Delineating the impact of obesity and its relationship on recovery after total joint arthroplasties

School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2G4.
Osteoarthritis and Cartilage (Impact Factor: 4.17). 03/2012; 20(6):511-8. DOI: 10.1016/j.joca.2012.02.637
Source: PubMed


The primary aim of this study was to determine the impact of obesity in predicting short and long-term pain relief and functional recovery in total joint arthroplasty (TJA) either as an independent risk factor or a factor mediated by two chronic conditions associated with obesity-cardiac disease and diabetes mellitus.
A prospective observational study of 520 patients with primary joint arthroplasties. Pain and functional outcomes were evaluated with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within a month of surgery and then 6 months and 3 years post-operatively. Obesity, cardiac disease and diabetes mellitus were examined as potential risk factors for poor recovery. Patients were classified into four groups based on body mass index (BMI): (normal<25.0 kg/m(2); overweight 25.0-29.9 kg/m(2); obese Class 1 30.0-34.9 kg/m(2); severe obese Class 2&3 35.0 ≥ kg/m(2)). Linear mixed models for each joint type (hip and knee arthroplasty) were developed to examine the pattern of recovery and the effect of obesity.
Ninety-nine (19%) patients were severely obese, 127 (24%) had cardiac disease and 58 (11%) had diabetes mellitus. Baseline pain and functional scores were similar regardless of BMI classification. Severe obesity was a significant risk factor for worse pain and functional recovery at 6 months but no longer at 3 years following total hip and knee arthroplasty. Cardiac disease predicted a slower recovery after hip arthroplasty. No significant interactions existed between obesity and cardiac disease or diabetes mellitus.
Severe obesity is an independent risk factor for slow recovery over 3 years for both hip and knee arthroplasties.

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Available from: Maria E Suarez-Almazor, Aug 25, 2014
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    • "Thirdly, we did not account for any injuries that the patient might have incurred during the follow-up period, such as fracture (independent of knee prosthesis). Moreover, no consideration was paid to other disorders such as comorbidities (Cheah et al. 2005, Nunez et al. 2011b, Jones et al. 2012) or other implant surgery in the hip or contralateral knee. These factors may have influenced the patient outcomes and may therefore have been potential confounders. "
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    ABSTRACT: Background Obesity contributes much to the development of knee osteoarthritis. However, the association between obesity and outcome after knee replacement is controversial. We investigated whether there was an association between the preoperative body mass index (BMI) of patients who underwent total knee arthroplasty (TKA) and their quality of life (QoL) and physical function 3–5 years after surgery. Methods 197 patients who had undergone primary TKA participated in a 3–5 year follow-up study. The outcome measures were the patient-reported Short Form 36 (SF-36) and the American Knee Society score (KSS). Results Ordinal logistic regression analysis (adjusted for age, sex, disease, and surgical approach) revealed a statistically significant correlation between BMI and 9 of the 14 outcome measures. For all outcome measures, we found an odds ratio (OR) of < 1. A difference in BMI of 1 kg/m2 increased the risk of a lower score from a minimum of 2% (OR = 0.98 (0.93–1.03); p = 0.5) (Mental Component score) to a maximum of 13% (OR = 0.87 (0.82–0.93); p < 0.001) (KSS function score). Interpretation Our findings indicate that TKA patients’ preoperative BMI is a predictor of the clinical effect and patients’ quality of life 3–5 years postoperatively. A high BMI increases the risk of poor QoL (SF-36) and physical function (KSS).
    Acta Orthopaedica 08/2013; 84(4):392-7. DOI:10.3109/17453674.2013.799419 · 2.77 Impact Factor
    • "Improvements in SF-36 physical function score were smaller in patients who were obese, however, BMI >30 kg/m2 was not a significant predictor of change in physical function from pre-surgery to follow up. A Canadian prospective observational study of 520 primary joint arthroplasties77 evaluating the effects of obesity on patterns of recovery from total knee and hip arthroplasty found that severe obesity is an independent risk factor for slow recovery over three years for both total knee and total hip arthroplasty. In this study, baseline pain and functional scores were similar regardless of BMI classification. "
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    ABSTRACT: The most significant impact of obesity on the musculoskeletal system is associated with osteoarthritis (OA), a disabling degenerative joint disorder characterized by pain, decreased mobility and negative impact on quality of life. OA pathogenesis relates to both excessive joint loading and altered biomechanical patterns together with hormonal and cytokine dysregulation. Obesity is associated with the incidence and progression of OA of both weight-bearing and non weight-bearing joints, to rate of joint replacements as well as operative complications. Weight loss in OA can impart clinically significant improvements in pain and delay progression of joint structural damage. Further work is required to determine the relative contributions of mechanical and metabolic factors in the pathogenesis of OA.
    The Indian Journal of Medical Research 08/2013; 138(2):185-93. · 1.40 Impact Factor
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    • "Variables, identified from the literature or by our clinical experts, and internal analysis as possible confounders were adjusted for in our models using propensity score weights. The following variables were included in the model as continuous covariates: age (Santaguida et al. 2008), operative time (Pulido et al. 2008), body mass index (BMI) (Namba et al. 2005, Jamsen et al. 2009, Jones et al. 2012), surgeon yearly average volume, hospital yearly average volume, and number of procedures performed by the surgeon with specific bearing design (Manley et al. 2009, Bozic et al. 2010). Surgeon and hospital yearly average volume were based on both the primary and the revision procedures performed by the surgeon or institution. "
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    ABSTRACT: Background and purpose There is no substantial clinical evidence for the superiority of alternative bearings in total knee arthroplasty (TKA). We compared the short-term revision risk in alternative surface bearing knees (oxidized zirconium (OZ) femoral implants or highly crosslinked polyethylene (HXLPE) inserts) with that for traditional bearings (cobalt-chromium (CoCR) on conventional polyethelene (CPE)). The risk of revision with commercially available HXLPE inserts was also evaluated. Methods All 62,177 primary TKA cases registered in a Total Joint Replacement Registry between April 2001 and December 2010 were retrospectively analyzed. The endpoints for the analysis were all-cause revisions, septic revisions, or aseptic revisions. Bearing surfaces were categorized as OZ-CPE, CoCr-HXLPE, or CoCr-CPE. HXLPE inserts were stratified according to brand name. Confounding was addressed using propensity score weights. Marginal Cox-regression models adjusting for surgeon clustering were used. Results The proportion of females was 62%. Average age was 68 (SD 9.3) years, and median follow-up time was 2.8 (IQR 1.2–4.9) years. After adjustments, the risks of all-cause, aseptic, and septic revision with CoCr-HXLPE and OZ-CPE bearings were not statistically significantly higher than with traditional CoCr-CPE bearings. No specific brand of HXLPE insert was associated with a higher risk of all-cause, aseptic, or septic revision compared to CoCr-CPE. Interpretation At least in the short term, none of the alternative knee bearings evaluated (CoCr-HXLPE or OZ-CPE) had a greater risk of all-cause, aseptic, and septic revision than traditional CoCr-CPE bearings.
    Acta Orthopaedica 03/2013; 84(2). DOI:10.3109/17453674.2013.784660 · 2.77 Impact Factor
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