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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    • "Earlier, Gandhi et al. (2010) reported that diabetes was not an independent predictor of poor functional outcome or improvement in pain, measured at 1 year using WOMAC, although a trend could also be seen in that study. Jones et al. (2012) "
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    ABSTRACT: Background and purpose — In some patients, for unknown reasons pain persists after joint replacement, especially in the knee. We determined the prevalence of persistent pain following primary hip or knee replacement and its association with disorders of glucose metabolism, metabolic syndrome (MetS), and obesity. Patients and methods — The incidence of pain in the operated joint was surveyed 1–2 years after primary hip replacement (74 patients (4 bilateral)) or primary knee replacement (119 patients (19 bilateral)) in 193 osteoarthritis patients who had participated in a prospective study on perioperative hyperglycemia. Of the 155 patients who completed the survey, 21 had undergone further joint replacement surgery during the follow-up and were excluded, leaving 134 patients for analysis. Persistent pain was defined as daily pain in the operated joint that had lasted over 3 months. Factors associated with persistent pain were evaluated using binary logistic regression with adjustment for age, sex, and operated joint. Results — 49 of the134 patients (37%) had a painful joint and 18 of them (14%) had persistent pain. A greater proportion of knee patients than hip patients had a painful joint (46% vs. 24%; p = 0.01) and persistent pain (20% vs. 4%; p = 0.007). Previously diagnosed diabetes was strongly associated with persistent pain (5/19 vs. 13/115 in those without; adjusted OR = 8, 95% CI: 2–38) whereas MetS and obesity were not. However, severely obese patients (BMI ≥ 35) had a painful joint (but not persistent pain) more often than patients with BMI < 30 (14/21 vs. 18/71; adjusted OR = 5, 95% CI: 2–15). Interpretation — Previously diagnosed diabetes is a risk factor for persistent pain in the operated joint 1–2 years after primary hip or knee replacement.
    Full-text · Article · May 2015 · Acta Orthopaedica
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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).
    Full-text · Article · Aug 2013 · Acta Orthopaedica
    • "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.
    No preview · Article · Aug 2013 · The Indian Journal of Medical Research
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