1
|
Poursalehian M, Soltani Farsani A, Habibi MA, Razzaghof M, Nafisi M, Ayati Firoozabadi M, Mortazavi SJ. Current Evidence Does Not Support the Use of Tibial Stem Extension in Total Knee Arthroplasty of Obese Patients: A Systematic Review. J Arthroplasty 2024:S0883-5403(24)00795-2. [PMID: 39067777 DOI: 10.1016/j.arth.2024.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Obesity rates have been increasing globally, leading to a higher incidence of knee osteoarthritis and a surge in primary and revision total knee arthroplasty (TKA). The debate continues on the impact of obesity on TKA success, particularly regarding the use of stemmed tibial components in obese patients. This systematic review aimed to compare the effectiveness of stemmed tibial components versus standard keeled tibial components in obese patients undergoing TKA, hypothesizing that stemmed components would yield better clinical and radiological outcomes. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Databases including PubMed, Embase, Scopus, and Web of Science were searched from inception to December 2023. The eligibility criteria were based on the PICO framework; Participants: Patients who have obesity undergoing TKA, Intervention: stemmed TKA, Comparator: standard keeled tibial TKA, Outcome: aseptic loosening, Patient-Reported Outcome Measures (PROMs), and overall revision. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane risk-of-bias tool for randomized trials. RESULTS The search yielded 470 studies, with 10 studies (42,533 knees) meeting the inclusion criteria. These studies included three randomized clinical trials and seven retrospective cohorts. The primary outcomes measured were aseptic loosening and overall revision rates, while secondary outcomes included PROMs. Results indicated mixed findings, with some studies suggesting improved outcomes with stemmed components in cases of aseptic loosening and mechanical failure, while others showed no significant difference. The PROMs did not show a significant difference between groups post-TKA. The certainty of the evidence was graded as "very low" using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. CONCLUSION Current literature does not provide conclusive evidence to support the routine use of stemmed tibial components in TKA for obese patients. The decision to use stem extensions should not solely rely on the patient's obesity status. Further high-quality studies are needed to clarify the role of stemmed components in TKA for this patient population.
Collapse
Affiliation(s)
- Mohammad Poursalehian
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Soltani Farsani
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Nafisi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ayati Firoozabadi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sm Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
2
|
Momtaz DA, Pereira DE, Singh A, Gonuguntla R, Mittal MM, Torres B, Lee TM, Dayhim F, Hosseinzadeh P, Bendich I. Prior Bariatric Surgery is Associated with Improved Total Hip Arthroplasty Outcomes in Patients Who Have Obesity: A National Cohort Study with 6 Years of Follow-Up. J Arthroplasty 2024:S0883-5403(24)00686-7. [PMID: 38969294 DOI: 10.1016/j.arth.2024.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Obesity is a risk factor for end-stage hip osteoarthritis (OA). While total hip arthroplasty (THA) is commonly performed to reduce pain and improve function associated with OA, obesity has been associated with an increased risk of complications after THA. Although bariatric surgery may also be utilized to reduce weight, the impact of bariatric surgery on THA outcomes remains inadequately understood. METHODS This retrospective cohort analysis utilized multicenter electronic medical record data ranging from 2003 to 2023. Patients who have obesity who underwent THA were stratified based on prior bariatric surgery. The final bariatric cohort comprised 451 patients after propensity score matching. Complication rates and revision risks were compared between cohorts at six, 24, and 72 months. Additional analysis stratified patients by interval between bariatric surgery and THA. RESULTS At six-month follow-up, the bariatric cohort had significantly lower risks of surgical site infection (SSI), wound dehiscence, and deep vein thrombosis (DVT). At 24 months, the bariatric cohort had a lower risk of DVT. At 72 month follow-up, the bariatric cohort had reduced rates of revision, mortality, cardiac morbidity, and Clavien-Dindo grade IV complications. CONCLUSION Obese patients who underwent bariatric surgery prior to THA experienced reduced medical complications at all time points and reduced rates of revision at 72 months relative to a matched cohort who did not undergo bariatric surgery.
Collapse
Affiliation(s)
- David A Momtaz
- UT Health San Antonio, Department of Orthopaedics, 8300 Floyd Curl Dr C, San Antonio, TX 78229, USA
| | - Daniel E Pereira
- Washington University School of Medicine, Department of Orthopaedics, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Aaron Singh
- UT Health San Antonio, Department of Orthopaedics, 8300 Floyd Curl Dr C, San Antonio, TX 78229, USA
| | - Rishi Gonuguntla
- UT Health San Antonio, Department of Orthopaedics, 8300 Floyd Curl Dr C, San Antonio, TX 78229, USA
| | - Mehul M Mittal
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Beltran Torres
- Washington University School of Medicine, Department of Orthopaedics, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Tiffany M Lee
- Baylor College of Medicine, 1 Baylor Plz, Houston, TX 77030, USA
| | - Fariba Dayhim
- SSM Health Good Samaritan Hospital, Good Samaritan Way, Mt Vernon, IL 62864, USA
| | - Pooya Hosseinzadeh
- Washington University School of Medicine, Department of Orthopaedics, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Ilya Bendich
- Washington University School of Medicine, Department of Orthopaedics, 660 S Euclid Ave, St. Louis, MO 63110, USA.
| |
Collapse
|
3
|
Magruder ML, Miskiewicz MJ, Rodriguez AN, Mont MA. Semaglutide Use Prior to Total Hip Arthroplasty Results in Fewer Postoperative Prosthetic Joint Infections and Readmissions. J Arthroplasty 2024; 39:716-720. [PMID: 38122837 DOI: 10.1016/j.arth.2023.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Semaglutide, a novel diabetes management medication, is known for its efficacy in inducing weight loss. Despite this, its impact on outcomes after total hip arthroplasty (THA) remains unclear. The aim of this study was to evaluate if THA patients on semaglutide demonstrate: (1) fewer medical complications; (2) fewer implant-related complications; (3) fewer readmissions; and (4) lower costs. METHODS Using a national claims database from 2010 to 2021, we retrospectively examined diabetic patients prescribed semaglutide who underwent primary THA. This yielded 9,465 patients (Semaglutide = 1,653; Control = 7,812). Multivariable logistic regression was used to evaluate the following outcomes: 90-day postoperative medical complications, 2-year implant-related complications, 90-day readmissions, in-hospital lengths of stay, and day-of-surgery and 90-day episode of care costs. RESULTS Semaglutide users exhibited lower 90-day readmission rates (6.2 versus 8.8%; odds ratio 0.68; P < .01) and reduced prosthetic joint infections (1.6 versus 2.9%; odds ratio 0.56; P < .01). However, medical complication rates, hospital stays, same-day surgical costs, and 90-day episode costs showed no significant differences. CONCLUSIONS This study highlights semaglutide users undergoing THA with fewer 90-day readmissions and 2-year prosthetic joint infections. Although no variance appeared in medical complications, hospital stays, or costs, the medication's notable glycemic control and weight loss benefits could prompt pre-surgery consideration. Further research is essential for a comprehensive understanding of semaglutide's impact on post-THA outcomes.
Collapse
Affiliation(s)
- Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Michael J Miskiewicz
- Renaissance School of Medicine at Stony Brook University Medical Center, Stony Brook, New York
| | - Ariel N Rodriguez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| |
Collapse
|
4
|
Magruder ML, Jacofsky D, Springer B, Scuderi GR, Hameed D, Mont MA. Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry? J Arthroplasty 2024; 39:277-282. [PMID: 38182322 DOI: 10.1016/j.arth.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | | | - Bryan Springer
- OrthoCarolina - Hip & Knee Center and Atrium Musculoskeletal Institute, Charlotte, North Carolina
| | - Giles R Scuderi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Orthopaedic Institute, New York, New York
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| |
Collapse
|