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Scheinberg M, Dan Zhang T, Galloway J, Campos J, Kalluraya S, Bernstein M, Shah A. Weight changes following Achilles debridement with flexor hallucis longus transfer: A retrospective analysis. J Foot Ankle Surg 2024:S1067-2516(24)00218-7. [PMID: 39245433 DOI: 10.1053/j.jfas.2024.08.018] [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: 02/22/2024] [Revised: 07/28/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
Obesity poses a growing concern, with global predictions estimating over half the population to be overweight or obese by 2030 (1). While prior research has extensively explored the impact of obesity on hip and knee surgeries, a notable gap persists in understanding weight changes following foot and ankle procedures. This retrospective study focuses on the relationship between Body Mass Index (BMI) and Achilles debridement with flexor hallucis longus (FHL) transfer. Despite prevailing research on the adverse effects of obesity on orthopedic outcomes, few studies examine the reciprocal influence of surgeries on weight. A retrospective analysis of 136 patients undergoing primary Achilles debridement with FHL transfer was conducted. Data encompassing BMI, demographic information, and medical comorbidities were extracted from electronic medical records (EMRs). A clinically meaningful BMI change was considered as a 5 % variation. Inferential statistics in the form of analysis of variance, t-test, and linear regression were employed for data analysis. Among the 136 patients in the study, no statistically significant BMI changes were noted up to two years after surgery (p = 0.9967). While obesity remains a significant factor in foot and ankle surgery complications, our study suggests that Achilles debridement with FHL transfer does not induce significant weight changes. Further research exploring factors influencing weight changes and varying outcomes across demographics is warranted. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Ting Dan Zhang
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - John Galloway
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Juan Campos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Swathi Kalluraya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Marc Bernstein
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States.
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Wall CJ, Lee SS, Ma Y, de Steiger RN, Vertullo CJ, Kondalsamy-Chennakesavan S. Do patients with osteoarthritis lose weight prior to elective joint replacement? ANZ J Surg 2024; 94:1373-1382. [PMID: 38853606 DOI: 10.1111/ans.19118] [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] [Received: 04/10/2024] [Revised: 05/21/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Obesity is a known risk factor for the development of osteoarthritis and the subsequent need for joint replacement. Weight loss has been shown to reduce pain, disability, and the need for joint replacement, particularly in patients with knee osteoarthritis. The aim of this study was to investigate pre-operative weight change in patients with hip, knee, and shoulder osteoarthritis at a regional, public hospital in Australia, to identify opportunities for pre-operative weight-loss intervention. METHODS A retrospective review of patients who underwent elective primary total hip (THR), knee (TKR), and shoulder (TSR) replacement for osteoarthritis was conducted between December 2019 and December 2022. BMI data were collected at three time points: (1) general practitioner (GP) referral; (2) orthopaedic clinic review; and (3) pre-admission clinic (PAC) assessment. RESULTS A total of 496 patients were included in the study, of which 205 underwent THR, 251 underwent TKR, and 40 underwent TSR. The mean patient age was 67 years, and 46.4% were female. At the time of GP referral, the mean body mass index (BMI) was 31.4 kg/m2. Across the study period, only 2% of patients experienced clinically significant weight loss pre-operatively (≥5% of total body weight). CONCLUSION This study has demonstrated that very few patients lose weight prior to undergoing joint replacement in the public sector in Australia. This highlights the need for targeted non-surgical weight loss interventions for patients currently awaiting joint replacement.
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Affiliation(s)
- Christopher J Wall
- Department of Orthopaedics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia
- School of Medicine, Rural Clinical School, University of Queensland, Brisbane, Queensland, Australia
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Susie S Lee
- Department of Orthopaedics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia
| | - Yanru Ma
- Intensive Care Unit, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia
| | - Richard N de Steiger
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Vertullo
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
- Knee Research Australia, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Botros M, Guirguis P, Balkissoon R, Myers TG, Thirukumaran CP, Ricciardi BF. Is Morbid Obesity a Modifiable Risk Factor in Patients Who Have Severe Knee Osteoarthritis and do Not Have a Formal Perioperative Optimization Program? J Arthroplasty 2024; 39:658-664. [PMID: 37717836 DOI: 10.1016/j.arth.2023.09.009] [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: 04/02/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Obesity is considered a modifiable risk factor prior to total knee arthroplasty (TKA); however, little data support this hypothesis. Our purpose was to evaluate patients who have a body mass index (BMI) >40 presenting for TKA to determine the incidence of: (1) patients who achieved successful weight loss through nutritional modification or bariatric surgery and (2) patients who underwent TKA over the study period without the presence of a formal optimization program. METHODS This was a retrospective, single-center analysis. Inclusion criteria included: Kellgren and Lawrence grade 3 or 4 knee osteoarthritis, BMI >40 at presentation, and minimum 1-year follow-up (mean 45 months) (N = 624 patients). Demographics, weight loss interventions, pursuit of TKA, maximum BMI change, and Patient-Reported Outcomes Measurement Information System scores were collected. Multivariable logistic and linear regressions evaluated associations of underlying demographic and treatment characteristics with outcomes. RESULTS There were 11% of patients who ended up pursuing TKA over the study period. Bariatric surgery was 3.7 times more likely to decrease BMI by minimum 10 compared to nonsurgical intervention (95% confidence interval [CI] [1.7, 8.1]; P = .001). Bariatric surgery resulted in mean BMI change of -3.3 (range, 0 to 22) compared to nonsurgical interventions (-2.6 [range, 0 to 12]) and no intervention (0.4 [range, 0 to 15]; P < .0001). Bariatric surgery patients were 3.1 times more likely to undergo TKA (95% CI [1.3, 7.1]; P = .008), and nonsurgical interventions were 2.4 times more likely to undergo TKA (95% CI [1.3, 4.5]; P = .006) compared to no intervention. Non-White patients across all interventions were less likely to experience loss >5 BMI compared to White patients (95% CI [0.2, 0.9]; P = .018). CONCLUSIONS Most patients were unable to reduce BMI more than 5 to 10 over a mean 4-year period without a formal weight optimization program. Utilization of bariatric surgery was most successful compared to nonsurgical interventions, although ultimate pursuit of TKA remained low in all cohorts.
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Affiliation(s)
- Mina Botros
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - Paul Guirguis
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - Rishi Balkissoon
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - Thomas G Myers
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - Caroline P Thirukumaran
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York; Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York
| | - Benjamin F Ricciardi
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York; Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York
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Oyem PC, Rullán PJ, Pasqualini I, Klika AK, Higuera CA, Murray TG, Krebs VE, Piuzzi NS. A Longitudinal Analysis of Weight Changes before and after Total Knee Arthroplasty: Weight Trends, Patterns, and Predictors. J Knee Surg 2024. [PMID: 38113910 DOI: 10.1055/a-2232-5083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Longitudinal data on patient trends in body mass index (BMI) and the proportion that gains or loses significant weight before and after total knee arthroplasty (TKA) are scarce. This study aimed to observe patients longitudinally for a 2-year period and determine (1) clinically significant BMI changes during the 1 year before and 1 year after TKA and (2) identify factors associated with clinically significant weight changes.A prospective cohort of 5,388 patients who underwent primary TKA at a tertiary health care institution between January 2016 and December 2019 was analyzed. The outcome of interests was clinically significant weight changes, defined as a ≥5% change in BMI, during the 1-year preoperative and postoperative periods, respectively. Patient-specific variables and demographics were assessed as potential predictors of weight change using multinomial logistic regression.Overall, 47% had a stable weight throughout the study period (preoperative: 17% gained, 15% lost weight; postoperative: 19% gained, 16% lost weight). Patients who were older (odds ratio [OR] = 0.95), men (OR = 0.47), overweight (OR = 0.36), and Obese Class III (OR = 0.06) were less likely to gain weight preoperatively. Preoperative weight loss was associated with postoperative weight gain 1 year after TKA (OR = 3.03). Preoperative weight gain was associated with postoperative weight loss 1 year after TKA (OR = 3.16).Most patients maintained a stable weight before and after TKA. Weight changes during the 1 year before TKA were strongly associated with reciprocal rebounds in BMI postoperatively, emphasizing the importance of ongoing weight management during TKA and the recognition of patients at higher risk for weight gain.Level of evidence II (prospective cohort study).
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Affiliation(s)
- Precious C Oyem
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
- Cleveland Clinic, Lerner College of Medicine of Case Western University, Cleveland, Ohio
| | - Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Trevor G Murray
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Rullán PJ, Oyem PC, Pumo TJ, Khan ST, Pasqualini I, Klika AK, Barsoum WK, Molloy RM, Piuzzi NS. A Longitudinal analysis of weight changes before and after total hip arthroplasty: Weight trends, patterns, and predictors. Technol Health Care 2024; 32:3747-3760. [PMID: 39331055 DOI: 10.3233/thc-231404] [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: 09/28/2024]
Abstract
BACKGROUND It is crucial to understand weight trends in patients undergoing total hip arthroplasty (THA). OBJECTIVE To evaluate preoperative and postoperative weight trends for patients undergoing primary THA and factors associated with clinically significant weight change. METHODS A prospective cohort who underwent primary unilateral THA (n= 3,011) at a tertiary healthcare system (January 2016 to December 2019) were included in the study. The primary outcomes were clinically significant weight change (> 5% change in body mass index [BMI]) during the one-year preoperative and one-year postoperative periods. RESULTS Preoperatively, 66.6% maintained a stable weight, 16.0% gained and 17.4% lost weight, respectively. Postoperatively, 64.0% maintained a stable weight, while 22.6% gained and 13.4% lost weight, respectively. Female sex, Black race, obesity, higher Charlson Comorbidity Index (CCI) scores, and older age were associated with preoperative weight loss. Female sex, obesity, higher CCI scores, and Medicare insurance were associated with postoperative weight loss. Preoperative weight loss was associated with postoperative weight gain (OR = 3.37 [CI: 2.67 to 4.25]; p< 0.001), and preoperative weight gain was associated with postoperative weight loss (OR = 1.74 [CI: 1.30 to 2.3]; p< 0.001). CONCLUSION Most patients maintained a stable BMI one-year before and one-year after THA. Several factors are associated with weight loss before and after THA. Preoperative weight changes were associated with a reciprocal rebound in BMI post-operatively.
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Pujol N, Lang E, Abitan A. Evolution of body mass index and complications rate in severely or morbidly obese patients undergoing total knee arthroplasty. Orthop Traumatol Surg Res 2023; 109:103704. [PMID: 37832867 DOI: 10.1016/j.otsr.2023.103704] [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: 02/01/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Associations between obesity and knee osteoarthritis or complications after total knee arthroplasty (TKA) are well established. The procedure can significantly improve knee function, favoring weight loss, despite the risk of surgical complications. The main objective of the present study was to assess change in body mass index (BMI) after TKA in patients with severe or morbid obesity (BMI≥35kg/m2). The secondary endpoint was the rate of surgical revision. The hypotheses were that there is no significant change in BMI after TKA and that there is a significant rate of revision. METHODS This retrospective descriptive study was conducted for the period June 2009 to December 2019. Thirty-three patients (48 knees) were included: 27 women, 6 men; mean age, 66.5 years (range, 55-80). Preoperatively, 11 patients had BMI 35-39.9kg/m2 and 22 BMI≥40 (including 11 with BMI≥45kg/m2). The preoperative axis was in varus for 35 patients (73%, including 54%≥10°) and in valgus for 13 (27% including 33%≥10°). Radiological and clinical evaluation was carried out at 3 months and 1 year postoperatively. At≥2 years, change in BMI and EQ5D functional score were established by telephone survey; >5% change in BMI was considered significant. RESULTS Mean follow-up was 6.9±2.3 years (range, 2.9-10.5). Twenty-five patients (38 knees) were included for analysis. Mean postoperative BMI was 41±5kg/m2, with a mean decrease of 1.2±3.6kg/m2. At the last follow-up, BMI had increased in 8 patients (32%), including 3 by >5% (12%), and decreased in 16 (64%), including 7 by >5% (28%). The higher the baseline BMI, the greater the decrease: for BMI [35-39.9], -0.81 (range, -6.8; +4.3); for BMI [40-44.5],-1 (range, -9; +5.22); and for BMI>45, -1.54 (range, -3.97; +1.3). EQ5D averaged 0.75 at last follow-up. The higher the preoperative BMI, the more satisfactory the postoperative EQ5D: EQ5D for BMI [35-39.9]=0.71 (range, 0.36; 1); for BMI [40-44.5]=0.75 (range, 0.45; 1); and for BMI>45=0.80 (range, 0.48; 1). Four early surgical site infections (10.5%) and 2 isolated changes of the tibial component for early loosening (5.2%) required surgical revision. CONCLUSION Patients with severe or morbid obesity had a low tendency to lose weight after TKA, but this does not appear to us to be clinically relevant: the functional results were good. Nevertheless, this series showed a significant rate of revision (15%). TKA was feasible in patients with BMI≥35kg/m2, but requires appropriate patient information. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicolas Pujol
- Service de chirurgie orthopédique et traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
| | - Elena Lang
- Service de chirurgie orthopédique et traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Alexandre Abitan
- Service de chirurgie orthopédique et traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
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Pavlovic N, Naylor J, Boland R, Harris IA, Flood VM, Genel F, Gao M, Hackett D, Vleeskens C, Brady B. Why do some people with osteoarthritis and obesity awaiting hip or knee arthroplasty achieve successful weight management? A qualitative study. J Clin Nurs 2023; 32:7543-7559. [PMID: 37583254 DOI: 10.1111/jocn.16841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023]
Abstract
AIM To explore perceived barriers and enablers to weight management among people with obesity awaiting total knee or hip arthroplasty. DESIGN A nested qualitative study within a multi-centre, quasi-experimental pilot study comparing usual care weight management to a dietitian-led weight-loss diet. METHODS Semi-structured individual interviews were conducted with adults with end-stage osteoarthritis and a body mass index ≥30 kg/m2 waitlisted for primary total knee or hip arthroplasty. Participants with diverse sociodemographic characteristics and varied success with weight management in the pilot study were purposively sampled. Interviews were analysed using inductive thematic analysis, underpinned by constructivist-interpretivist epistemology. The Patient Activation Measure and Health Literacy Questionnaire were used for context when interpreting the findings. RESULTS Twenty-five participant interviews were conducted with a sociodemographically varied sample (aged 44-80 years, 9 born in Australia, 6 in paid employment and 11 lost ≥5% of their baseline weight). Four identified themes underpinned successful weight management: beliefs, adaptability, navigating healthcare and sociocultural context. Beliefs about whether weight was perceived as a problem, the expectation of weight loss and treatment-related beliefs influenced participants' perspectives towards weight loss. Adaptability, the ability to overcome barriers to weight loss, comprised three subthemes; readiness to act, degree of independence and problem-solving skills. Approaches towards navigating healthcare influenced uptake and adherence to weight management recommendations. Importantly, these themes were dependent on social and environmental circumstances, which influenced the type of barriers experienced and resources available to the individual. CONCLUSION Differences in a person's beliefs, their ability to adapt and navigate healthcare and sociocultural context appear to explain successful weight management among people with end-stage arthritis. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Clinicians should allow for individualisation cognisant of the identified themes when providing advice and treatment to promote adherence to weight management interventions. IMPACT This study explored perceived barriers and enablers to weight management among people with obesity awaiting total knee or hip arthroplasty. Four identified themes underpinned successful weight management: beliefs, adaptability, navigating healthcare and sociocultural context. Beliefs about whether weight was perceived as a problem, the expectation of weight loss and treatment-related beliefs influenced participants' perspectives towards weight loss. Understanding and assessing the contribution of each factor may guide weight management from clinicians treating patients with obesity and osteoarthritis. REPORTING METHOD The data are reported using the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION Patients contributed to the data collected.
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Affiliation(s)
- Natalie Pavlovic
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Justine Naylor
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Robert Boland
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Victoria M Flood
- University Centre for Rural Health, Northern Rivers, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Furkan Genel
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Manxin Gao
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Danella Hackett
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carol Vleeskens
- SPHERE Musculoskeletal Clinical Academic Group, Consumer Community Council, Sydney, New South Wales, Australia
| | - Bernadette Brady
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
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8
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Ighani Arani P, Wretenberg P, Stenberg E, Ottosson J, W-Dahl A. Total knee arthroplasty and bariatric surgery: change in BMI and risk of revision depending on sequence of surgery. BMC Surg 2023; 23:53. [PMID: 36899340 PMCID: PMC10007771 DOI: 10.1186/s12893-023-01951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Patients with obesity have a higher risk of complications after total knee arthroplasty (TKA). We investigated the change in weight 1 and 2 years post-Bariatric Surgery (BS) in patients that had undergone both TKA and BS as well as the risk of revision after TKA based on if BS was performed before or after the TKA. METHODS Patients who had undergone BS within 2 years before or after TKA were identified from the Scandinavian Obesity Surgery Register (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) between 2007 and 2019 and 2009 and 2020, respectively. The cohort was divided into two groups; patients who underwent TKA before BS (TKA-BS) and patients who underwent BS before TKA (BS-TKA). Multilinear regression analysis and a Cox proportional hazards model were used to analyze weight change after BS and the risk of revision after TKA. RESULTS Of the 584 patients included in the study, 119 patients underwent TKA before BS and 465 underwent BS before TKA. No association was detected between the sequence of surgery and total weight loss 1 and 2 years post-BS, - 0.1 (95% confidence interval (CI), - 1.7 to 1.5) and - 1.2 (95% CI, - 5.2 to 2.9), or the risk of revision after TKA [hazard ratio 1.54 (95% CI 0.5-4.5)]. CONCLUSION The sequence of surgery in patients undergoing both BS and TKA does not appear to be associated with weight loss after BS or the risk of revision after TKA.
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Affiliation(s)
- Perna Ighani Arani
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden. .,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden.
| | - Per Wretenberg
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden
| | - Erik Stenberg
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden.,Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Scandinavian Obesity Surgery Registry, Örebro, Sweden
| | - Johan Ottosson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden.,Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Scandinavian Obesity Surgery Registry, Örebro, Sweden
| | - Annette W-Dahl
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, OrthopedicsLund, Sweden.,The Swedish Arthroplasty Register, Göteborg, Sweden
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9
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Stock LA, Brennan JC, Turcotte JJ, King PJ. Effect of Weight Change on Patient-Reported Outcomes Following Total Joint Arthroplasty. J Arthroplasty 2022; 37:1991-1997.e1. [PMID: 35569706 DOI: 10.1016/j.arth.2022.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Increased body mass index (BMI) has been previously described as a risk factor for complications after total joint arthroplasty (TJA); however, its effect on patient-reported outcomes has not been thoroughly investigated. This study examines the effect of postoperative weight change on the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) scores for total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. METHODS A retrospective review of 988 patients undergoing THA or TKA was performed. PROMIS-PF scores and BMI were recorded throughout the study duration. Patients were classified by a 5% change in BMI. A univariate analysis evaluated differences across groups. Mixed-effect models evaluated predictors of change in functional score over the postoperative follow-up time. RESULTS 43.1% patients had a THA and 56.9% patients had a TKA. At 0 to 3 months, 92% of patients had no change in BMI, 3 to 6 months 82% had no change, and 6 to 12 months 80% had no change. There were no significant demographic or comorbidity differences across groups for both THA and TKA. Similar improvements in PROMIS-PF scores were observed across weight change groups. In the mixed-effect models, postoperative time was found to be a significant predictor of postoperative PF score. Both THA and TKA patients saw greater improvements in PROMIS-PF scores in patients with lower preoperative BMIs. CONCLUSION These results demonstrate most patients do not experience substantial changes in weight following TJA. However, lower BMIs at the time of surgery were associated with an increased functional improvement. Therefore, efforts to optimize BMI should be focused preoperatively to improve surgical outcomes.
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Affiliation(s)
| | | | | | - Paul J King
- Anne Arundel Medical Center, Annapolis, Maryland
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10
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Wu M, Cochrane NH, Kim B, Belay ES, O'Donnell J, Ryan SP, Jiranek WA, Seyler TM. Patterns and Predictors of Weight Change Before and After Total Hip Arthroplasty in Class 2 and 3 Obese Patients. J Arthroplasty 2022; 37:880-887. [PMID: 35031418 DOI: 10.1016/j.arth.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to better understand body mass index (BMI) change patterns and factors associated with BMI change before and after total hip arthroplasty (THA) in Class 2 and 3 obese patients, and assess if preoperative or postoperative BMI change affects postoperative clinical outcomes. METHODS We retrospectively reviewed World Health Organization Class 2 and 3 obese patients (BMI > 35.0 at surgery) who underwent THA at a tertiary medical center from 2010 to 2020. BMI was recorded at 1 year preoperatively (mean 11.6 months), and at most recent postoperative visit (mean 29.0 months). Baseline demographics and postoperative clinical outcomes were recorded. RESULTS We reviewed 436 THAs with a mean age of 59.9 (11.5) years. Leading up to surgery 55.5% had unchanged BMI, and postoperatively 48.2% had unchanged BMI. Multivariate logistic regression revealed that those who lost BMI preoperatively were more likely to gain BMI postoperatively (odds ratio [OR] 3.28, confidence interval [CI] 1.83-5.97, P = .005), but those who gained >5% BMI preoperatively had no association with BMI change postoperatively. Those in a higher BMI class preoperatively were less likely to gain BMI preoperatively (Class 3 obese patients: OR 0.001, CI 0.0002-0.004, P < .001). African American patients were more likely to gain BMI preoperatively (OR 2.32, CI 1.16-4.66, P = .017). We did not detect an association between BMI change and postoperative clinical outcomes. CONCLUSION In World Health Organization Class 2 or 3 obese patients, most maintained BMI between their first preoperative and final postoperative visit. Preoperatively, Class 3 obese patients were less likely to gain weight than Class 2 obese patients. The primary predictor of postoperative weight gain was preoperative weight loss. Weight change preoperatively and postoperatively were not associated with worse clinical outcomes.
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Affiliation(s)
- Mark Wu
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Billy Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Elshaday S Belay
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Jeffrey O'Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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11
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Preoperative Weight Loss and Postoperative Weight Gain Independently Increase Risk for Revision After Primary Total Knee Arthroplasty. J Arthroplasty 2022; 37:674-682. [PMID: 34915131 DOI: 10.1016/j.arth.2021.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The current American Association of Hip and Knee Surgeons (AAHKS) guidelines recommend preoperative weight loss before total knee arthroplasty (TKA) in patients with body mass index (BMI) ≥40 kg/m2. However, there is a paucity of evidence on TKA outcomes after preoperative weight loss. This study therefore evaluated predictors of preoperative and postoperative BMI changes and their impact on outcomes after TKA. METHODS This is a retrospective review of 3058 primary TKAs at an academic institution from 2015 to 2019. BMI was collected on the day of surgery. Preoperative and postoperative BMI at 6 months and 1 year were also obtained. BMI change of ≥5% was considered clinically significant. Mean follow-up was 3.2 years. Patient demographics, acute postoperative outcomes, and all-cause revisions were compared between patients who gained, lost, or maintained weight using univariate and multivariable analyses. RESULTS Preoperative weight loss was predictive of postoperative weight gain (P < .001), and preoperative weight gain was predictive of postoperative weight loss (P < .001). Cox regression analysis revealed that ≥5% BMI loss preoperatively increased risk for all-cause revisions (P = .030), while ≥5% BMI gain postoperatively increased risk for prosthetic joint infections (P = .016). Patients who lost significant weight both before and after surgery had the highest risk for all-cause revisions (P = .022). CONCLUSION Weight gain postoperatively was associated with inferior outcomes. Significant weight loss before surgery led to a "rebound" in weight gain, and independently increased risk for all-cause revision. Therefore, current recommendations for weight loss before TKA in morbidly obese patients should be re-evaluated.
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12
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The Fate of Morbidly Obese Patients With Joint Pain: A Retrospective Study of Patient Outcomes. J Arthroplasty 2021; 36:3101-3107.e1. [PMID: 33757715 DOI: 10.1016/j.arth.2021.02.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/13/2021] [Accepted: 02/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The number of obese patients seeking a total joint arthroplasty (TJA) continues to increase. Weight loss is often recommended to treat joint pain and reduce risks associated with TJA. We sought to determine the effectiveness of an orthopedic surgeon's recommendation to lose weight. METHODS We identified morbidly obese (body mass index (BMI) 40-49.9 kg/m2) and super obese (BMI ≥50 kg/m2) patients with hip or knee osteoarthritis. Patients with less than 3-month follow-up were excluded. Patient characteristics (age, gender, BMI, comorbidities), disease characteristics (joint affected, radiographic osteoarthritis grading), and treatments were recorded. Clinically meaningful weight loss was defined as weight loss greater than 5%. RESULTS Two hundred thirty morbid and 50 super obese patients were identified. Super obese patients were more likely to be referred to weight management (52.0% vs 21.7%, P < .001) and were less likely to receive TJA (20.0% vs 41.7%, P = .004). Each 1 kg/m2 increase in BMI decreased the odds of TJA by 10.9% (odds ratio = 0.891, 95% confidence interval: 0.833-0.953, P = .001). Forty (23.0%) of the nonoperatively treated patients achieved clinically meaningful weight loss, and 19 (17.9%) patients who underwent TJA lost weight before surgery. After surgery, the number of patients who achieved a clinically meaningful weight loss grew to 32 (30.2%). CONCLUSION In morbid and super obese patients, increasing BMI reduces the likelihood that a patient will receive TJA, and when counseled by their orthopedic surgeon, few patients participate in weight-loss programs or are otherwise able to lose weight. Weight loss is an inconsistently modifiable risk factor for joint replacement surgery.
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13
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Khow YZ, Goh GS, Chen JY, Lo NN, Yeo SJ, Liow MHL. Change in Body Mass Index after Simultaneous Bilateral Total Knee Arthroplasty: Risk Factors and Its Influence on Functional Outcomes. J Arthroplasty 2021; 36:1974-1979. [PMID: 33602589 DOI: 10.1016/j.arth.2021.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous studies evaluating weight changes following total knee arthroplasty (TKA) were performed on heterogenous cohorts. However, no study has evaluated weight changes in a cohort of simultaneous-bilateral TKA (SB-TKA) patients. This study aimed to evaluate the prevalence of patients who lost or gained weight, determine if postoperative weight change influences functional outcome, and identify predictors of weight change after SB-TKA. METHODS Prospectively collected registry data of 560 patients who underwent SB-TKA were reviewed. Patients were assessed preoperatively, at 6 months, and 2 years using the Knee Society Score, Oxford Knee Score, Short-Form 36, and range of motion. Change in body mass index (BMI) >5% was used to categorize patients into 3 groups: lost, maintained, or gained weight. Analysis of variance, Kruskal-Wallis test, and chi-squared test were used to compare functional outcomes between groups. Multivariable logistic regression evaluated predictors for postoperative weight changes. RESULTS At 2 years, 59% of patients maintained weight, 28% of patients gained weight, and 13% of patients lost weight. All groups experienced similar improvements in functional outcomes, rates of minimal clinically important difference attainment, and patient satisfaction (P > .05). Older patients were more likely to gain weight (P < .05). Patients with higher preoperative BMI were more likely to gain weight (P < .05) and less likely to lose weight (P < .05). Patients with greater preoperative comorbidities were less likely to lose weight (P < .05). CONCLUSION Up to 41% of patients experience significant weight changes after SB-TKA. Older patients with higher preoperative BMI were more likely to gain weight, while higher preoperative BMI with more comorbidities were less likely to lose weight following SB-TKA; however, postoperative weight changes do not appear to affect functional outcomes. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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14
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Tucker A, Warnock JM, Cassidy R, Napier RJ, Beverland D. Are patient-reported outcomes the same following second-side surgery in primary hip and knee arthroplasty? Bone Jt Open 2021; 2:243-254. [PMID: 33881349 PMCID: PMC8085620 DOI: 10.1302/2633-1462.24.bjo-2020-0187.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aims Up to one in five patients undergoing primary total hip (THA) and knee arthroplasty (TKA) require contralateral surgery. This is frequently performed as a staged procedure. This study aimed to determine if outcomes, as determined by the Oxford Hip Score (OHS) and Knee Score (OKS) differed following second-side surgery. Methods Over a five-year period all patients who underwent staged bilateral primary THA or TKA utilizing the same type of implants were studied. Eligible patients had both preoperative and one year Oxford scores and had their second procedure completed within a mean (2 SDs) of the primary surgery. Patient demographics, radiographs, and OHS and OKS were analyzed. Results A total of 236 patients met the inclusion criteria, of which 122 were THAs and 114 TKAs. The mean age was 66.5 years (SD 9.4), with a 2:1 female:male ratio. THAs showed similar significant improvements in outcomes following first- and second-side surgery, regardless of sex. In contrast for TKAs, although male patients demonstrated the same pattern as the THAs, female TKAs displayed significantly less improvement in both OKS and its pain component following second-side surgery. Conclusion Female patients undergoing second-side TKA showed less improvement in Oxford and pain scores compared to the first-side. This difference in outcome following second-side surgery did not apply to male patients undergoing TKA, or to either sex undergoing THA. Cite this article: Bone Jt Open 2021;2(4):243–254.
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15
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Khan SA, Logan P, Asokan A, Handford C, Rajgor HD, Khadabadi NA, Moores T, Targett J. The incidence of venous thromboembolism in total joint replacement during COVID-19 pandemic: has lockdown had an influence? Bone Jt Open 2020; 1:751-756. [PMID: 33367283 PMCID: PMC7750738 DOI: 10.1302/2633-1462.112.bjo-2020-0144.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Aims As the first wave of the COVID-19 pandemic began to dip, restarting elective orthopaedics became a challenge. Protocols including surgery at ‘green’ sites, self-isolation for 14 days, and COVID-19 testing were developed to minimize the risk of transmission. In this study, we look at risk effects of 14-day self-isolation on the incidence of venous thromboembolism (VTE) in our green site hospital among patients undergoing total joint replacement (TJR). Methods This retrospective cohort study included 50 patients who underwent TJR. Basic demographic data was collected including, age, sex, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), type of surgery, and complications at two and four weeks. Univariate and multivariate analysis were used to identify risk factors associated with an increased risk of VTE. Results A total of 50 patients were included in our study, with 24 males and 26 females. The mean age was 67.86 (SD 11.803). Overall, 8% of patients suffered a VTE complication; symptomatic non-fatal pulmoary embolism was confirmed in 6% of patients (n = 3) as an inpatient, and symptomatic deep vein thrombosis was diagnosed in 2% of patients (n = 1) within two weeks of their operation. All patients were found to be female (p < 0.001), had a BMI > 30 (p = 0.317), and were immobile prior to their operation using walking aids (p = 0.016). Conclusion The incidence we report is much higher than the reported incidence in the literature, which we believe is related to the 14-day self-isolation period and immobility prior to their operation. We recommend that all patients undergoing TJR that require a period of self-isolation, are pre-assessed prior to self-isolation for their risk of VTE, potentially using mechanical and chemical prophylaxis to reduce the likelihood of developing VTE. Cite this article: Bone Jt Open 2020;1-12:751–756.
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Affiliation(s)
- Shehzaad A Khan
- Trauma and Orthopaedics, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.,Trauma and Orthopaedics, Nuffield Health Brentwood Hospital, Brentwood, UK
| | - Peter Logan
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, UK
| | - Ajay Asokan
- Trauma and Orthopaedics, Nuffield Health Brentwood Hospital, Brentwood, UK
| | | | | | | | - Thomas Moores
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, UK
| | - John Targett
- Trauma and Orthopaedics, Nuffield Health Brentwood Hospital, Brentwood, UK
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16
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Patterns of Weight Change and Their Effects on Clinical Outcomes Following Total Knee Arthroplasty in an Asian Population. J Arthroplasty 2020; 35:375-379. [PMID: 31563395 DOI: 10.1016/j.arth.2019.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This prospective cohort study was designed to evaluate weight change patterns and their effects on clinical outcomes following total knee arthroplasty (TKA) in the Asian population. We hypothesized that Asian patients will have a different pattern of weight change following TKA compared to Western patients and that weight loss following TKA will be associated with better clinical outcomes. METHODS A cohort of consecutive patients who underwent TKA from 2004 to 2015 was included. All patients received a conventional posterior-stabilized TKA implant and underwent a standard perioperative care pathway. Assessments were done preoperatively, at 6 months, and 2 years after surgery. The range of motion, Knee Society Score, Oxford Knee Score, and the Short-Form 36 questionnaire were used to assess outcomes. Height and weight of patients were recorded for body mass index (BMI) calculation. Patterns of weight loss following TKA in this cohort were charted. Clinical outcomes were then analyzed against the change in BMI. RESULTS A total of 602 patients (602 knees) were reviewed. Mean age was 66.39 ± 7.27 years. Mean BMI was 27.75 ± 4.51 kg/m2. Overall, 63.12% of all our patients gained weight following TKA. Moreover, weight loss did not influence patients' odds for better clinical outcomes. Furthermore, patients who were in the preoperative BMI category of obese class I were more likely to gain weight as compared to those in the normal category (odds ratio 0.35, 95% confidence interval 0.2-0.61, P < .001). Moreover, older people were more likely to gain more weight compared to younger people. We also showed that the mean 2-year Knee Society Knee Score was significantly higher in the patients who gained weight while the patients who lost weight had the highest mean 2-year Oxford Knee Score and the lowest mean 2-year Knee Society Function Score. CONCLUSION Asians tend to gain weight following TKA. However, this weight change following TKA does not affect clinical outcomes, which remain good across all BMI groups. LEVEL OF EVIDENCE Therapeutic Level III.
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17
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Naylor JM, Mills K, Pocovi N, Dennis S, Hackett D, Hassett L, Brady B, Lewin AM, Adie S, Xuan W. Patient factors associated with weight gain and weight loss after knee or hip arthroplasty. Obes Res Clin Pract 2019; 13:371-377. [DOI: 10.1016/j.orcp.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 01/19/2023]
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18
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Roman M, Monaghan A, Serraino GF, Miller D, Pathak S, Lai F, Zaccardi F, Ghanchi A, Khunti K, Davies MJ, Murphy GJ. Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes. Br J Surg 2018; 106:181-189. [DOI: 10.1002/bjs.11001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/16/2018] [Accepted: 08/21/2018] [Indexed: 12/18/2022]
Abstract
Abstract
Background
The aim was to investigate whether preoperative weight loss results in improved clinical outcomes in surgical patients with clinically significant obesity.
Methods
This was a systematic review and aggregate data meta-analysis of RCTs and cohort studies. PubMed, MEDLINE, Embase and CINAHL Plus databases were searched from inception to February 2018. Eligibility criteria were: studies assessing the effect of weight loss interventions (low-energy diets with or without an exercise component) on clinical outcomes in patients undergoing any surgical procedure. Data on 30-day or all-cause in-hospital mortality were extracted and synthesized in meta-analyses. Postoperative thromboembolic complications, duration of surgery, infection and duration of hospital stay were also assessed.
Results
A total of 6060 patients in four RCTs and 12 cohort studies, all from European and North American centres, were identified. Most were in the field of bariatric surgery and all had some methodological limitations. The pooled effect estimate suggested that preoperative weight loss programmes were effective, leading to significant weight reduction compared with controls: mean difference –7·42 (95 per cent c.i. –10·09 to –4·74) kg (P < 0·001). Preoperative weight loss interventions were not associated with a reduction in perioperative mortality (odds ratio 1·41, 95 per cent c.i. 0·24 to 8·40; I2 = 0 per cent, P = 0·66) but the event rate was low. The weight loss groups had shorter hospital stay (by 27 per cent). No differences were found for morbidity.
Conclusion
This limited preoperative weight loss has advantages but may not alter the postoperative morbidity or mortality risk.
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Affiliation(s)
- M Roman
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - A Monaghan
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - G F Serraino
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - D Miller
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - S Pathak
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - F Lai
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - F Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - A Ghanchi
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - G J Murphy
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
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19
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Patients Less Likely to Lose Weight Following a Knee Replacement: Results From the Osteoarthritis Initiative. J Clin Rheumatol 2018; 23:355-360. [PMID: 28937470 DOI: 10.1097/rhu.0000000000000579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Knee replacement typically results in reduced pain and improved function, but it is unclear if these improvements lead to weight loss. OBJECTIVE The purpose of this study was to examine weight change patterns preoperatively and postoperatively among overweight/obese knee replacement patients. METHODS The study evaluated 210 overweight/obese patients from the Osteoarthritis Initiative who underwent a knee replacement during an 8-year longitudinal study. Average annual weight changes during 1- to 2-year intervals prior to, including, and subsequent to knee replacement were categorized as loss (≥-2.5%), maintain (>-2.5% to <2.5%), and gain (≥2.5%). Weight changes across time intervals were compared using logistic regression with generalized estimating equations, adjusting for demographic, health, and knee factors. RESULTS On average, patients lost -0.6 kg/y during the interval when the surgery was performed, but weight gain (0.9 kg/y) in the initial postoperative interval represented an overall net weight gain (0.3 kg/y) compared with presurgery. Continued weight gain (0.3 kg/y) was also seen among patients with additional follow-ups. Patients were significantly less likely to have a meaningful weight loss in the time interval immediately following the surgery compared with the interval in which the surgery took place (odds ratio, 0.37; 95% confidence interval, 0.18-0.79). CONCLUSIONS Overweight and obese patients initially lost weight during the interval including knee replacement; however, they were less likely to lose more than 2.5% of their weight in the 1 to 2 years immediately after the surgery. Knee replacement patients may benefit from weight management interventions both preoperatively and postoperatively.
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20
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Chen JY, Xu S, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ. Change in Body Mass Index After Total Knee Arthroplasty and Its Influence on Functional Outcome. J Arthroplasty 2018; 33:718-722. [PMID: 29174759 DOI: 10.1016/j.arth.2017.10.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is often an assumption by patients that weight loss will occur once their knee pain is relieved by total knee arthroplasty (TKA). This study aims to evaluate (1) the change in patients' body mass index (BMI) after TKA; (2) if postoperative change in BMI influences functional outcome and survival rate of TKA; and (3) the predictive factors associated with change in BMI. METHODS Seven thousand seven hundred thirty-three patients who underwent a primary TKA between 2001 and 2010 were included in this study. Functional outcome scores collected at 2 years after surgery include the Oxford Knee Score, Knee Society Function Score, Knee Society Knee Score, Physical Component Score, and Mental Component Score of short form 36. RESULTS Among these patients, 1067 (14%) had reduction in BMI, 5045 (65%) maintained their BMI, and 1621 (21%) had gain in BMI. The differences in improvement in Oxford Knee Score, Knee Society Function Score, Knee Society Knee Score, and Physical Component Score among the 3 groups of patients were less than the known minimal clinically important difference of these scores. The 10-year survival rate of TKA was not influenced by patients' change in BMI after surgery (P = .435). Obese class I, II, and III patients were more likely to reduce their BMI after TKA than those with normal preoperative BMI (P = .002, P = .012, and P = .004, respectively), while older patients were less likely to have gain in BMI after surgery (P = .001). CONCLUSION A change in BMI after TKA did not influence the functional outcome clinically or the survival rate of the TKA implant.
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Affiliation(s)
- Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Sheng Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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21
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22
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Schwartsmann CR, Borges AM, Freitas GLSD, Migon EZ, Oliveira GKD, Rodrigues MW. Do patients lose weight after total knee replacement? Rev Bras Ortop 2017; 52:159-163. [PMID: 28409132 PMCID: PMC5380789 DOI: 10.1016/j.rboe.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/29/2016] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Several studies show that patients undergoing total knee arthroplasty (TKA) tend to maintain or gain weight after the procedure, which would result in increased wear of the prosthesis and new surgical interventions in a smaller period of time in comparison with patients with adequate body mass index (BMI). The aim of this study was to investigate the effect of TKA surgery on these patients' BMI. METHODS Initially the records were analyzed, chosen at random from 91 patients undergoing TKA during the period from August 2011 to July 2013. Patients were stratified by BMI as normal weight (BMI between 20 and 25), overweight (BMI between 25 and 30), and obesity (BMI > 30). They were re-evaluated in a minimum period of 18 months. RESULTS The mean age of the sample population was 68.1 years; 69.1 for men and 67.2 for women. The mean preoperative BMI was 27.24 kg/m2. Among the study participants, in the preoperative period, 17 patients had normal weight, 65 were overweight, and nine were obese. Postoperative analysis showed weight loss in 41 patients (46%), and weight gain in 50 patients (54%). The mean postoperative BMI was 27.16 kg/m2, in general, experiencing a slight decline in the mean BMI of 0.08 kg/m2. CONCLUSION Patients who underwent TKA did not achieve significant reduction in BMI after surgery.
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Affiliation(s)
- Carlos Roberto Schwartsmann
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
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23
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Springer BD, Carter JT, McLawhorn AS, Scharf K, Roslin M, Kallies KJ, Morton JM, Kothari SN. Obesity and the role of bariatric surgery in the surgical management of osteoarthritis of the hip and knee: a review of the literature. Surg Obes Relat Dis 2017; 13:111-118. [DOI: 10.1016/j.soard.2016.09.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 12/14/2022]
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24
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Formby PM, Purcell RL, Baird M, Wagner M, Goodlett RP, Mack AW. No clinically meaningful weight changes in a young cohort following total joint arthroplasty at 3-year follow-up. ANZ J Surg 2016; 87:60-64. [PMID: 27905187 DOI: 10.1111/ans.13765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/19/2016] [Accepted: 07/30/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Total joint arthroplasty (TJA) is one of the most successful operations. There is little in the literature regarding weight change following TJA, particularly in a young cohort. METHODS Retrospective analysis of 181 primary total hip arthroplasty (THA) and 185 primary total knee arthroplasty (TKA) patients was conducted. We reviewed preoperative and post-operative weights and post-operative body mass index at 3 and 6 months, 1 year, 2 and 3 years. We evaluated expected versus actual weight gain, and performed subgroup analyses of obese versus non-obese patients and active duty versus civilian patients. We used a minimal clinically meaningful weight change from baseline of ≥5%. RESULTS One hundred and fifty-one (41.3%) patients were active duty military service members with the mean age of 53 ± 11.1 years. In TKA patients, statistically significant differences were found in mean weights at 3 months (-1.8%, P ≤ 0.0001) and 2 years (+1.9%, P = 0.0006). In THA patients, statistically significant weight gains were found at 6 months (+1.1%, P = 0.006). For obese TKA patients, significant weight changes were observed at 3 months (-2.5%, P ≤ 0.0001), and none in the obese THA group. There were no statistical or clinically meaningful weight changes in the non-obese TKA or THA groups. There was a clinically meaningful weight gain in active duty TKA patients at 3 years (5.18%, P = 0.17). CONCLUSION Despite a theoretical ability to lose weight following TJA, patients maintain their preoperative weight following TJA. We found a clinically meaningful weight gain at 3 years post-operatively only in active duty TKA patients. Overall, however, we found no clinically significant weight changes following TJA at 3-year follow-up.
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Affiliation(s)
- Peter M Formby
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Richard L Purcell
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Baird
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Matthew Wagner
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Ronald P Goodlett
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Andrew W Mack
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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25
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Morbid Obesity in Total Hip Arthroplasty: Redefining Outcomes for Operative Time, Length of Stay, and Readmission. J Arthroplasty 2016; 31:1949-53. [PMID: 26994650 DOI: 10.1016/j.arth.2016.02.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The incidence of obesity among patients presenting for elective total hip arthroplasty (THA) has increased in the last decade, and the relationship between obesity and the need for joint arthroplasty has been demonstrated. This study evaluates the effects of morbid obesity on outcomes after primary THA by comparing short-term outcomes in THA between a morbidly obese (body mass index [BMI] ≥40) and a normal weight (BMI, 18.5 to <25) cohort at our institution between January 2003 and December 2010. METHODS Thirty-nine patients included in the morbidly obese group were compared with 186 in the normal weight group. Operative time, length of stay, complications, readmission, and length of readmission were compared. RESULTS Operative time was increased in the morbidly obese group at 122 minutes compared with 100 minutes (P = .002). Postoperatively, there was an increased 30-day readmission rate related to surgery of 12.8% associated with BMI ≥40 compared with 2.7% (P = .005) as well as a 5.1-fold increase in surgery-related readmitted bed days-0.32 bed days per patient for normal weight compared with 1.64 bed days per patient for the morbidly obese (P = .026). CONCLUSION Morbidly obese patients present a technical challenge and likely this, and the resultant complications are underestimated. More work needs to be performed to enable suitable allocation of resources.
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Kubat E, Giori NJ, Hwa K, Eisenberg D. Osteoarthritis in veterans undergoing bariatric surgery is associated with decreased excess weight loss: 5-year outcomes. Surg Obes Relat Dis 2016; 12:1426-1430. [DOI: 10.1016/j.soard.2016.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/19/2016] [Accepted: 02/15/2016] [Indexed: 01/08/2023]
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Kulkarni K, Karssiens T, Kumar V, Pandit H. Obesity and osteoarthritis. Maturitas 2016; 89:22-8. [DOI: 10.1016/j.maturitas.2016.04.006] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 01/23/2023]
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Hurwit DJ, Trehan SK, Cross MB. New Joints, Same Old Weight: Weight Changes After Total Hip and Knee Arthroplasty. HSS J 2016; 12:193-5. [PMID: 27385952 PMCID: PMC4916088 DOI: 10.1007/s11420-015-9481-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/22/2015] [Indexed: 02/07/2023]
Abstract
Obesity is a well-known risk factor for postoperative complications following total joint arthroplasty. However, because the operation is often successful, orthopedic surgeons continue to operate on obese individuals, and many surgeons do so under the assumption that patients will lose weight after they are able to walk and exercise without pain. In this article, we review a recent study by Ast et al., who performed a retrospective review, using a single-center institutional registry, to determine (1) whether patients do actually lose weight after total hip and/or total knee arthroplasty, (2) whether there are predictors of postoperative weight change, and (3) whether postoperative weight changes affect patient-reported clinical outcomes. The principle conclusion was that most patients maintained their body mass index (BMI) after total hip and total knee arthroplasty (73 and 69%, respectively). However, patients undergoing total knee arthroplasty, patients who had a higher preoperative BMI, and female patients were more likely to lose weight postoperatively. When examined in the context of the current literature, this study provides valuable information for the preoperative counseling of total joint arthroplasty candidates, especially in the setting of obesity.
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Affiliation(s)
- Daniel J. Hurwit
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Samir K. Trehan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Michael B. Cross
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Lui M, Jones CA, Westby MD. Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review. Syst Rev 2015; 4:121. [PMID: 26410227 PMCID: PMC4584125 DOI: 10.1186/s13643-015-0107-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/28/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Of the more than 104,000 Canadians who underwent elective total joint arthroplasty (TJA) surgery in 2012-2013 for hip and knee osteoarthritis (OA), 40 and 60 %, respectively, were obese. Obesity is associated with increased risks for receiving TJA, post-operative complications and delayed functional recovery. Current guidelines for patients with a body mass index (BMI) of ≥30 kg/m(2) are to participate in a weight management programme and to lose weight prior to TJA surgery. As part of a larger project, a rapid review was conducted to examine the effects of short-term non-pharmacological and non-surgical weight loss interventions in adults in the year prior to total hip arthroplasty (THA) and total knee arthroplasty (TKA) on surgical and patient outcomes, and adverse events. METHODS We performed a rapid review and searched seven electronic databases for English language articles published between 1990 and February 2015. Observational studies evaluating the association between pre-operative weight loss and short- and long-term outcomes, and controlled trials of non-pharmacological and non-surgical weight loss interventions were considered for inclusion. Two reviewers independently screened and selected articles, assessed methodological quality and extracted data. RESULTS Of 263 articles identified, a total of four studies met our inclusion criteria. In one of two high-quality retrospective cohort studies, weight loss ≥5 % of body weight in the year prior to TJA and maintained in the year after surgery was associated with a higher likelihood of deep surgical site infection in THA patients and 90-day readmission in TKA patients. No significant differences were reported in incidence of superficial surgical site infections in THA or TKA patients who lost weight pre-operatively compared to those who maintained their weight in either study. Two abstracts of randomized controlled trials were included; however, despite contacting the authors, full-length articles were not available. The limited information from the trials suggested that short-term dietician-supervised weight loss interventions were effective in weight loss prior to TJA. CONCLUSIONS There is limited evidence to support the recommendation of weight loss in the year prior to TJA and to determine the effectiveness of short-term non-pharmacological, non-surgical weight management interventions on patient and surgical outcomes.
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Affiliation(s)
- Michelle Lui
- Department of Occupational Therapy, Surrey Memorial Hospital, 13750 96 Avenue, Surrey, BC, V3V 1Z2, Canada.
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - Marie D Westby
- School of Public Health, University of Alberta, c/o Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.
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Inacio MCS, Kritz-Silverstein D, Raman R, Macera CA, Nichols JF, Shaffer RA, Fithian DC. The risk of surgical site infection and re-admission in obese patients undergoing total joint replacement who lose weight before surgery and keep it off post-operatively. Bone Joint J 2014; 96-B:629-35. [DOI: 10.1302/0301-620x.96b5.33136] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluated whether obese patients who lost weight before their total joint replacement and kept it off post-operatively were at lower risk of surgical site infection (SSI) and re-admission compared with those who remained the same weight. We reviewed 444 patients who underwent a total hip replacement and 937 with a total knee replacement who lost weight pre-operatively and sustained their weight loss after surgery. After adjustments, patients who lost weight before a total hip replacement and kept it off post-operatively had a 3.77 (95% confidence interval (CI) 1.59 to 8.95) greater likelihood of deep SSIs and those who lost weight before a total knee replacement had a 1.63 (95% CI 1.16 to 2.28) greater likelihood of re-admission compared with the reference group. These findings raise questions about the safety of weight management before total replacement of the hip and knee joints. Cite this article: Bone Joint J 2014;96-B:629–35.
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Affiliation(s)
- M. C. S. Inacio
- Kaiser Permanente, Department
of Surgical Outcomes and Analysis, 8954 Rio
San Diego Drive, Suite 406, San
Diego, California, 92108, USA
| | - D. Kritz-Silverstein
- University of California, San Diego, School
of Medicine, 9500 Gilman Drive, La
Jolla, California, 92093-0725, USA
| | - R. Raman
- University of California, San Diego, School
of Medicine, 9500 Gilman Drive, La
Jolla, California, 92093-0717, USA
| | - C. A. Macera
- San Diego State University, Graduate
School of Public Health, Hardy Tower, 5500
Campanile Drive, San Diego, California, 92182-4162, USA
| | - J. F. Nichols
- San Diego State University, Department of Exercise & Nutritional Sciences, 5500 Campanile Drive, San Diego, California, 92182, USA
| | - R. A. Shaffer
- San Diego State University, Graduate
School of Public Health, Hardy Tower, 5500
Campanile Drive, San Diego, California, 92182-4162, USA
| | - D. C. Fithian
- Kaiser Permanente, Department
of Orthopaedic Surgery, 250 S Travelodge Dr, El
Cajon, California, 92020, USA
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