. In 31 consecutively enrolled patients with primary gonarthrosis, 33 customized TKA (custTKA) and in 31 patients, a conventional TKA (convTKA) was implanted. Perioperative and postoperative management were identical. Radio- graphic evaluation, ROM, KSS (Knee society score) and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) were performed and patients satisfaction was evaluated after 3 and 12 months. Groups were comparable for age, sex, body mass index and extension/flexion. After 92 days average flexion in the convTKA group was significantly higher (119 vs. 113 degrees; unpaired t-test). At 375 days, mean flexion in both groups was 120 degrees. There was a significant higher number of outliers of neutral mechanical axis for convTKA patients (11 vs. 3; Chi-squared test). After 92 days there was no difference for KSS (convTKA: 160, custTKA: 167) but significant better results for WOMAC (19 vs. 40) in the custTKA group (unpaired t-test, p= 0.02). In addition, significantly better KSS (181 vs. 156) and WOMAC (99 vs. 42) were found for the custTKA group at 375 days (unpaired t-test, p= 0.002 and 0.001). Patients with the custTKA implant reported significant higher fulfillment of their expectations regarding function and knee strength. In the present study, the patients with a custTKA implant showed significantly superior short-term clinical results and fulfillment of their expectations regarding knee function.
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18
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Onggo JR, Ang JJM, Onggo JD, de Steiger R, Hau R. Greater risk of all-cause revisions and complications for obese patients in 3 106 381 total knee arthroplasties: a meta-analysis and systematic review. ANZ J Surg 2021; 91:2308-2321. [PMID: 34405518 DOI: 10.1111/ans.17138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity is a major public health issue and has considerable implications on outcomes of total knee arthroplasty (TKA). However, there has been conflicting evidence and conclusions on the effects of obesity on TKA. This meta-analysis compares the outcomes, complications, and peri-operative parameters of TKA in the obese (body mass index [BMI] ≥ 30 kg/m2 ) versus non-obese (BMI < 30 kg/m2 ) population as well as subgroup analysis of morbidly obese (BMI ≥ 40 kg/m2 ) versus non-obese population. METHODS A meta-analysis was conducted with a multi-database search according to PRISMA guidelines on 12 September 2019. Data from all published literature meeting inclusion criteria were extracted and analysed. RESULTS Ninety-one studies were included, consisting of 917 447 obese and 2 188 834 non-obese TKA. Obese patients had higher risk of all-cause revisions (odds ratio [OR] = 1.15, 95% CI: 1.08-1.24, p < 0.0001), all complications (OR = 1.21, 95% CI: 1.06-1.38, p = 0.004), deep infections (OR = 1.47, 95% CI: 1.27-1.69, p < 0.0001), superficial infections (OR = 1.59, 95% CI: 1.32-1.91, p < 0.0001), wound dehiscence (OR = 1.46, 95% CI: 1.24-1.72, p < 0.0001) and readmissions (OR = 1.21, 95% CI: 1.05-1.40, p = 0.009). Subgroup analysis of morbidly obese patients revealed greater risks of all-cause revisions (OR = 1.25, 95% CI: 1.10-1.43, p = 0.0009), deep infections (OR = 1.98, 95% CI: 1.05-3.75, p = 0.04), superficial infections (OR = 2.44, 95% CI: 2.08-2.88, p < 0.0001) and readmissions (OR = 1.33, 95% CI: 1.20-1.47, p < 0.0001). No analysis was performed on patient reported outcome measures due to heterogeneous reporting methods. CONCLUSION Obese and morbidly obese patients have higher risks of revisions and infections post TKA. Surgeons should counsel patients of these risks during the informed consenting process and adopt preventative strategies into clinical practice to reduce risks where possible. In conclusion, obesity is a significant, modifiable risk factor for increased complications following TKA.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - James Jia Ming Ang
- Monash Medical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Richard de Steiger
- Department of Surgery Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Epworth Eastern Hospital, Melbourne, Victoria, Australia
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19
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Giesinger K, Giesinger JM, Hamilton DF, Rechsteiner J, Ladurner A. Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:635. [PMID: 34303341 PMCID: PMC8310599 DOI: 10.1186/s12891-021-04512-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/02/2021] [Indexed: 12/22/2022] Open
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).
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Affiliation(s)
- K Giesinger
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - J M Giesinger
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - D F Hamilton
- School of Health and Social Care, Edinburgh Napier Univ, ersity, Edinburgh, Scotland
| | - J Rechsteiner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - A Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
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Khow YZ, Goh GS, Chen JY, Lo NN, Yeo SJ, Liow MHL. Change in Body Mass Index after Simultaneous Bilateral Total Knee Arthroplasty: Risk Factors and Its Influence on Functional Outcomes. J Arthroplasty 2021; 36:1974-1979. [PMID: 33602589 DOI: 10.1016/j.arth.2021.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous studies evaluating weight changes following total knee arthroplasty (TKA) were performed on heterogenous cohorts. However, no study has evaluated weight changes in a cohort of simultaneous-bilateral TKA (SB-TKA) patients. This study aimed to evaluate the prevalence of patients who lost or gained weight, determine if postoperative weight change influences functional outcome, and identify predictors of weight change after SB-TKA. METHODS Prospectively collected registry data of 560 patients who underwent SB-TKA were reviewed. Patients were assessed preoperatively, at 6 months, and 2 years using the Knee Society Score, Oxford Knee Score, Short-Form 36, and range of motion. Change in body mass index (BMI) >5% was used to categorize patients into 3 groups: lost, maintained, or gained weight. Analysis of variance, Kruskal-Wallis test, and chi-squared test were used to compare functional outcomes between groups. Multivariable logistic regression evaluated predictors for postoperative weight changes. RESULTS At 2 years, 59% of patients maintained weight, 28% of patients gained weight, and 13% of patients lost weight. All groups experienced similar improvements in functional outcomes, rates of minimal clinically important difference attainment, and patient satisfaction (P > .05). Older patients were more likely to gain weight (P < .05). Patients with higher preoperative BMI were more likely to gain weight (P < .05) and less likely to lose weight (P < .05). Patients with greater preoperative comorbidities were less likely to lose weight (P < .05). CONCLUSION Up to 41% of patients experience significant weight changes after SB-TKA. Older patients with higher preoperative BMI were more likely to gain weight, while higher preoperative BMI with more comorbidities were less likely to lose weight following SB-TKA; however, postoperative weight changes do not appear to affect functional outcomes. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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21
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Liu J, Yang Y, Wan S, Yao Z, Zhang Y, Zhang Y, Shi P, Zhang C. A new prediction model for patient satisfaction after total knee arthroplasty and the roles of different scoring systems: a retrospective cohort study. J Orthop Surg Res 2021; 16:329. [PMID: 34016153 PMCID: PMC8136158 DOI: 10.1186/s13018-021-02469-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although total knee arthroplasty (TKA) is an efficacious treatment for end-stage osteoarthritis, ~20% of patients are dissatisfied with the results. We determined which factors contribute to patient satisfaction and compared the various scoring systems before and after surgery. METHODS In this retrospective cohort study, 545 patients were enrolled and evaluated preoperatively and 1 year postoperatively. Patient demographics, as well as scores for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF)-12, and 1989 Knee Society Clinical Rating System (1989 KSS), were recorded preoperatively and postoperatively. The possible predictors were introduced into a prediction model. Scores for overall satisfaction and the 2011 Knee Society Score (2011 KSS) were also assessed after TKA to identify the accuracy and agreement of the systems. RESULTS There were 134 male patients and 411 female patients, with an overall prevalence of satisfaction of 83.7% 1 year after surgery. A history of surgery (p < 0.001) and the 1989 KSS and SF-12 were of the utmost importance in the prediction model, whereas the WOMAC score had a vital role postoperatively (change in WOMAC pain score, p < 0.001; change in WOMAC physical function score, p < 0.001; postoperative WOMAC pain score, p = 0.004). C-index of model was 0.898 > 0.70 (95% confidence interval (CI): 0.86-0.94). The Hosmer-Lemeshow test showed a p value of 0.586, and the AUC of external cohort was 0.953 (sensitivity=0.87, specificity=0.97). The agreement between the assessment of overall satisfaction and the 2011 KSS satisfaction assessment was general (Kappa=0.437 > 0.4, p < 0.001). CONCLUSION A history of surgery, the preoperative 1989 KSS, and the preoperative SF-12 influenced patient satisfaction after primary TKA. We recommend the WOMAC (particularly the pain subscale score) to reflect overall patient satisfaction postoperatively.
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Affiliation(s)
- Jinyu Liu
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yi Yang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shengcheng Wan
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhenjun Yao
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ying Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yueqi Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Peng Shi
- Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Chi Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Jester R, Rodney A. The relationship between obesity and primary Total Knee Replacement: A scoping review of the literature. Int J Orthop Trauma Nurs 2021; 42:100850. [PMID: 34044216 DOI: 10.1016/j.ijotn.2021.100850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Primary Total Knee Replacement (TKR) is one of the most commonly performed elective orthopaedic procedures globally. Many patients undergoing this type of surgery are overweight or obese. In the UK, clinical commissioning groups have imposed arbitrary Body Mass Index (BMI) thresholds for TKR surgery. Many obese patients undergoing TKR believe they will lose weight following the procedure because of increased mobility. AIM This paper aims to present the findings of a scoping literature review about the relationship between obesity and primary TKR and to make recommendations for clinical practice, education and policy. METHODS A scoping literature review investigated the impact of BMI/body weight on the need for TKR, the impact of body weight and or BMI on patient outcomes following TKR, weight loss/gain following TKR and the implications of obesity on cost of TKR. FINDINGS Seventy-one papers were included in the review. Seven studies reported statistically significant associations between increased BMI/obesity with the need for TKR. Thirty of the studies reported worse outcomes for obese patients compared to non-obese comparisons. Forty of the studies reported no difference between obese and non-obese participants, including some where outcomes of obese patients were better than non-obese comparisons. Eight studies reported on changes to weight before and after TKR, three of the studies reporting a higher percentage losing weight than gaining weight and four studies reporting that obese patients gained weight. The 8th study reported that morbidly obese patients largely returned to their baseline BMI postoperatively. CONCLUSION The findings of the review challenge the legitimacy of setting BMI thresholds to control access to TKR surgery. There is an urgent need to develop evidence based approaches to support weight loss and weight management for this group of patients. Obese patients undergoing TKR should receive specific information regarding potential additional risks of complications and poorer outcomes. There is a need for health promotion regarding the association of being overweight/obese in young adulthood and developing osteoarthritis of the knee joints requiring TKR in middle and older age.
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Affiliation(s)
- Rebecca Jester
- Institute of Health Faculty of Education, Health and Wellbeing the University of Wolverhampton Wolverhampton, WV1 1DT UK.
| | - Amanda Rodney
- Institute of Health Faculty of Education, Health and Wellbeing the University of Wolverhampton Wolverhampton, WV1 1DT UK
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Higher treatment effect after total knee arthroplasty is associated with higher patient satisfaction. Knee Surg Sports Traumatol Arthrosc 2021; 29:3426-3432. [PMID: 32918556 PMCID: PMC8458187 DOI: 10.1007/s00167-020-06272-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study was to investigate what influence the treatment effect after total knee arthroplasty (TKA) had on patient satisfaction. METHODS Prospective registry data of a University-based arthroplasty centre were used. 582 patients with unilateral bicondylar TKA were analyzed. Treatment effect (TE) was deduced from Oxford Knee Score (OKS) before and one year after surgery. Positive values correspond to improved symptoms (maximum 1.0 reflect no symptoms at all) and negative values correspond to deterioration of symptoms. Satisfaction on a visual-analogue scale from 0 to 10 and the willingness to undergo TKA surgery again was assessed one year after surgery. RESULTS The mean OKS improved from 22.1 before to 36.7 one year after TKA. Treatment effects ranged from 1.0 to -0.62 with a mean TE of 0.56. Taking an individual treatment effect of 0.2 as a cut-off between responder and non-responder, a total of 85.8% would be classified as responder after TKA. The mean satisfaction score with the TKA was 8.1. There was a significant correlation between the individual treatment effect and satisfaction after TKA (p < 0.001). The majority of patients (84.5%) would undergo surgery again. Patients not willing to undergo surgery again or those uncertain about this had lower satisfaction scores, a lower treatment effect and were more often female compared to patients who would undergo surgery again. CONCLUSION Higher individual treatment effects resulted in higher patient satisfaction and willingness to undergo surgery again. However, some patients with a relatively low treatment effect were highly satisfied, which indicates the need for both information. LEVEL OF EVIDENCE II.
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Zhao G, Liu C, Chen K, Chen F, Lyu J, Chen J, Shi J, Huang G, Wei Y, Wang S, Xia J. Predictive value of adipose to muscle area ratio based on MRI at knee joint for postoperative functional outcomes in elderly osteoarthritis patients following total knee arthroplasty. J Orthop Surg Res 2020; 15:494. [PMID: 33109259 PMCID: PMC7590798 DOI: 10.1186/s13018-020-02014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current research used a new index-adipose to muscle area ratio (AMR)-to measure fatness compared with body mass index (BMI) in elderly osteoarthritis (OA) patients following total knee arthroplasty. Our study aimed to test the relationship between the two indexes (AMR and BMI) and to examine whether AMR was a predictive factor of patient-reported outcome measures (PROMS) for elderly OA patients following total knee arthroplasty (TKA). METHODS The retrospective data of 78 OA patients (older than 60 years) following TKA was included in our study. Clinical features of patients included age, BMI, sex, AMR, side of the implant, time of follow-up, complications, the Knee Society Score (KSS score), and the Hospital for Special Surgery knee score (HSS score). The area of adipose tissue and muscle tissue was measured on the cross section (supra-patella, midline of the patella, joint line of the knee) of the knee magnetic resonance imaging (MRI). AMR was calculated as the average of adipose to muscle area ratio at the three levels. The Pearson correlation analysis, simple linear regression, and multiple linear regression were used to study the relationship between BMI, AMR, and PROMS (KSS total-post score and HSS-post score) in the study. RESULTS Of all patients, the mean (± standard deviations (SD)) of age was 67.78 ± 4.91 years. For BMI and AMR, the mean (± SD) were 26.90 ± 2.11 and 2.36 ± 0.69, respectively. In Pearson correlation analysis, BMI had a good correlation with AMR (r = 0.56, p = 0.000), and AMR (r = - 0.37, p = 0.001, HSS-post score; r = - 0.43, p = 0.000, KSS total-post score) had better correlations with PROMS postoperatively compared with BMI (r = - 0.27, p = 0.019, HSS-post score; r = - 0.33, p = 0.003, KSS total-post score). In multivariate linear regression analysis, AMR was negatively correlated with KSS total-post score as well as HSS-post score, while BMI was not. As for patients with complications, AMR values were between the 3rd quartile and 4th quartile of the AMR value in the entire study cohort. CONCLUSIONS In this study, the new obesity evaluation indicator-AMR, which was well related with BMI, was found to be a predictor of PROMS (KSS total-post score and HSS-post score) in elderly OA patients following TKA.
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Affiliation(s)
- Guanglei Zhao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Changquan Liu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Kangming Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Feiyan Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jinyang Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jie Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jingsheng Shi
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Gangyong Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Yibing Wei
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Siqun Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jun Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040 China
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Differences in case mix and outcomes between Swiss and Scottish total knee arthroplasty patients. Knee Surg Sports Traumatol Arthrosc 2020; 28:1797-1804. [PMID: 31267190 DOI: 10.1007/s00167-019-05597-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE The clinical benefits of total knee arthroplasty (TKA) are well defined, but little attention has been paid to the cross-cultural variation. The objective of this study was to compare case mix and outcomes following TKA in Swiss and Scottish patients. METHODS Data from local registries at a Swiss and a Scottish orthopaedic hospital were extracted to evaluate: (A) age, sex, body mass index (BMI), self-reported health status (EQ-5D), and joint awareness (Forgotten Joint Score-12 (FJS-12)) at pre-surgery, (B) improvement in EQ-5D and FJS-12 scores from pre-surgery to 1 year, and (C) patient satisfaction at 1 year. RESULTS Data from 2075 Swiss and 994 Scottish TKA patients were available from the local registries. Swiss and Scottish patients differed in age (69.3 vs 68.8 years, p = 0.046), sex ratio (62.9% vs 56.9% women, p = 0.002) and BMI (29.6 vs 30.9, p < 0.001). At pre-surgery, FJS-12 scores were comparable (Swiss 12.1 vs Scottish 10.9, n.s.), but EQ-5D scores were better in Swiss patients (0.52 vs 0.40, p < 0.001). Post-operative improvement was greater in Switzerland for the FJS-12 (+ 55.1 vs + 32.2, p < 0.001), but not for the EQ-5D (+ 0.31 vs + 0.29, n.s.). The satisfaction rate was similar in both groups (88.3% vs 89.6%, n.s.). CONCLUSION Subtle cross-cultural variation was evident in TKA case-mix factors between the two countries. Satisfaction and improvement in health status were similar, while improvement in joint-specific outcome was notably greater in Switzerland. Understanding cross-cultural variability of the outcome has important implications when interpreting study and registry data from other countries and when counselling a patient in daily practice. LEVEL OF EVIDENCE Retrospective cohort, Level III.
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Li H, Gu S, Song K, Liu Y, Wang J, Wang J, Yin Q. The influence of obesity on clinical outcomes following primary total knee arthroplasty: A prospective cohort study. Knee 2020; 27:1057-1063. [PMID: 32345460 DOI: 10.1016/j.knee.2020.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the influence of obesity on patients' function, pain, and complications following primary total knee arthroplasty (TKA) with an enhanced-recovery program. METHODS A total of 157 patients were enrolled into a prospective study and assigned into one of three groups on the basis of their body mass index (BMI): normal (BMI 18.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), or obese (BMI ≥30.0 kg/m2). The primary outcome was knee range of motion (ROM) on postoperative day (POD) 3, 15, 30, and 90, and secondary outcomes were visual analog scale (VAS) on POD 1, 2, 3, 15, 30, and 90, length of stay, and complications. RESULTS The ROM of patients in the obese group on POD 3 was higher than in the normal (104.4 ± 8.5 vs. 98.9 ± 8.9, P = .010) and overweight (104.4 ± 8.5 vs. 97.7 ± 7.8, P = .001) groups. Similarly, the VAS in the obese group at rest on POD 1 was lower than in the normal (2.0 ± 0.7 vs. 2.2 ± 0.6, P = .043) and overweight (2.0 ± 0.7 vs. 2.3 ± 0.6, P = .010) groups. In addition, the incidence of complications did not differ significantly among the three groups, but the length of hospital stay in the obese group was longer (P = .027). CONCLUSIONS Obesity may not affect patients' function and pain, and may not increase the incidence of complications following primary TKA. Obese patients may obtain satisfactory functional rehabilitation outcomes, but with a longer duration of rehabilitation.
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Affiliation(s)
- Haifeng Li
- Department of Orthopaedic Surgery, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, Jiangsu, People's Republic of China
| | - Sanjun Gu
- Department of Orthopaedic Surgery, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, Jiangsu, People's Republic of China.
| | - Kerong Song
- Department of Orthopaedic Surgery, Nanjing Medical University Affiliated to Wuxi Second Hospital, Wuxi, Jiangsu, People's Republic of China
| | - Yu Liu
- Department of Orthopaedic Surgery, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, Jiangsu, People's Republic of China
| | - Jian Wang
- Department of Orthopaedic Surgery, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, Jiangsu, People's Republic of China
| | - Jianbing Wang
- Department of Orthopaedic Surgery, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, Jiangsu, People's Republic of China
| | - Qudong Yin
- Department of Orthopaedic Surgery, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, Jiangsu, People's Republic of China
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Taniguchi H, Itoh M, Yoshimoto N, Itou J, Kuwashima U, Okazaki K. Noise after total knee arthroplasty has limited effect on joint awareness and patient-reported clinical outcomes: retrospective study. BMC Musculoskelet Disord 2020; 21:115. [PMID: 32085760 PMCID: PMC7035734 DOI: 10.1186/s12891-020-3134-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Some patients complain of noise after total knee arthroplasty (TKA). Controversy still exists on how the noise affects the clinical outcomes, including joint awareness, after TKA. The Forgotten Joint Score—12 (FJS-12) measures the clinical outcomes focusing on joint awareness after surgery. The Knee Society Scoring System—2011 (KSS-2011) includes questionnaires for satisfaction, expectation, and functional activities. The aim of this study is to clarify the relationship among FJS-12, KSS-2011, and the noise. Furthermore, the relationship between FJS-12 and KSS-2011 was validated. Methods Using FJS-12 and KSS-2011, 295 knees from 225 patients who underwent TKA were retrospectively evaluated. Noise perception was evaluated by a questionnaire with five grades, a method that follows the questionnaire form of FJS-12 (“Are you aware of the noise of your artificial joint?”; never, almost never, seldom, sometimes, mostly). Correlations among FJS-12, KSS-2011, and noise were analyzed. The patients were divided into four groups based on the mechanism of their implant [cruciate retaining, posterior stabilized, cruciate sacrificed, and bicruciate stabilized (BCS)]. FJS-12, KSS-2011, and noise were compared among the groups. Results A strong correlation was found between FJS-12 and total score of KSS-2011 (0.70; P < 0.001). FJS-12 correlated with KSS-2011 subcategories of “symptoms,” “satisfaction,” and “standard activities,” with correlation coefficients at approximately 0.60. Noise had weak correlations with FJS-12 (0.28; P < 0.001) and KSS-2011 (0.20 P < 0.001). In comparing the TKA mechanisms, BCS had remarkably better KSS-2011 and greater movement range but worse noise scores. Conclusions Noise perception after TKA had limited effect on joint awareness and clinical outcomes. FJS-12 correlated strongly with KSS-2011 and associated with satisfaction, residual symptoms, and daily activities, as assessed by KSS-2011 subscores. Trial registration This study was approved by the Medical Ethical Committee of the Tokyo Women’s Medical University (approval number: 4681 on March 2, 2018).
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Affiliation(s)
- Hiroto Taniguchi
- Department of Orthopaedic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Nobuyuki Yoshimoto
- Department of Orthopaedic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan.
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Blanchett JW, Kuhlmann NA, Fidai MS, Borowsky PA, Muh SJ, Makhni EC. Using Patient-Reported Outcome Measurement Information System Computer Adaptive Testing Domains to Investigate the Impact of Obesity on Physical Function, Pain Interference, and Mental Health in Sports Medicine Patients. J Obes Metab Syndr 2020; 28:246-253. [PMID: 31909367 PMCID: PMC6939707 DOI: 10.7570/jomes.2019.28.4.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/09/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022] Open
Abstract
Background While obesity has become an increasingly prevalent health concern in the United States, little emphasis has been placed on utilizing patient reported outcome measures (PROM) to investigate its impact on life from the patients’ perspective. The purpose of the study was to determine the association between patients’ body mass index (BMI) and three Patient-Reported Outcome Measurement Information System (PROMIS) computer adaptive test scores: upper extremity physical function (UE) or lower extremity physical function (PF), pain interference (PI), and depression (D). Methods Patients were recruited from two sports medicine orthopedic surgery clinics. PROMIS questionnaires were administered to patients arriving for their first visit. Patients were stratified into BMI groupings according to the National Institute of Health standards. Patients’ BMI, sex, race, ethnicity, and injury were determined retroactively. Data were analyzed using a Pearson correlation and a least significant difference post hoc test. Results A total of 833 patients completed the set of PROMIS questionnaires that were retrospectively analyzed. BMI was found to have a correlation with PROMIS-UE (R=−0.111, P<0.05), PROMIS-PF (R=−0.174, P<0.01), PROMIS-PI (R=0.224, P<0.01), and PROMIS-D (R=0.092, P<0.05). Obese patients also portrayed the worst PROMIS-UE, PROMIS-PI, and PROMIS-PF. Conclusion We found BMI to correlate with each PROMIS domain: negatively with PROMIS-UE, PROMIS-PF, PROMIS-D, and positively with PROMIS-PI. Additionally, overweight and obese BMI patients portrayed worse physical function and pain interference scores than their healthy group counterparts.
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Affiliation(s)
- Jacob W Blanchett
- Department of Orthopedic Surgery, Henry Ford Hospital, West Bloomfield, MI, USA
| | - Noah A Kuhlmann
- Department of Orthopedic Surgery, Henry Ford Hospital, West Bloomfield, MI, USA
| | - Mohsin S Fidai
- Department of Orthopedic Surgery, Henry Ford Hospital, West Bloomfield, MI, USA
| | - Peter A Borowsky
- Department of Orthopedic Surgery, Henry Ford Hospital, West Bloomfield, MI, USA
| | - Stephanie J Muh
- Department of Orthopedic Surgery, Henry Ford Hospital, West Bloomfield, MI, USA
| | - Eric C Makhni
- Department of Orthopedic Surgery, Henry Ford Hospital, West Bloomfield, MI, USA
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Toguchi K, Nakajima A, Akatsu Y, Sonobe M, Yamada M, Takahashi H, Saito J, Aoki Y, Suguro T, Nakagawa K. Predicting clinical outcomes after total knee arthroplasty from preoperative radiographic factors of the knee osteoarthritis. BMC Musculoskelet Disord 2020; 21:9. [PMID: 31906935 PMCID: PMC6945497 DOI: 10.1186/s12891-019-3029-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/30/2019] [Indexed: 12/15/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is the major surgical treatment for end-stage osteoarthritis (OA). Despite its effectiveness, there are about 20% of patients who are dissatisfied with the outcome. Predicting the surgical outcome preoperatively could be beneficial in order to guide clinical decisions. Methods One-hundred and ten knees of 110 consecutive patients who underwent TKAs for varus knees resulting from OA were included in this study. Preoperative varus deformities were evaluated by femorotibial angle (FTA), medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), and classified as a severe varus (SV) or a mild varus (MV) group. The osteophyte score (OS), which we developed originally, was also calculated based on the size of the osteophytes and classified as groups with more or less osteophytes. We compared preoperative and 1-year postoperative range of motion, the Knee Society Score, and Japanese Knee injury Osteoarthritis Outcome Score (KOOS) between SV and MV groups (varus defined by FTA, MPTA, or LDFA), in each group with more or less osteophytes. Results When varus deformities were defined by FTA, regardless of OS, postoperative KOOS subscales and/or the improvement rates were significantly higher in the SV group than in the MV group. When varus defined by MPTA, regardless of OS, there were no significant differences in postoperative KOOS subscales between groups. However, when varus defined by LDFA, scores for pain, activities of daily living (ADL), and quality of life (QOL) on postoperative KOOS and/or the improvement rates were significantly higher in the SV group than in the MV group only in patients with less osteophytes. No significant differences were found between groups in patients with more osteophytes. Conclusions We classified OA types by radiographic measurements of femur and tibia in combination with OS. Postoperative patient-reported outcomes were better in patients with SV knees but were poor in patients with knees with MV deformity and less osteophytes.
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Affiliation(s)
- Kaoru Toguchi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan.,Department of Orthopaedic Surgery, Sawara Prefectural Hospital, I-2285 Sawara, Katori-city, Chiba, 287-0003, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan.
| | - Yorikazu Akatsu
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan
| | - Manabu Yamada
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane-city, Chiba, 283-8686, Japan
| | - Toru Suguro
- Japan Research Institute of Artificial Joint, 725-1 Sugo, Kisarazu-city, Chiba, 292-0036, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan
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Regional differences between the US, Scandinavia, and South Korea in patient demographics and patient-reported outcomes for primary total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140:93-108. [PMID: 31650229 DOI: 10.1007/s00402-019-03286-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Differences in total knee arthroplasty (TKA) patient demographics and clinical outcomes may exist between international regions, yet research is limited. The aim of this study was, therefore, to compare TKA patient demographics and patient-reported outcome measure (PROM) scores between the US, Scandinavia, and South Korea. MATERIALS AND METHODS A total of 398 TKA patients from three regions were assessed: 169 in Scandinavia (3 centers), 129 in the US (3 centers), and 100 patients in South Korea (2 centers). Regional variation in patient demographics was assessed using Kruskal-Wallis H tests. Regional variation in PROM scores from preoperative, 1-, 3- and 5-year visits was assessed using piecewise linear mixed effect models. The PROMs analyzed were a numerical rating scale for satisfaction and the Knee Osteoarthritis Outcome Score. RESULTS South Korean patients were the oldest (p < 0.001) and had the highest Charnley class (p < 0.001); US patients had the highest BMI (p < 0.001); Scandinavian patients had the lowest preoperative KL grade (p < 0.001). Scandinavian patients were associated with better preoperative and worse postoperative PROM scores. Scandinavian patients were also associated with moderately lower levels of satisfaction. These differences were lessened but remained significant after controlling for relevant demographic and surgical factors. CONCLUSIONS Regional differences were found in TKA patient demographics and PROMs between the US, Scandinavia, and South Korea. The regional differences in patient demographics support the need for more research and clear guidelines related to TKA appropriateness criteria. The better preoperative and worse postoperative Scandinavian PROM scores may have been related to their less severe KL grade but might also reflect cultural differences in how patients reflect on their health state when answering PROMs. Clinicians should be aware of these international differences in PROM scores when interpreting studies conducted in different international regions. Future studies should investigate TKA variation between more international regions and assess intraregional variation. LEVEL OF EVIDENCE Level III.
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Effect of morbid obesity on patient-reported outcomes in total joint arthroplasty: a minimum of 1-year follow-up. Arthroplast Today 2019; 5:493-496. [PMID: 31886396 PMCID: PMC6920710 DOI: 10.1016/j.artd.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/05/2022] Open
Abstract
The objective of this study is to explore the effect of morbid obesity on patient-reported outcomes in primary total joint arthroplasty. We retrospectively reviewed 755 primary total joint arthroplasty cases with a minimum of 1-year follow-up. Two groups were compared: (1) patients with BMI < 40 and (2) those with BMI ≥ 40. The primary outcome was the difference in Short Form-12 physical component summary, Short Form-12 mental component summary, Western Ontario and McMaster Universities Osteoarthritis Index, and patient satisfaction. Multivariate analyses were performed to control for potential confounding factors. 37 patients (5%) were morbidly obese. Morbidly obese patients undergoing total knee arthroplasty had significantly lower net gains in their Short Form-12 physical component summary (P = .008), Short Form-12 mental component summary (P = .049), and Western Ontario and McMaster Universities Osteoarthritis Index (P = .009) in the first 6 months only. For total hip arthroplasty, morbid obesity did not affect any of the outcomes measured (P > .05). There was also no difference in patient satisfaction rates between the two groups (P = .401 and .143 for total hip arthroplasty and total knee arthroplasty, respectively). The impact of morbid obesity on patient-reported outcomes appears to be limited to total knee arthroplasty only in the initial 6 months after surgery.
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Overgaard A, Lidgren L, Sundberg M, Robertsson O, W-Dahl A. Patient-reported 1-year outcome not affected by body mass index in 3,327 total knee arthroplasty patients. Acta Orthop 2019; 90:360-365. [PMID: 30994041 PMCID: PMC6718174 DOI: 10.1080/17453674.2019.1604940] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patient-reported outcome (PRO) in total knee arthroplasty (TKA) patients with high body mass index (BMI) is controversial. We compared pain, function, quality of life, general health, and satisfaction among different BMI categories preoperatively and 1 year after primary TKA. Patients and methods - 4,318 patients were operated with a TKA for knee osteoarthritis in the Region of Skane in 2013-2015. In all, 3,327 patients (77%) had complete PRO data and information on BMI and were included. Preoperatively the patients filled in the Knee injury and Osteoarthritis Outcome Score (KOOS) and EQ-VAS (general health). 1 year postoperatively the same questionnaires were filled in together with a question asking whether they were satisfied with the surgery. Information on age, sex, BMI, and ASA grade were obtained from the Swedish Knee Arthroplasty Register. Each patient was classified as Outcome Measures in Rheumatology- Osteoarthritis Research Society International (OMERACT-OARSI) responder or not based on a combination of absolute and relative changes in scores. Welch's t-test and a chi-square test were used in the statistical analysis. Results - Both preoperatively and 1 year postoperatively the obese patients reported somewhat worse scores than the normal weight and overweight. The differences were small with 1 exception, the KOOS sport- and recreation function postoperatively, where normal-weight and overweight patients reported fewer problems than obese patients with a BMI over 35 (40 and 39 points vs. 31 points, p < 0.001). Similar proportions of patients were satisfied and categorized as OMERACT-OARSI responders in the different BMI categories. Interpretation - The degree of improvement in PROs 1 year after TKA surgery does not seem to be affected by BMI.
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Affiliation(s)
- Anders Overgaard
- The Parker Institute, Copenhagen University Hospital Fredriksberg, Copenhagen, Denmark; ,Correspondence:
| | - Lars Lidgren
- The Swedish Knee Arthroplasty Register, Lund, Sweden; ,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden
| | - Martin Sundberg
- The Swedish Knee Arthroplasty Register, Lund, Sweden; ,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Lund, Sweden; ,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Lund, Sweden; ,Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden
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Age, gender, functional KSS, reason for revision and type of bone defect predict functional outcome 5 years after revision total knee arthroplasty: a multivariable prediction model. Knee Surg Sports Traumatol Arthrosc 2019; 27:2289-2296. [PMID: 30689000 PMCID: PMC6609585 DOI: 10.1007/s00167-019-05365-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/18/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE The number of revision total knee arthroplasties (rTKA) is increasing. Unfortunately, not all patients benefit from revision surgery. The aim of this study was to develop a clinical prediction model that can be used to predict the functional outcome 5 years after rTKA. METHODS Data of patients receiving rTKA at Sint Maartenskliniek, Nijmegen, The Netherlands, from 2004 onwards were prospectively collected. Demographic and clinical variables and patient-reported outcome scores were collected and considered as potential predictors. Beneficial outcome was defined as an increase of ≥ 20 points on the functional knee society scores (fKSS) or an absolute fKSS ≥ 80 points 5 years after surgery. The prediction model was developed using backward logistic regression. Regression coefficients were converted into an easy to use prediction rule. RESULTS Overall, 295 rTKA patients were included of whom 157 (53%) had beneficial fKSS 5 years later. Age, gender, femoral bone defects, preoperative fKSS, and stiffness as reason for revision were included in the model. Men had a higher chance of beneficial fKSS than women (OR 1.59, 95% CI 0.91-2.78). Patients with major bone defects (OR 0.44, 95% CI 0.22-0.85), higher age (IQR OR 0.39, 95% CI 0.26-0.58), higher preoperative fKSS (IQR OR 0.42, 95% CI 0.30-0.59), and severe stiffness (OR 0.48, 95% CI 0.20-1.15) had a lower chance of successful outcome. The model's AUC was 0.76, 95% CI 0.70-0.81. CONCLUSION Easily determinable characteristics of patients who need rTKA can be used to predict future functional outcome. Young men with low preoperative fKSS without severe stiffness are more likely to achieve a beneficial outcome. LEVEL OF EVIDENCE IV.
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Dahlgren N, Lehtonen E, Anderson M, Archie AT, McGwin G, Shah A, Naranje SM. Readmission Following Revision Total Knee Arthroplasty: An Institutional Cohort. Cureus 2018; 10:e3640. [PMID: 30723640 PMCID: PMC6351006 DOI: 10.7759/cureus.3640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Total knee arthroplasty (TKA) is the most common joint replacement surgery performed in the United States. Given the aging and increasingly comorbid patient populations undergoing these procedures, complication rates and the need for subsequent hospital readmission are only expected to rise. It is, therefore, crucial to investigate the risk factors leading to readmission in order to improve patient outcomes. The purpose of this study is to identify significant risk factors for readmission following revision TKA procedures. Methods: Patients undergoing revision TKA were identified at our institution from 2006-2017. The primary outcome was hospital readmission after revision TKA. Patient demographics, comorbidities, and postoperative complications were recorded and compared between readmitted and non-readmitted patients. Results: Forty-five (26.2%) of the 171 cases were readmitted following revision TKA. The leading diagnoses at readmission varied from arthrofibrosis in 28.9% of patients, implant infection in 22.2% of patients, and implant failure in 20.0% of patients. Male gender was found to be a significant independent variable for readmission. This study also found that 51.1% of all readmitted patients continued to have complaints that required additional hospital readmissions. The average number of total readmissions was 2.1 per readmitted patient. Conclusion: This study was successful in identifying variables associated with readmission following revision TKA, as well as presenting information regarding the diagnoses associated with readmission. Our data also showed that if a patient was readmitted after revision TKA, it was likely that they would be admitted again. Due to the increasing prevalence and cost of these procedures, further studies are needed to better understand the risk factors and comorbidities leading to readmission in order to improve the perioperative care of these patients.
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Affiliation(s)
- Nicholas Dahlgren
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Eva Lehtonen
- Orthopaedics, University of Miami, Miller School of Medicine, Miami, USA
| | - Matthew Anderson
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Adam T Archie
- Orthopedics, University of Alabama School of Medicine, Birmingham, USA
| | - Gerald McGwin
- Epidemiology, University of Alabama School of Medicine, Birmingham, USA
| | - Ashish Shah
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Sameer M Naranje
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
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