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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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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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Özden F, Coşkun G, Bakırhan S. The test-retest reliability and concurrent validity of the five times sit to stand test and step test in older adults with total hip arthroplasty. Exp Gerontol 2020; 142:111143. [DOI: https:/doi.org/10.1016/j.exger.2020.111143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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The test-retest reliability and concurrent validity of the five times sit to stand test and step test in older adults with total hip arthroplasty. Exp Gerontol 2020; 142:111143. [PMID: 33157185 DOI: 10.1016/j.exger.2020.111143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to determine the test-retest reliability and concurrent validity of the five times sit to stand test (FTST) and step test (ST) in older adults with total hip arthroplasty (THA). METHODS A cross-sectional and prospective study was carried out with 32 unilateral total hip arthroplasty patients. FTST, ST, and Timed Up & Go Test were evaluated at the first evaluation session. The test-retest reliability was evaluated by performing two repetitions of the FTST and ST. Besides, the functional status of the patients was evaluated with the Harris Hip Score (HHS). The test-retest reliability of the FTST and ST were assessed by the intraclass correlation coefficient (ICC). In the concurrent validity analysis, the Pearson correlation coefficient was analyzed. In addition, the standard error of measurement (SEM95) and minimal detectable change (MDC95) values of the FTST and ST were also calculated. RESULTS The mean age of the participants was 75.4 ± 10.3 years. The ICC score of FTST, ST (right) and ST (left) were 0.987, 0.908 and 0.846, respectively. SEM95 and MDC95 values of the FTST were 1.05 and 2.91, respectively. FTST was correlated with both the HHS and TUG (r1 = -0.522, r2 = 0.730, p < 0.01). SEM95 and MDC95 values of the ST (right) were 0.37 and 1.02, respectively. SEM95 and MDC95 values of the ST (left) were 0.55 and 1.52, respectively. Also, ST (right) was only correlated with TUG (r = -0.654, p < 0.01). ST (right) were correlated with both the HHS and TUG (r1 = 0.503, r2 = -0.806, p < 0.01). The degree of correlations was strong. CONCLUSION The FTST and ST are valid and reliable performance tests in older adults with primary unilateral THA.
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Unver B, Baris RH, Yuksel E, Cekmece S, Kalkan S, Karatosun V. Reliability of 4-meter and 10-meter walk tests after lower extremity surgery. Disabil Rehabil 2017; 39:2572-2576. [PMID: 27728985 DOI: 10.1080/09638288.2016.1236153] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the test-retest reliability of the 4-meter walk test (4 MWT) and 10-meter walk test (10 MWT) in patients undergoing lower extremity surgery during inpatient rehabilitation. METHOD In all, 102 patients with total hip arthroplasty (THA), total knee arthroplasty (TKA), lower extremity fracture (LEF) and soft tissue operation were recruited. Patients performed two 4 MWT and two 10 MWT trials on the same day. The same researcher performed all the measurements to avoid inter-rater variability. RESULTS The 4 MWT and 10 MWT were shown to have excellent test-retest reliability. The ICCs for the 4 MWT and 10 MWT were found as 0.94 and 0.95, respectively. The SEMs for the 4 MWT and 10 MWT were 2.0 and 5.5 seconds, respectively. The smallest real difference at the 95% confidence level (SRD95) was 5.5 seconds for the 4 MWT and 12.2 seconds for 10 MWT and SRD95 percentage was 31.2 for the 4 MWT and 28.5 for the 10 MWT. CONCLUSION Both the 4 MWT and the 10 MWT have excellent reliability in patients undergoing lower extremity surgery such as TKA, THA, LEF and soft tissue operation during inpatient rehabilitation. Clinicians and researchers can be confident that changes above the SRD95s for the different patient groups, for both sexes and with regard to weight-bearing status, represent a real clinical change in rehabilitation process. Implications for Rehabilitation The 4 MWT and the 10 MWT are simple methods and were also shown to be reliable measurement methods in many patient groups. This study illustrates that the test-retest reliability of the 4 MWT and 10 MWT are excellent in patients undergoing lower extremity surgery during inpatient rehabilitation (ICC: 0.94 for 4 MWT, ICC: 0.95 for 10 MWT). Clinicians and researchers can be confident that changes above the SRD95s for the different patient groups, for both sexes and with regard to weight-bearing status represent a real clinical change in rehabilitation process.
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Affiliation(s)
- Bayram Unver
- a Department of Orthopedic Physiotherapy , School of Physical Therapy and Rehabilitation, Dokuz Eylul University , Izmir , Turkey
| | - Refik Hilmi Baris
- a Department of Orthopedic Physiotherapy , School of Physical Therapy and Rehabilitation, Dokuz Eylul University , Izmir , Turkey
| | - Ertugrul Yuksel
- a Department of Orthopedic Physiotherapy , School of Physical Therapy and Rehabilitation, Dokuz Eylul University , Izmir , Turkey
| | - Senol Cekmece
- a Department of Orthopedic Physiotherapy , School of Physical Therapy and Rehabilitation, Dokuz Eylul University , Izmir , Turkey
| | - Serpil Kalkan
- a Department of Orthopedic Physiotherapy , School of Physical Therapy and Rehabilitation, Dokuz Eylul University , Izmir , Turkey
| | - Vasfi Karatosun
- b Department of Orthopedics and Traumatology , School of Medicine, Dokuz Eylul University , Izmir , Turkey
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Bakirhan S, Bozan O, Unver B, Karatosun V. EVALUATION OF FUNCTIONAL CHARACTERISTICS IN PATIENTS WITH KNEE OSTEOARTHRITIS. ACTA ORTOPEDICA BRASILEIRA 2017; 25:248-252. [PMID: 29375253 PMCID: PMC5782857 DOI: 10.1590/1413-785220172506144577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study evaluated the physical and functional characteristics of Turkish patients with knee osteoarthritis and how this disease affects their physical and functional status. METHODS This study included 320 patients, who were evaluated to assess body mass index (BMI) and Hospital for Special Surgery (HSS) score in terms of age, sex and functional characteristics. RESULTS Mean patient age was 66.92±8.89 years and mean BMI was 31.02±5.20 kg/m2. Mean patient HSS score was 58.70±11.08. According to their sit-to-stand test results, 33% of the patients (n=104) were found to be independent. There was a significant relationship between BMI and functional activity score (p<0.05). CONCLUSIONS The majority of the patients in our study were female and obese, and had low functionality levels. Function in patients with OA is restricted as a result of excess weight, so preventive measures can help Turkish patients with OA maintain their ideal weight. Furthermore, patient education can be help this population acquire the habit of regular exercise in order to reduce pain and improve their physical activity and quality of life. Level of Evidence IV, Case Series.
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Affiliation(s)
- Serkan Bakirhan
- . Departments of Physical Therapy and Rehabilitation, Lefke, Faculty of Health Sciences, European University of Lefke, TRNC Mersin 10, Turkey
| | | | - Bayram Unver
- . School of Physiotherapy , Dokuz Eylül University, Izmir, Turkey
| | - Vasfi Karatosun
- . Department of Orthopedics, School of Medicine, Dokuz Eylül University, Izmir, Turkey
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Seida JC, Sharma AM, Johnson JA, Forhan M. Hospital rehabilitation for patients with obesity: a scoping review. Disabil Rehabil 2016; 40:125-134. [DOI: 10.1080/09638288.2016.1243163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jennifer C. Seida
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Arya M. Sharma
- Obesity Research and Management, University of Alberta, Edmonton, Canada
| | - Jeffrey A. Johnson
- Alliance for Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Moon J, Shin I, Kang M, Kim Y, Lee K, Park J, Kim K, Hong D, Koo D, O'sullivan D. The Effect of Shoulder Flexion Angles on the Recruitment of Upper-extremity Muscles during Isometric Contraction. J Phys Ther Sci 2013; 25:1299-301. [PMID: 24259780 PMCID: PMC3820192 DOI: 10.1589/jpts.25.1299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/29/2013] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to investigate the differences in muscle activation
patterns of the biceps brachii (BB) and flexor carpi radialis (FCR) muscles, while
measuring the resultant force (RF) at different shoulder flexion angles. [Subjects]
Thirteen healthy males (age 24.85±3.4 years, weight; 77.8±7.9 kg; height, 1.7±0.05 m) were
enrolled in this study. [Methods] The resultant force was measured by a force transducer .
The elbow angle remained constant and the flexion shoulder angle was changed (30°, 45°,
60°, 75° and 90°). [Results] The results of the surface EMG show the largest muscle
activities occurred at a shoulder flexion of 75° for BB and 90° for FCR. The largest
resultant force was measured at a shoulder flexion angle of 75°. We conclude, that when
performing the biceps curl exercise using an arm curl machine, the shoulder should be
flexed at 75° to maximize the focus of the exercise for the BB. [Conclusion] These results
are useful from the perspective of design as they highlight the differences in the muscle
activation of BB and FCR with postural change. Ultimately this knowledge can be used in
the design of rehabilitation training for the shoulder as they show that posture can
affect muscle activation.
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Affiliation(s)
- Jeheon Moon
- Biomechanics Laboratory, Department of Physical Education, Seoul National University, Republic of Korea
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Unver B, Karatosun V, Bakirhan S. Reliability of Goniometric Measurements of Flexion in Total Knee Arthroplasty Patients: with Special Reference to the Body Position. J Phys Ther Sci 2009. [DOI: 10.1589/jpts.21.257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylül University
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Unver B, Karatosun V, Bakirhan S, Gunal I. Effects of Total Knee Arthroplasty on Body Weight and Functional Outcome. J Phys Ther Sci 2009. [DOI: 10.1589/jpts.21.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Bayram Unver
- School of Physiotherapy, Dokuz Eylül University Hospital
| | | | | | - Izge Gunal
- Orthopedics, Dokuz Eylül University Hospital
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12
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Unver B, Karatosun V, Kilic E. The Effects of External Supports on Knee Flexion Degree. J Phys Ther Sci 2008. [DOI: 10.1589/jpts.20.221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | | | - Emine Kilic
- School of Physiotherapy, Dokuz Eylül University
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