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LaValva SM, Grubel J, Ong J, Chiu YF, Lyman S, Mandl LA, Cushner FD, Gonzalez Della Valle A, Parks ML. Is Preoperative Weight Reduction in Patients Who Have Body Mass Index ≥ 40 Associated With Lower Complication Rates After Primary Total Hip Arthroplasty? J Arthroplasty 2024; 39:S73-S79. [PMID: 38897262 DOI: 10.1016/j.arth.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Given the heightened risk of postoperative complications associated with obesity, delaying total hip arthroplasty (THA) in patients who have a body mass index (BMI) > 40 to maximize preoperative weight loss has been advocated by professional societies and orthopaedic surgeons. While the benefits of this strategy are not well-understood, previous studies have suggested that a 5% reduction in weight or BMI may be associated with reduced complications after THA. METHODS We identified 613 patients who underwent primary THA in a single institution during a 7-year period and who had a BMI >40 recorded from 9 to 12 months prior to surgery. Subjects were stratified into 3 cohorts based on whether their baseline BMI decreased by >5% (147 patients, 24%), was unchanged ( ± 5%) (336 patients, 55%), or increased by >5% (130 patients, 21%) on the day of surgery. The frequency of 90-days Hip Society and Centers for Medicare & Medicaid Services complications was compared between these cohorts. There were significant baseline differences between the cohorts with respect to baseline American Society of Anesthesiologists class (P < .001) and hemoglobin A1C (P = .011), which were accounted for in a multivariate regression analysis. RESULTS In univariate analysis, there was a lower incidence of readmission (P = .025) and total complications (P = .005) in the increased BMI cohort. The overall complication rate was 18.4% in the decreased BMI cohort, 17.6% in the unchanged cohort, and 6.2% in the increased cohort. However, multivariable regression analysis controlling for potential confounders did not find that preoperative change in BMI was associated with differences in 90-days complications between cohorts (P > .05). CONCLUSIONS Patients who have a BMI >40 and achieved a clinically significant (>5%) BMI reduction prior to THA did not have a lower risk of 90-days complications or readmissions. Thus, delaying THA in these patients to encourage weight loss may result in restricting access to a beneficial surgery without an appreciable safety benefit.
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Affiliation(s)
- Scott M LaValva
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jacqueline Grubel
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Justin Ong
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Stephen Lyman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Fred D Cushner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | | - Michael L Parks
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Driscoll DA, Grubel J, Ong J, Chiu YF, Mandl LA, Cushner F, Parks ML, Gonzalez Della Valle A. Obesity Severity Does Not Associate With Rate, Timing, or Invasiveness of Early Reinterventions After Total Knee Arthroplasty. J Arthroplasty 2024; 39:S167-S173.e1. [PMID: 38428689 DOI: 10.1016/j.arth.2024.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The use of body mass index (BMI) cutoff values has been suggested for proceeding with total knee arthroplasty (TKA) in obese patients. However, the relationship between obesity severity and early reoperations after TKA is poorly defined. This study evaluated whether increased World Health Organization (WHO) obesity class was associated with risk, severity, and timing of reintervention within one year after TKA. METHODS There were 8,674 patients from our institution who had a BMI ≥ 30 and underwent unilateral TKA for primary osteoarthritis between 2016 and 2021. Patients were grouped by WHO obesity class: 4,456 class I (51.5%), 2,527 class II (29.2%), and 1,677 class III (19.4%). A chart review was performed to determine patient characteristics and identify patients who underwent any closed or open reintervention requiring anesthesia within the first postoperative year. Regression analyses were performed to identify variables associated with increased odds ratios (ORs) for requiring a reintervention, its timing, and invasiveness. RESULTS There were 158 patients (1.8%) who required at least one reintervention, and 15 patients (0.2%) required at least 2 reinterventions. Reintervention rates for obesity classes I, II, and III were 1.8% (n = 81), 2.0% (n = 51), and 1.4% (n = 23), respectively. There were 65 closed procedures (41.1%), 47 minor procedures (29.7%), 34 open with or without liner exchange (21.5%), and 12 revisions with component exchange (7.6%). Obesity class was not associated with reintervention rate (P = .3), timing (P = .36), or invasiveness (P = .93). Diabetes (odds ratio [OR] = 2.47; P = .008) was associated with a need for reintervention. Non-Caucasian race (OR = 1.7; P = .01) and Charlson comorbidity index (OR = 2.1; P = .008) were associated with earlier reintervention. No factors were associated with the invasiveness of reintervention. CONCLUSIONS The WHO obesity class did not associate with rate, timing, or invasiveness of reintervention after TKA in obese patients. These findings suggest that policies that restrict the indication for elective TKA based only on a BMI limit have limited efficacy in reducing early reintervention after TKA in obese patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel A Driscoll
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jacqueline Grubel
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Justin Ong
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Fred Cushner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Michael L Parks
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Wu KA, Helmkamp J, Levin JM, Hurley ET, Goltz DE, Cook CE, Pean CA, Lassiter TE, Boachie-Adjei YD, Anakwenze O, Klifto C. Association between radiographic soft-tissue thickness and increased length of stay, operative time, and infection rate after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:1267-1275. [PMID: 38036256 DOI: 10.1016/j.jse.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/11/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) is a widely performed surgical procedure to address various shoulder pathologies. Several studies have suggested that radiographic soft-tissue thickness may play a role in predicting complications after orthopedic surgery, but there have been limited studies determining the use of radiographic soft-tissue thickness in RSA. The purpose of this study was to evaluate whether radiographic soft-tissue thickness could predict clinical outcomes after RSA and compare the predictive capabilities against body mass index (BMI). We hypothesized that increased radiographic shoulder soft-tissue thickness would be a strong predictor of operative time, length of stay (LOS), and infection in elective RSA. MATERIAL AND METHODS A retrospective review of patients undergoing RSA at an academic institution was conducted. Preoperative radiographic images were evaluated including measurements of the radius from the humeral head center to the skin (HS), deltoid radius-to-humeral head radius ratio (DHR), deltoid size, and subcutaneous tissue size. Different correlation coefficients were used to analyze various types of relationships, and the strength of these associations was classified based on predefined boundaries. Subsequently, multivariable linear and logistic regressions were performed to determine whether HS, DHR, deltoid size, and subcutaneous tissue size could predict LOS, operative time, or infection while controlling for patient factors. RESULTS HS was the most influential factor in predicting both operative time and LOS after RSA, with strong associations indicated by standardized β coefficients of 0.234 for operative time and 0.432 for LOS. Subcutaneous tissue size, deltoid size, and DHR also showed stronger predictive values than BMI for both outcomes. In terms of prosthetic joint infection, HS, deltoid size, and DHR were significant predictors, with HS demonstrating the highest predictive power (Nagelkerke R2 = 0.44), whereas BMI did not show a statistically significant association with infection. Low event counts resulted in wide confidence intervals for odds ratios in the infection analysis. CONCLUSION Greater shoulder soft-tissue thickness as measured with concentric circles on radiographs is a strong predictor of operative time, LOS, and postoperative infection in elective primary RSA patients.
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Affiliation(s)
- Kevin A Wu
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Joshua Helmkamp
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Chad E Cook
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christian A Pean
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Yaw D Boachie-Adjei
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Wu KA, Anastasio AT, Krez AN, Kutzer KM, DeOrio JK, Easley ME, Nunley JA, Adams SB. Association of Radiographic Soft Tissue Thickness With Revision Total Ankle Arthroplasty Following Primary Total Ankle Arthroplasty: A Minimum of 5-year Follow-up. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241255351. [PMID: 38803651 PMCID: PMC11129576 DOI: 10.1177/24730114241255351] [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: 05/29/2024] Open
Abstract
Background The incidence of primary total ankle arthroplasty (TAA) is rising, with a corresponding increase in revision surgeries. Despite this, research on risk factors for revision TAA following primary TAA remains limited. Radiographic soft tissue thickness has been explored as a potential predictor for outcomes in hip, knee, and shoulder arthroplasty, but its role in TAA has not been assessed. This study aimed to assess the predictive value of radiographic soft tissue thickness for identifying patients at risk of requiring revision surgery following primary TAA. Methods A retrospective study was conducted on 323 patients who underwent primary TAA between 2003 and 2019. Radiographic measurements of soft tissue thickness were obtained from preoperative radiographs. Two novel radiographic measures of soft tissue thickness were developed and assessed (tibial tissue thickness and talus tissue thickness). Clinical variables including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, diabetes, smoking status, primary diagnosis, and implant type were recorded. Logistic regression analysis was used to assess the predictive value of soft tissue thickness and BMI for revision TAA. Results The rate of revision surgery was 4.3% (14 of 323 patients). Patients requiring revision had significantly greater tibial tissue (3.54 vs 2.48 cm; P = .02) and talus tissue (2.79 vs 2.42 cm; P = .02) thickness compared with those not requiring revision. Both the tibial tissue thickness (odds ratio 1.16 [1.12-1.20]; P < .01) and the talus tissue thickness (odds ratio: 1.10 [1.05-1.15]; P < .01) measurements were significant predictors of revision TAA in multivariable logistic regression models. However, BMI was not a significant predictor of revision TAA. The two metrics demonstrated excellent interrater reliability. Conclusion Greater soft tissue thickness was a better predictor of revision TAA compared with BMI. These findings suggest that radiographic soft tissue thickness may be a valuable tool for assessing the risk of the need for revision TAA following primary TAA. Further research is needed to validate and explore the potential impact on clinical practice. Level of Evidence Level III, comparative study.
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Affiliation(s)
- Kevin A. Wu
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Albert T. Anastasio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alexandra N. Krez
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Katherine M. Kutzer
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - James K. DeOrio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Mark E. Easley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - James A. Nunley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Samuel B. Adams
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
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Parikh S, Pannu TS, Davis T, Gomez O, Corces A. Local Soft-Tissue Thickness vs. Body Mass Index as Predictors of Complications After Total Knee or Hip Arthroplasty: A Literature Review. JBJS Rev 2023; 11:01874474-202311000-00009. [PMID: 38016004 DOI: 10.2106/jbjs.rvw.22.00128] [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: 11/30/2023]
Abstract
» Body mass index (BMI) is a nonspecific measure of general fat composition that demonstrates little conclusive or definitive association with surgical site complications after total knee and total hip arthroplasty.» Quantifying soft-tissue thickness (STT) around the joint of interest has shown positive correlations with complications and is arguably a better predictor than BMI.» In this literature review, 14 articles (7 discussing hips and 7 discussing knees) discussing the association of STT, BMI, and surgical site complications after total hip and knee arthroplasty were scrutinized and summarized to present relevant information necessary to compare STT with BMI.» Five of the 7 studies involving hips and 4 of the 7 studies involving knees show a positive relationship between STT and outcomes including complications and infection, with some claiming STT as a stronger predictor of surgery site problems than BMI.» Since many variables, such as STT measurement technique, surgical outcomes, sample sizes, and surgical approach, varied between the studies, definitive inferences are difficult to make and future studies of bigger sample size and higher power should focus on the described measurement techniques.
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Affiliation(s)
- Sarthak Parikh
- Department of Orthopaedic Surgery, Larkin Community Hospital, South Miami, Florida
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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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Marinier MC, Ogunsola AS, Elkins JM. Whole-body phase angle correlates with pre-operative markers in total joint arthroplasty. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2023; 14:60-65. [PMID: 38162816 PMCID: PMC10750321 DOI: 10.2478/joeb-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 01/03/2024]
Abstract
Background Bioimpedance derived whole body phase angle (ϕ), a measure of cellular integrity, has been identified as an independent marker of morbidity and mortality in many medical and surgical specialties. While similar measures of water homeostasis like extracellular edema (EE) have been associated with pre-operative risk, ϕ has not been studied in orthopaedics, despite potential to serve as a pre-operative marker. This study aims to identify relationships between ϕ, EE, and body composition metrics, laboratory values, patient reported outcomes, and comorbidities. Methods Multi-frequency bioimpedance analysis (BIA) records, laboratory values, and patient reported outcomes of adult patients presenting to an academic arthroplasty clinic were retrospectively reviewed. Correlation coefficients between ϕ, EE, and reviewed information were conducted. Results ϕ was significantly correlated (p<0.001) most positively with measures of lean tissue such as skeletal muscle mass (r=0.48), appendicular skeletal muscle index (r=0.39), lean body mass (r=0.43), and dry lean mass (r=0.47), while it held negative correlations (p<0.001) with age (r= -0.55), and body fat mass (r= -0.11). ϕ was not correlated with body mass index (BMI, p = 0.204). In contrast, EE demonstrated its strongest positive correlations (p<0.001) with body fat mass (r=0.32), age (r=0.50), and BMI (r=0.26), and its strongest negative correlations (p<0.001) with serum albumin (r= -0.37) and total protein (r= -0.23). Conclusions Based on their associations with markers of health and fitness, BIA determined ϕ and EE demonstrate relationships to markers currently implemented in orthopaedic practice. This likely indicates that ϕ has potential as a comprehensive surrogate for several commonly used markers to quantify pre-operative risk. In the future, ϕ may aid in developing risk-stratifications for intervention and prevention of complications.
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Affiliation(s)
- Michael C. Marinier
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA USA
| | - Ayobami S. Ogunsola
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA USA
| | - Jacob M. Elkins
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA USA
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Ighani Arani P, Wretenberg P, W-Dahl A. Information and BMI limits for patients with obesity eligible for knee arthroplasty: the Swedish surgeons' perspective from a nationwide cross-sectional study. J Orthop Surg Res 2022; 17:550. [PMID: 36536418 PMCID: PMC9762022 DOI: 10.1186/s13018-022-03442-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the past decades, the incidence of obesity has increased worldwide. This disease is often accompanied with several comorbidities and therefore, surgeons and anesthesiologists should be prepared to provide optimal management for these patients. The aim of this descriptive cross-sectional study was to map the criteria and routines that are used by Swedish knee arthroplasty surgeons today when considering patients with obesity for knee arthroplasty. METHODS A survey including 21 items was created and sent to all the Swedish centers performing knee arthroplasty. The survey included questions about the surgeons' experience, hospital routines of preoperative information given and the surgeons' individual assessment of patients with obesity that candidates for knee arthroplasty. Descriptive statistics were used to present the data. RESULTS A total of 203 (64%) knee surgeons responded to the questionnaire. Almost 90% of the surgeons claimed to inform their patients with obesity that obesity has been associated with an increased risk of complications after knee arthroplasty. Seventy-nine percent reported that they had an upper BMI limit to perform knee arthroplasty, a larger proportion of the private centers had a BMI limit compared to public centers. The majority of the centers had an upper BMI limit of 35. CONCLUSION The majority of the knee arthroplasty surgeons in Sweden inform their patients with obesity regarding risks associated with knee arthroplasty. Most centers that perform knee arthroplasties in Sweden have an upper BMI limit.
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Affiliation(s)
- Perna Ighani Arani
- grid.412367.50000 0001 0123 6208Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden ,grid.15895.300000 0001 0738 8966Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81 Örebro, Sweden
| | - Per Wretenberg
- grid.412367.50000 0001 0123 6208Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden ,grid.15895.300000 0001 0738 8966Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81 Örebro, Sweden
| | - Annette W-Dahl
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, 221 00 Lund, Sweden ,The Swedish Arthroplasty Register, Göteborg, Sweden
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DeMik DE, Marinier MC, Glass NA, Elkins JM. Prevalence of Sarcopenia and Sarcopenic Obesity in an Academic Total Joint Arthroplasty Practice. Arthroplast Today 2022; 16:124-129. [PMID: 35677943 PMCID: PMC9168043 DOI: 10.1016/j.artd.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/24/2022] [Accepted: 05/01/2022] [Indexed: 10/29/2022] Open
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What Is the Impact of Body Mass Index Cutoffs on Total Hip Arthroplasty Complications? J Arthroplasty 2022; 37:1320-1325.e1. [PMID: 35271979 DOI: 10.1016/j.arth.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Body mass index (BMI) cutoffs are commonly utilized to decide whether to offer obese patients elective total hip arthroplasty (THA). However, weight loss goals may be unachievable for many, and some patients are thereby denied complication-free surgery. The purpose of this study was to assess the impact of varying BMI cutoffs on the rates of complication-free surgery after THA. METHODS Patients undergoing THA between 2015 and 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Common Procedural Terminology code 27130. BMI and rates of 30-day complications were collected. BMI cutoffs of 30, 35, 40, 45, and 50 kg/m2 were applied to model the incidence of complications if THA would have been allowed to proceed based on BMI. RESULTS A total of 192,394 patients underwent THA, and 13,970 (7%) of them had a BMI ≥40 kg/m2. With a BMI cutoff of 40 kg/m2, 178,424 (92.7%) patients would have proceeded with THA. From this set, 170,296 (95.4%) would experience complication-free surgery, and 11.8% of complications would be prevented. THA would proceed for 191,217 (99.3%) patients at a BMI cutoff of 50 kg/m2, of which 182,123 (95.2%) would not experience a complication, and 1.3% of complications would be prevented. Using 35 kg/m2 as the BMI cutoff would prevent 28.6% of complications and permit 75.9% of complication-free surgeries to proceed. CONCLUSION Lower BMI cutoffs for THA can result in fewer complications although they will consequentially limit access to complication-free THA. Consideration of risks of obesity in THA may be best considered as part of a holistic assessment and shared decision-making when deciding on goals for weight reduction.
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Marinier MC, Ogunsola AS, Elkins JM. Body Composition Changes in the Immediate Peri-operative Period Following Total Joint Arthroplasty. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2022; 13:39-44. [PMID: 36196241 PMCID: PMC9487908 DOI: 10.2478/joeb-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Bioimpedance analysis (BIA) is a readily available tool to assess body composition in a clinical setting. BIA has received little attention in orthopaedics and namely joint arthroplasty. This study aims to quantify changes in body composition in the immediate peri-operative period following total joint arthroplasty. METHODS Adults scheduled for elective total joint arthroplasty were recruited to participate. Patients underwent BIA scans in the immediate peri-operative period: pre-operative on their day of surgery, post-operative day 0, and post-operative day 1. RESULTS 67 patients were enrolled to undergo BIA scans. Mean age was 62.64 ± 10.28 years old, and 49.2% were females. The all-supine cohort exhibited a 0.36 ± 0.61 kg increase in dry lean mass (p < 0.001) and 1.30 ± 2.14 kg increase in lean body mass on postoperative day 0 (p < 0.001). Patients received to 1.16 ± 0.58 kg of fluid mass, on average. CONCLUSION BIA is a rapid, portable tool that allows for body composition analysis of an inpatient surgical population. This study demonstrated that BIA can detect net fluid changes and may approximate implant mass following total joint arthroplasty. This may aid surgeons in interpreting post-operative body composition changes.
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Affiliation(s)
- Michael C. Marinier
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IAUSA
| | - Ayobami S. Ogunsola
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IAUSA
| | - Jacob M. Elkins
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IAUSA
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Mayne AIW, Cassidy RS, Magill P, Diamond OJ, Beverland DE. Increased fat depth is not associated with increased risk of surgical complications following total hip arthroplasty. Bone Joint J 2020; 102-B:1146-1150. [PMID: 32862677 DOI: 10.1302/0301-620x.102b9.bjj-2020-0207.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Previous research has demonstrated increased early complication rates following total hip arthroplasty (THA) in obese patients, as defined by body mass index (BMI). Subcutaneous fat depth (FD) has been shown to be an independent risk factor for wound infection in cervical and lumbar spine surgery, as well as after abdominal laparotomy. The aim of this study was to investigate whether increased peritrochanteric FD was associated with an increased risk of complications in the first year following THA. METHODS We analyzed prospectively collected data on a consecutive series of 1,220 primary THAs from June 2013 until May 2018. The vertical soft tissue depth from the most prominent part of the greater trochanter to the skin was measured intraoperatively using a sterile ruler and recorded to the nearest millimetre. BMI was calculated at the patient's preoperative assessment. All surgical complications occuring within the initial 12 months of follow-up were identified. RESULTS Females had a significantly greater FD at the greater trochanter in comparison to males (median 3.0 cm (interquartile range (IQR) 2.3 to 4.0) vs 2.0 cm (IQR 1.7 to 3.0); p < 0.001) despite equivalent BMI between sexes (male median BMI 30.0 kg/m2 (IQR 27.0 to 33.0); female median 29.0 kg/m2 (IQR 25.0 to 33.0)). FD showed a weak correlation with BMI (R² 0.41 males and R² 0.43 females). Patients with the greatest FD (upper quartile) were at no greater risk of complications compared with patients with the lowest FD (lower quartile); 7/311 (2.3%) vs 9/439 (2.1%); p = 0.820 . Conversely, patients with the highest BMI (≥ 40 kg/m2) had a significantly increased risk of complications compared with patients with lower BMI (< 40 kg/m2); 5/60 (8.3% vs 18/1,160 (1.6%), odds ratio (OR) 5.77 (95% confidence interval (CI) 2.1 to 16.1; p = 0.001)). CONCLUSION We found no relationship between peritrochanteric FD and the risk of surgical complications following primary THA. Cite this article: Bone Joint J 2020;102-B(9):1146-1150.
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Affiliation(s)
| | | | - Paul Magill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
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13
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Smith EL, Shahien AA, Chung M, Stoker G, Niu R, Schwarzkopf R. The Obesity Paradox: Body Mass Index Complication Rates Vary by Gender and Age Among Primary Total Hip Arthroplasty Patients. J Arthroplasty 2020; 35:2658-2665. [PMID: 32482478 DOI: 10.1016/j.arth.2020.04.094] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/19/2020] [Accepted: 04/28/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND High body mass index (BMI) has long been recognized as a risk factor for postoperative complication among total hip arthroplasty (THA) patients. However, recent studies showed mixed results in the effect of high BMI on surgical outcomes. Our study is to examine the association of preoperative BMI with complication incidence, stratified by age and gender. METHODS We queried the American College of Surgeons National Surgical Quality Improvement Project database to identify patients who underwent elective primary THA between 2012 and 2016. We examined the associations between BMI as a continuous and a categorical variable and risk of 30-day postoperative complication, using 2 multiple polynomial logistic regression models. We also created predictive plots to graphically assess the relationship between BMI and complication by gender and age. RESULTS In total, 117,567 eligible patients were included in the analyses. The predictive probability of all-type postoperative complications showed a U-shaped relationship with continuous BMI values (range 10-65 kg/m2). The lowest complication risks occurred in patients with BMI between 35 and 40. Females had higher complication rate than males across all BMI values. This U-shaped relationship was only observed among patients younger than 60 years old, while the associations appear to be inversely linear among patients aged greater than 60 years. CONCLUSION Our results suggest that the current theory of a linear association between BMI and complication risk may not apply to elective primary THA. Strict BMI cutoffs may not minimize risk, especially among patients over 60 years old. Orthopedic surgeons should factor in patient-specific variables of age and gender when determining acceptable surgical risk given a particular BMI value.
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Affiliation(s)
- Eric L Smith
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | - Amir A Shahien
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts
| | - Mei Chung
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Geoffrey Stoker
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | - Ruijia Niu
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts
| | - Ran Schwarzkopf
- Division of Adult Reconstruction Surgery, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
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14
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Vahedi H, Ward DT, Lee YS, Shohat N, Chen AF. Greater Knee Soft Tissue Thickness Predisposes Patients to Subsequent Periprosthetic Joint Infection After Total Knee Arthroplasty. J Arthroplasty 2020; 35:1924-1927. [PMID: 32192832 DOI: 10.1016/j.arth.2020.02.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/29/2020] [Accepted: 02/21/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although obesity is a risk factor for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA), the role of soft tissue thickness (STT) at the surgical site has not been well studied. This study examined if increased STT in the medial and anterior aspects of the knee are independent risk factors for PJI. METHODS A retrospective study was conducted on 206 patients who underwent 2-stage exchange arthroplasty for PJI from 2000 to 2015. They were matched 1:3 to a control group of primary, noninfected TKA patients with minimum 2 years infection-free survival by age, gender, age-adjusted Charlson Comorbidity Index, date of surgery, and body mass index (BMI). Two blinded orthopedic surgeons measured the medial STT from the medial aspect of the knee at the level of the joint line on an anteroposterior radiograph, and anterior STT 8 cm above the joint line on a lateral radiograph from the skin to the quadriceps tendon. RESULTS Increased STT was significantly associated with a higher risk for PJI. The mean anterior STT was 29.74 ± 13.76 mm in the PJI group and 24.88 ± 9.76 mm in the control group. The mean medial STT was 42.42 ± 14.66 mm for PJI and 37.27 ± 12.51 mm for control. Both STT measurements were significantly higher in PJI cases with BMI <30 kg/m2 vs control patients with BMI <30 kg/m2. CONCLUSION Anterior and medial knee STT was an independent risk factor for PJI after primary TKA and represents a simple radiographic method to assess postoperative infection risk. Excess adipose tissue around the surgical site can predispose patients to PJI after TKA regardless of BMI.
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Affiliation(s)
- Hamed Vahedi
- Department of Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Derek T Ward
- Department of Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Yong Seuk Lee
- Department of Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Noam Shohat
- Department of Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA; Department of Orthopaedics, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Boston, MA
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15
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Sprowls GR, Allen BC, Wilson TJ, Pruszynski JE, Hammonds KAP. Predictive value of lateral soft tissue thickness for complications after total hip arthroplasty with a lateral incision. Proc (Bayl Univ Med Cent) 2020; 33:336-341. [PMID: 32675949 DOI: 10.1080/08998280.2020.1753455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study was to determine the relationship between soft tissue thickness lateral to the greater trochanter, as measured on anteroposterior pelvis radiograph, and postoperative complications following primary total hip arthroplasty. A retrospective review of 1110 consecutive patients treated at a single institution from 2003 to 2011 was conducted. Postoperative complications were divided into surgical site infections, deep wound infections, noninfectious surgical complications, need for revision surgery, and medical complications. Lateral soft tissue thickness (LSTT) was measured as the horizontal distance from the most lateral point on the greater trochanter to the skin edge obtained from anteroposterior hip radiographs. Among the 1110 study patients, 19.19% had a postoperative complication, with a deep infection rate of 3.42%. Of the previously identified risk factors, increased LSTT and body mass index were both associated with surgical site infection and deep infection, and LSTT was associated with revision surgery. An LSTT value of >5 cm was predictive of surgical site infection, deep infection, and revision surgery. This easily obtainable radiographic measurement, along with clinical examination near the operative site, might prove helpful in making preoperative risk assessments.
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Affiliation(s)
- Gregory R Sprowls
- Department of Orthopaedic Surgery, Baylor Scott & White HealthTempleTexas.,College of Medicine, Texas A&M Health Science CenterTempleTexas
| | - Bryce C Allen
- Department of Orthopaedic Surgery, Baylor Scott & White HealthTempleTexas.,College of Medicine, Texas A&M Health Science CenterTempleTexas
| | - Travis J Wilson
- Department of Orthopaedic Surgery, Baylor Scott & White HealthTempleTexas.,College of Medicine, Texas A&M Health Science CenterTempleTexas
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16
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Chen Y, Wang Y, Chen Z, Xin Q, Yu X, Ma D. The effects of rapid growth on body mass index and percent body fat: A meta-analysis. Clin Nutr 2020; 39:3262-3272. [PMID: 32151438 DOI: 10.1016/j.clnu.2020.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/12/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND & AIMS Rapid growth in childhood and obesity are highly prevalent in congenital deficiency infants, but the associations between them remain controversial. This meta-analysis was performed to explore the effects of rapid growth on body mass index (BMI) and percent body fat (PBF), and to clarify potential confounders. METHODS A systematic search was performed using electronic databases including EMBASE (1985 to July 2019) and Medline (1966 to July 2019) for English articles. China National Knowledge Infrastructure Chinese citation database (CNKI) and WANFANG database were used to search articles in Chinese. Reference lists were also screened as supplement. All relevant studies that compare BMI or PBF between rapid group and control group were identified. The definition of rapid growth should be clearly specified. Means and standard deviations/95% confidence intervals (CIs) of BMI and PBF should be available. Relevant information was extracted independently by two reviewers. Study quality was reassessed using the Newcastle-Ottawa Scale. Publication bias and heterogeneity were detected. The random effect model was adopted for combined and stratified analysis. RESULTS About the effect of rapid growth on BMI, seventeen researches (4473 participants) involving 49 comparisons were included. Pooled analysis showed rapid group had higher BMI of 0.573 (95% CI, 0.355 to 0.791; P < 0.001). Stratified analyses revealed that catch-up weight gain, follow-up age >6 years old, rapid growth duration >2 years, full-term, comparing rapid growth SGA infants with control SGA infants, and from developed and developing countries, would all lead to higher BMI in rapid groups. About the effect of rapid growth on PBF, eleven researches (4594 participants) involving 37 comparisons were included. Pooled analysis showed rapid group had higher PBF of 2.005 (95% CI, 1.581 to 2.429; P < 0.001). Subgroup analyses suggested that catch-up weight gain, follow-up age ≤6 years old, rapid growth duration >2 years, full-term, comparing rapid growth SGA infants with control AGA infants, and participants from developing countries, would lead to increased PBF in rapid groups. CONCLUSION Rapid growth has a positive correlation with BMI and PBF. However, stratified analyses show that it is catch-up weight gain that lead to higher BMI and PBF, but not catch-up growth. In addition, rapid growth have long-term effect on BMI and short-term effect on PBF. Rapid growth duration longer than 2 years may increase the risk effect of rapid growth on BMI and PBF. But given that rapid growth would induce multiple health outcomes apart from BMI and PBF, the benefits and risks of rapid growth must be carefully considered and weighted.
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Affiliation(s)
- Yunli Chen
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Wang
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zekun Chen
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Qinghua Xin
- Academy of Occupational Health and Occupational Medicine, Shandong, China
| | - Xue Yu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Defu Ma
- School of Public Health, Peking University Health Science Center, Beijing, China.
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17
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Gøttsche D, Gromov K, Viborg PH, Bräuner EV, Pedersen AB, Troelsen A. Weight affects survival of primary total knee arthroplasty: study based on the Danish Knee Arthroplasty Register with 67,810 patients and a median follow-up time of 5 years. Acta Orthop 2019; 90:60-66. [PMID: 30516408 PMCID: PMC6366474 DOI: 10.1080/17453674.2018.1540091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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 - Obesity is a rising issue worldwide and growing evidence supports poor outcome amongst obese patients following total knee arthroplasty (TKA). Using nationwide registries we investigated the association between bodyweight and risk of revision of primary TKA. Patients and methods - All primary TKA performed during 1997-2015, weight at time of primary TKA and subsequent TKA revisions were identified in the Danish Knee Arthroplasty Register (DKR). Data on comorbidities and a priori selected confounding variables were collected from nationwide registries. The association between weight and 1st time TKA revision was calculated as both crude and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) using Cox regression. Results - Of 67,810 identified primary TKAs, 4.8% were revised within a median follow-up time of 5.4 years. No association between weight and risk of any revision in patients aged 18-54 and 55-70 years was found. Increased risk of any revision was seen in patients >70 years, 80-89 kg (aHR =1.5, CI 1.2-1.8), 90-99 kg (aHR =1.7, CI 1.3-2.1) and patients >99 kg (aHR =1.6, CI 1.3-2.1), as well as those weighing 45-60 kg (aHR =1.4, CI 1.1-1.9) compared with same aged patients weighing 70-79 kg. Interpretation - We found a complex association between weight and knee arthroplasty survival. There was an increased risk of any revision in patients older than 70 years of age weighing <60 kg and >80 kg. Patients aged 18-55 years weighing 60-69 kg had a lower risk of revision compared with all other weight groups, whereas weight was not found to affect risk of any revision in patients aged 55-70 years.
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Affiliation(s)
- David Gøttsche
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Clinical Orthopaedic Research Hvidovre (CORH), Denmark; ,Correspondence:
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Clinical Orthopaedic Research Hvidovre (CORH), Denmark;
| | | | - Elvira V Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Clinical Orthopaedic Research Hvidovre (CORH), Denmark;
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Rantasalo MT, Palanne R, Juutilainen K, Kairaluoma P, Linko R, Reponen E, Helkamaa T, Vakkuri A, Olkkola KT, Madanat R, Skants NKA. Randomised controlled study comparing general and spinal anaesthesia with and without a tourniquet on the outcomes of total knee arthroplasty: study protocol. BMJ Open 2018; 8:e025546. [PMID: 30580277 PMCID: PMC6307602 DOI: 10.1136/bmjopen-2018-025546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Total knee arthroplasty is a highly effective treatment for end-stage knee osteoarthritis, and it is usually performed under spinal or general anaesthesia with or without a surgical tourniquet. Some debate about the preferred mode of anaesthesia regarding patient outcomes remains. The aim of this study, which compares general and spinal anaesthesia with and without a tourniquet on the outcomes of total knee arthroplasty, is to determine the optimal type of anaesthesia regimen and assess the effect of a tourniquet on the patient's recovery following total knee arthroplasty. METHODS AND ANALYSIS This study is a randomised, controlled, parallel-group, four-arm study comparing spinal and general anaesthesia with and without a tourniquet in 400 patients undergoing fast-track total knee arthroplasty, with a 12-month follow-up. The primary outcome is cumulative intravenous oxycodone consumption by patient-controlled analgesia during the first 24 postoperative hours. Secondary outcomes include postoperative nausea and vomiting, the length of hospital stay, the duration of the surgery, blood loss, demand for surgical unit resources, complications, readmissions, postoperative knee function, range of motion, health-related quality of life, prolonged pain and mortality. ETHICS AND DISSEMINATION This study's protocol is in accordance with the declaration of Helsinki. The results of this study will be disseminated in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03364088; Pre-results.
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Affiliation(s)
- Mikko Tuomas Rantasalo
- Peijas Hospital, Department of Orthopaedics and Traumatology, Arthroplasty Centre, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Riku Palanne
- Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Katarina Juutilainen
- Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Pekka Kairaluoma
- Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Rita Linko
- Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Elina Reponen
- Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Teemu Helkamaa
- Peijas Hospital, Department of Orthopaedics and Traumatology, Arthroplasty Centre, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Anne Vakkuri
- Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Klaus T Olkkola
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rami Madanat
- Peijas Hospital, Department of Orthopaedics and Traumatology, Arthroplasty Centre, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
| | - Noora Kati Annukka Skants
- Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Vantaa, Finland
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桑 朝, 任 海, 孟 湛, 江 建. [Risk factors for surgical site infection following posterior lumbar intervertebral fusion]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:969-974. [PMID: 30187865 PMCID: PMC6744044 DOI: 10.3969/j.issn.1673-4254.2018.08.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the risk factors of surgical site infection (SSI) following posterior lumbar intervertebral fusion. METHODS This retrospective case-control study was conducted in 2904 patients undergoing posterior lumbar intervertebral fusion from 2011 to 2016. Forty-three patients with SSI within 30 days after the operation served as the case group, and 334 randomly selected patients without infection served as the control group. Age, gender, diabetes, body mass index (BMI), albumin level, multilevel procedures, subcutaneous fat thickness, surgery duration and the percentage of lumbar multifidus muscle fat infiltration were analyzed, and univariate and multivariate logistic regression analyses were performed to identify the risk factors of SSI. RESULTS Multivariate logical regression analysis identified a female gender, subcutaneous fat thickness, multilevel surgery, and lumbar multifidus muscle fat infiltration as significant risk factors for SSI (P < 0.05). BMI was not correlated with fat infiltration in the lumbar multifidus muscle (P > 0.05). CONCLUSIONS A female gender, multilevel surgery, subcutaneous fat thickness and fat infiltration in the multifidus muscle are related to SSI following posterior lumbar intervertebral fusion. Fat infiltration in the multifidus muscle was a spine-specific risk factor for SSI independent of BMI.
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Affiliation(s)
- 朝辉 桑
- />南方医科大学南方医院脊柱骨科,广东 广州 510515Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 海龙 任
- />南方医科大学南方医院脊柱骨科,广东 广州 510515Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 湛东 孟
- />南方医科大学南方医院脊柱骨科,广东 广州 510515Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 建明 江
- />南方医科大学南方医院脊柱骨科,广东 广州 510515Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou 510515, China
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20
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Pozzobon D, Ferreira PH, Blyth FM, Machado GC, Ferreira ML. Can obesity and physical activity predict outcomes of elective knee or hip surgery due to osteoarthritis? A meta-analysis of cohort studies. BMJ Open 2018; 8:e017689. [PMID: 29487072 PMCID: PMC5855486 DOI: 10.1136/bmjopen-2017-017689] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/14/2017] [Accepted: 11/23/2017] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis. DESIGN Systematic review and meta-analysis. DATA SOURCE AND ELIGIBILITY CRITERIA A systematic search was performed on the Medline, CINAHL, EMBASE and Web of Science electronic databases. Longitudinal cohort studies were included in the review. To be included, studies needed to have assessed the association between obesity or physical activity participation measured at baseline and clinical outcomes (ie, pain, disability and adverse events) following hip or knee arthroplasty. DATA EXTRACTION Two independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications. RESULTS 62 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that compared to obese participants, non-obese participants report less pain at both short term (standardised mean difference (SMD) -0.43; 95% CI -0.67 to -0.19; P<0.001) and long term post-surgery (SMD -0.36; 95% CI -0.47 to -0.24; P<0.001), as well as less disability at long term post-surgery (SMD -0.32; 95% CI -0.36 to -0.28; P<0.001). They also report fewer postsurgical complications at short term (OR 0.48; 95% CI 0.25 to 0.91; P<0.001) and long term (OR 0.55; 95% CI 0.41 to 0.74; P<0.001) along with less postsurgical infections after hip arthroplasty (OR 0.33; 95% CI 0.18 to 0.59; P<0.001), and knee arthroplasty (OR 0.42; 95% CI 0.23 to 0.78; P=0.006). CONCLUSIONS Presurgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed. PROSPERO REGISTRATION NUMBER CRD42016032711.
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Affiliation(s)
- Daniel Pozzobon
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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21
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Matson AP, Morwood MP, Peres Da Silva A, Cone EB, Hurwitz SR, Zura RD. Obese Patients Have Fewer Wound Complications Following Fixation of Ankle Fractures. Foot Ankle Spec 2017; 10:435-440. [PMID: 28030963 DOI: 10.1177/1938640016685146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Outcomes following ankle fracture surgery have been well studied; however, factors associated with surgical wound healing specifically are less clear. We aimed to study the relationship between wound healing and body mass index, as well as other variables following surgical treatment of ankle fractures. There were 127 consecutive, isolated, closed, malleolar ankle fractures treated with open reduction and internal fixation at a level-1 trauma center from 2008 to 2012. Patient, injury, and treatment variables were recorded and clinical records were reviewed to identify wound complications. There were 6 major and 18 minor wound complications. The overall rate of wound complication of any type was significantly lower in obese patients at 11.7% (7/60) compared with 25.4% (17/67, P < .05) in nonobese patients. When controlling for other variables obesity was associated with a significantly lower risk of developing a wound complication (OR 0.267, 95% CI 0.087-0.822), as was low energy mechanism (OR 0.246, 95% CI 0.067-0.906). No other covariates tested were associated with an increased risk of a wound infection. Ankle anatomy may present a unique situation whereby obesity may be protective against wound complications. Further studies are needed to confirm this clinical observation, and to demonstrate the mechanism through which this may occur. LEVELS OF EVIDENCE Therapeutic, Level IV: Retrospective.
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Affiliation(s)
- Andrew P Matson
- Duke University School of Medicine, Durham, North Carolina (APM, MPM, APDS, EBC).,University of North Carolina School of Medicine, Chapel Hill, North Carolina (SRH).,Louisiana State University Health Sciences Center, New Orleans, Louisiana (RDZ)
| | - Michael P Morwood
- Duke University School of Medicine, Durham, North Carolina (APM, MPM, APDS, EBC).,University of North Carolina School of Medicine, Chapel Hill, North Carolina (SRH).,Louisiana State University Health Sciences Center, New Orleans, Louisiana (RDZ)
| | - Ashwin Peres Da Silva
- Duke University School of Medicine, Durham, North Carolina (APM, MPM, APDS, EBC).,University of North Carolina School of Medicine, Chapel Hill, North Carolina (SRH).,Louisiana State University Health Sciences Center, New Orleans, Louisiana (RDZ)
| | - Eugene B Cone
- Duke University School of Medicine, Durham, North Carolina (APM, MPM, APDS, EBC).,University of North Carolina School of Medicine, Chapel Hill, North Carolina (SRH).,Louisiana State University Health Sciences Center, New Orleans, Louisiana (RDZ)
| | - Shepard R Hurwitz
- Duke University School of Medicine, Durham, North Carolina (APM, MPM, APDS, EBC).,University of North Carolina School of Medicine, Chapel Hill, North Carolina (SRH).,Louisiana State University Health Sciences Center, New Orleans, Louisiana (RDZ)
| | - Robert D Zura
- Duke University School of Medicine, Durham, North Carolina (APM, MPM, APDS, EBC).,University of North Carolina School of Medicine, Chapel Hill, North Carolina (SRH).,Louisiana State University Health Sciences Center, New Orleans, Louisiana (RDZ)
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22
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Oosting E, Hoogeboom TJ, Dronkers JJ, Visser M, Akkermans RP, van Meeteren NLU. The Influence of Muscle Weakness on the Association Between Obesity and Inpatient Recovery From Total Hip Arthroplasty. J Arthroplasty 2017; 32:1918-1922. [PMID: 28110849 DOI: 10.1016/j.arth.2016.12.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is ongoing discussion about whether preoperative obesity is negatively associated with inpatient outcomes of total hip arthroplasty (THA). The aim was to investigate the interaction between obesity and muscle strength and the association with postoperative inpatient recovery after THA. METHODS Preoperative obesity (body mass index [BMI] >30 kg/m2) and muscle weakness (hand grip strength <20 kg for woman and <30 kg for men) were measured about 6 weeks before THA. Patients with a BMI <18.5 kg/m2 were excluded. Outcomes were delayed inpatient recovery of activities (>2 days to reach independence of walking) and prolonged length of hospital stay (LOS, >4 days and/or discharge to extended rehabilitation). Univariate and multivariable regression analyses with the independent variables muscle weakness and obesity, and the interaction between obesity and muscle weakness, were performed and corrected for possible confounders. RESULTS Two hundred and ninety-seven patients were included, 54 (18%) of whom were obese and 21 (7%) who also had muscle weakness. Obesity was not significantly associated with prolonged LOS (odds ratio [OR] 1.36, 95% confidence interval [CI] 0.75-2.47) or prolonged recovery of activities (OR 1.77, 95% CI 0.98-3.22), but the combination of obesity and weakness was significantly associated with prolonged LOS (OR 3.59, 95% CI 1.09-11.89) and prolonged recovery of activities (OR 6.21, 95% CI 1.64-23.65). CONCLUSION Obesity is associated with inpatient recovery after THA only in patients with muscle weakness. The results of this study suggest that we should measure muscle strength in addition to BMI (or body composition) to identify patients at risk of prolonged LOS.
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Affiliation(s)
- Ellen Oosting
- Department of Physical Therapy, Gelderse Vallei Hospital, Ede, The Netherlands; Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jaap J Dronkers
- Department of Physical Therapy, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Marlieke Visser
- Gelderse Vallei Hospital, Research Unit, Ede, The Netherlands
| | - Reinier P Akkermans
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Nico L U van Meeteren
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands; Top Sector Life Sciences & Health, The Hague, The Netherlands
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23
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Abstract
Obesity is an epidemic, with approximately 35% of the US population affected. This rate is unlikely to decline and may increase the demand for total knee arthroplasty (TKA). Data regarding the risks, benefits, and potential complications of TKA in this patient population are conflicting. Preoperative considerations are optimization of nutritional status, safe weight loss strategies, and bariatric surgery. Intraoperative concerns unique to this population include inadequate exposure, implant alignment, and durable implant fixation; postoperative issues include tibial loosening, wound complications, cardiovascular events, and respiratory complications. A thorough understanding of the medical and surgical complications associated with TKA in the obese patient will facilitate research efforts and improve outcomes.
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24
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Dennis DA. CORR Insights ®: Do Stemmed Tibial Components in Total Knee Arthroplasty Improve Outcomes in Patients With Obesity? Clin Orthop Relat Res 2017; 475:146-148. [PMID: 27125822 PMCID: PMC5174031 DOI: 10.1007/s11999-016-4849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/14/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Douglas A. Dennis
- Colorado Joint Replacement, 2535 S. Downing St. #100, Denver, CO 80210 USA
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25
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Frisch N, Wessell NM, Charters M, Peterson E, Cann B, Greenstein A, Silverton CD. Effect of Body Mass Index on Blood Transfusion in Total Hip and Knee Arthroplasty. Orthopedics 2016; 39:e844-9. [PMID: 27172370 DOI: 10.3928/01477447-20160509-04] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/28/2016] [Indexed: 02/03/2023]
Abstract
Perioperative blood management remains a challenge during total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to systematically examine the relationship between body mass index (BMI) and perioperative blood transfusion during THA and TKA while attempting to resolve conflicting results in previously published studies. The authors retrospectively evaluated 2399 patients, 896 of whom underwent THA and 1503 of whom underwent TKA. Various outcome variables were assessed for their relationship to BMI, which was stratified using the World Health Organization classification scheme (normal, <25 kg/m(2); overweight, 25-30 kg/m(2); obese, >30 kg/m(2)). Among patients undergoing THA, transfusion rates were 34.8%, 27.6%, and 21.9% for normal, overweight, and obese patients, respectively (P=.002). Among patients undergoing TKA, transfusion rates were 17.3%, 11.4%, and 8.3% for normal, overweight, and obese patients, respectively (P=.002). Patients with an elevated BMI have decreased rates of blood transfusion following both THA and TKA. This same cohort also loses a significantly decreased percentage of estimated blood volume. No trends were identified for a relationship between BMI and deep venous thrombosis, pulmonary embolism, myocardial infarction, discharge location, length of stay, 30-day readmission rate, and preoperative hemoglobin level. Elevated BMI was significantly associated with increased estimated blood loss in patients undergoing THA and those undergoing TKA. There was a statistically significant trend toward increased deep surgical-site infection in patients undergoing THA (P=.043). Patients with increased BMI have lower rates of blood transfusion and lose a significantly smaller percentage of estimated blood volume following THA and TKA. [Orthopedics.2016; 39(5):e844-e849.].
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26
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Fournier MN, Hallock J, Mihalko WM. Preoperative Optimization of Total Joint Arthroplasty Surgical Risk: Obesity. J Arthroplasty 2016; 31:1620-4. [PMID: 27143019 DOI: 10.1016/j.arth.2016.02.085] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 02/01/2023] Open
Abstract
Obesity is a problem that is increasing in prevalence in the United States and in other countries, and it is a common comorbidity in patients seeking total joint arthroplasty for degenerative musculoskeletal diseases. Obesity, as well as commonly associated comorbidities such as diabetes mellitus, cardiovascular disease, and those contributing to the diagnosis of metabolic syndrome, have been shown to have detrimental effects on total joint arthroplasty outcomes. Although there are effective surgical and nonsurgical interventions which can result in weight loss in these patients, concomitant benefit on arthroplasty outcomes is not clear. Preoperative optimization of surgical risk in obese total joint arthroplasty patients is an important point of intervention to improve arthroplasty outcomes.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Bariatric Surgery
- Comorbidity
- Diabetes Mellitus/epidemiology
- Humans
- Metabolic Syndrome/epidemiology
- Obesity/epidemiology
- Obesity/therapy
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- Postoperative Complications/prevention & control
- Preoperative Care/standards
- Prevalence
- Risk Factors
- United States/epidemiology
- Weight Reduction Programs
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Affiliation(s)
- Matthew N Fournier
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - Justin Hallock
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - William M Mihalko
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
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27
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Watts CD, Houdek MT, Wagner ER, Taunton MJ. Subcutaneous Fat Thickness Is Associated With Early Reoperation and Infection After Total Knee Arthroplasty in Morbidly Obese Patients. J Arthroplasty 2016; 31:1788-91. [PMID: 26989030 DOI: 10.1016/j.arth.2016.02.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/28/2015] [Accepted: 02/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Morbid obesity has been associated with increased complications after primary total knee arthroplasty (TKA), but previous studies have failed to take factors such as body composition and fat distribution into consideration. The aims of this study were to (1) assess the interobservable and intraobservable reliabilities of measuring anterior knee subcutaneous fat thickness on lateral knee radiographs and (2) determine if these measurements associate with early complications in patients with morbid obesity. METHODS Using a retrospective case-control analysis, we reviewed 1689 primary TKAs performed in morbidly obese patients at our institution from 1995 to 2012. All patients (n = 58) who required reoperation for wound complication or infection within 90 days were compared to a matched cohort of morbidly obese patients who did not require early reoperation. Distances from patella skin (prepatellar thickness) and tibial tubercle skin (pretubercular thickness) were measured on routine lateral knee radiographs and associated with outcomes. RESULTS Intraobserver and interobserver reliabilities were excellent for both measurements. Knees in the reoperation group had significantly greater prepatellar (P = .0001) and pretubercular (P = .0006) soft tissue thickness. Prepatellar thickness ≥15 mm and pretubercular thickness ≥25 mm increased the risk of early reoperation by 2.0× (P = .0003) and 1.6× (P = .023), respectively, and were more predictive measurements than body mass index. CONCLUSION Anterior knee subcutaneous fat thickness can be reproducibly measured on lateral knee radiographs and is associated with a significantly increased risk of early reoperation for wound complications and infection after primary TKA in morbidly obese patients.
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Affiliation(s)
- Chad D Watts
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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28
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Adhikary SD, Liu WM, Memtsoudis SG, Davis CM, Liu J. Body Mass Index More Than 45 kg/m(2) as a Cutoff Point Is Associated With Dramatically Increased Postoperative Complications in Total Knee Arthroplasty and Total Hip Arthroplasty. J Arthroplasty 2016; 31:749-53. [PMID: 26652477 DOI: 10.1016/j.arth.2015.10.042] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Higher body mass index (BMI) has been associated with postoperative complications in total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, the association of incremental increases of BMI and its effects on postoperative complications has not been well studied. We hypothesize that there is a BMI cutoff at which there is a significant increase of the risk of postoperative complications. METHODS We studied the American College of Surgeons National Surgical Quality Improvement Program from 2006 to 2013. The final cohort included 77,785 primary TKA and 49,475 primary THA subjects, respectively. Patients were separated into 7 groups based on BMI (18.5-24.9 kg/m(2), 25.0-29.9 kg/m(2), 30.0-34.9 kg/m(2), 35.0-39.9 kg/m(2), 40.0-44.9 kg/m(2), 45.0-49.9 kg/m(2), and >50.0 kg/m(2)). We analyzed data on five 30-day composite complication variables, including any complication, major complication, wound infection, systemic infection, and cardiac and/or pulmonary complication. RESULTS The odds ratio for 4 (any complication, major complication, wound infection, and systemic infection) of 5 composite complications started to increase exponentially once BMI reached 45.0 kg/m(2) or higher in TKA. Similarly, the odds ratio in 3 (any complication, systemic infection, and wound infection) of 5 composite complications showed similar trends in THA patients. These findings were further confirmed with propensity score matching and entropy balancing. CONCLUSIONS Our study suggested that there was a positive correlation between BMI and incidences of 30-day postoperative complications in both TKA and THA. The odds of complications increased dramatically once BMI reached 45.0 kg/m(2).
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Affiliation(s)
- Sanjib D Adhikary
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Wai-Man Liu
- Research School of Finance, Actuarial Studies & Applied Statistics, The Australian National University, Canberra, Australia
| | | | - Charles M Davis
- Department of Orthopaedics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jiabin Liu
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Walls JD, Abraham D, Nelson CL, Kamath AF, Elkassabany NM, Liu J. Hypoalbuminemia More Than Morbid Obesity is an Independent Predictor of Complications After Total Hip Arthroplasty. J Arthroplasty 2015; 30:2290-5. [PMID: 26148837 DOI: 10.1016/j.arth.2015.06.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/12/2015] [Accepted: 06/04/2015] [Indexed: 02/01/2023] Open
Abstract
Health care reform is directing clinical practice towards improving outcomes and minimizing complications. Preoperative identification of high-risk patients and modifiable risk factors present opportunity for clinical research. A total of 49,475 total hip arthroplasty patients were identified from National Surgical Quality Improvement Program between 2006 and 2013. We compared morbidly obese patients (BMI≥40 kg/m(2)) and non-morbidly obese patients (BMI 18.5-40 kg/m(2)). We also compared patients with hypoalbuminemia (serum albumin <3.5 g/dL) against those with normal albumin. Our study demonstrates that hypoalbuminemia is a significant risk factor for mortality and major morbidity among total hip arthroplasty patients, while morbid obesity was only associated with an increased risk of superficial surgical site infection. Impressively, hypoalbuminemia patients carried a 5.94-fold risk of 30-day mortality.
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Affiliation(s)
- Jason D Walls
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Abraham
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles L Nelson
- Department of Orthopaedic Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nabil M Elkassabany
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jiabin Liu
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
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30
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Safer U, Binay Safer V, Cintosun U. Determination of body fat mass: bioelectrical impedance analysis. J Arthroplasty 2015; 30:895-6. [PMID: 25951951 DOI: 10.1016/j.arth.2014.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/06/2014] [Indexed: 02/01/2023] Open
Affiliation(s)
- Umut Safer
- Department of Geriatrics, Gulhane School of Medicine, Ankara, Turkey
| | - Vildan Binay Safer
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Umit Cintosun
- Department of Geriatrics, Gulhane School of Medicine, Ankara, Turkey
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