Complication rates and resource utilization after total hip and knee arthroplasty stratified by body mass index

Turcotte, Justin; Kelly, McKayla; Aja, Jacob M.; King, Paul J.; MacDonald, James

doi:10.1016/j.jor.2021.02.024

Cited by 19 publications

(12 citation statements)

References 32 publications

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“…As the mean follow-up in our study was greater than two years, it is likely that we were able to identify all patients in our cohort who had developed a PJI. Turcotte et al also found that after stratifying by BMI, patients with a similar BMI as our cohort had a mean LOS of 2.2+/-3.3 days for TKA and 2.1+/-3.8 days for THA [17]. This is slightly lower than what was found in our study: 4.3+/-1.5 days following TKA and 2.9+/-1.1 days following THA, possibly due to the small sample size resulting in increased variability in our results.…”

Section: Discussionsupporting

confidence: 71%

“…In the subgroup of patients who were completely optimized, there were no complications, including infection. The rate of complications following TKA or THA is generally low, with fewer than one percent of patients typically experiencing deep vein thrombosis or pulmonary embolism, urinary tract infection, myocardial infarction, renal failure, pneumonia, and mortality [ 17 ]. Furthermore, the rate of PJI is highest during the first two years following surgery and typically ranges between 0.5% and 2% for TKA and 0.5% and 1.0% for THA [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Optimizing Total Joint Arthroplasty for Patients Living With Human Immunodeficiency Virus

Yeramosu¹,

Chiang²,

Barnes³

et al. 2022

Cureus

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IntroductionSignificant advancements in human immunodeficiency virus (HIV) treatment have led to an increasing life expectancy among patients living with HIV (PLWH). Given this rise in life expectancy, as well as the ability to lead a more active lifestyle, the rate of total joint arthroplasty (TJA) in this population is increasing. Unfortunately, the current medical literature surrounding the safety and efficacy of TJA in this patient population is indeterminant. Therefore, the purpose of this study was to determine if optimization of PLWH prior to TJA would result in any changes in the incidence of postoperative complications and hospital length of stay (LOS) when compared to historically reported data. Materials and methodsA retrospective study was performed of all PLWH 18 years and older who underwent either a primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) between 2009 and 2019 at our academic institution. Medical records were reviewed for each patient to assess demographics, comorbidities, preoperative laboratory studies, operative details, length of hospital stay, complications, and follow-up time. Patients were optimized using our institution's current optimization guidelines: body mass index (BMI) less than 40 kg/m 2 , hemoglobin >12 g/dL, no tobacco use within 30 days of surgery, albumin >3.5 g/dL. Independentsample t-tests and Pearson's chi-square tests were used to evaluate the continuous and categorical variables, respectively. ResultsThis study included 47 TJA in PLWH, including 14 TKA and 33 THA. Out of the 47 patients, 13 (27.7%) were fully optimized for all four variables: BMI, hemoglobin, non-smoking status, and albumin. There was no significant difference between the group of PLWH that was completely optimized and the group that was not in any patient characteristics, preoperative labs, intraoperative variables, or postoperative variables, including length of hospital stay and complications. A larger proportion of patients not completely optimized was found to be active smokers (p=0.0003). All complications occurred in cases in which the patients were not fully optimized. Subgroup analysis of PLWH, who were completely optimized, showed an average LOS of 4.3+/-1.5 days following TKA and 2.9+/-1.1 days following THA. Subgroup analysis of PLWH not completely optimized showed that each case was optimized for at least one variable and that those optimized for albumin had the largest (12.2%) number of complications. ConclusionPLWH can achieve a low rate of complications and LOS similar to that of the general population if medically and nutritionally optimized. Additional research is necessary to reveal well-defined parameters for achieving a higher rate of optimization prior to surgery in this important patient population.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Optimizing Total Joint Arthroplasty for Patients Living With Human Immunodeficiency Virus

Yeramosu¹,

Chiang²,

Barnes³

et al. 2022

Cureus

View full text Add to dashboard Cite

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“…With a clear and strong link already established between obesity and osteoarthritis, the rise of obesity in recent years have directly correlated with an increased rate of total joint arthroplasty (TJA) [4][5][6] . Obesity has been identified as an independent risk factor for various perioperative and long term complications [7][8][9] such as wound infections 10 , longer operative time 11 , thromboembolic events 12 , readmissions 13,14 , and reoperations 15 .…”

Section: Introductionmentioning

confidence: 99%

“…time, 11 thromboembolic events, 12 readmissions, 13,14 and reoperations. 15 While several studies have explored the weight change of patients after undergoing total knee arthroplasty (TKA), [16][17][18][19] there is still a paucity of information in the literature about longitudinal weight trends of patients before and after TKA.…”

mentioning

confidence: 99%

A Longitudinal Analysis of Weight Changes before and after Total Knee Arthroplasty: Weight Trends, Patterns, and Predictors

Oyem,

Rullán,

Pasqualini

et al. 2023

J Knee Surg

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Introduction: Longitudinal data on patient trends in body mass index (BMI) and the proportion that gain or lose significant weight before and after total knee arthroplasty (TKA) is scarce. This study aimed to observe patients longitudinally for a two-year period and determine 1) clinically significant BMI changes during the one-year before and one-year after TKA; and 2) identify factors associated with clinically significant weight changes. Methods: A prospective cohort of 5,388 patients who underwent primary TKA at a tertiary healthcare institution between January 2016 and December 2019 were analyzed. The outcome of interests were 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. Results: 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 (OR=0.95), men (OR=0.47), overweight (OR=0.36), and obese class III (OR=0.06) were less likely to gain weight pre-operatively. Preoperative weight loss was associated with postoperative weight gain one-year after TKA (OR=3.03). Preoperative weight gain was associated with postoperative weight loss one-year after TKA (OR=3.16). Conclusion: Most patients maintained a stable weight before and after TKA. Weight changes during the one-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.

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“…Additionally, rates of total knee arthroplasty (TKA) are also expected to increase as a result of an aging population [4][5][6]. Prior studies have found that obese patients face increased risk of surgical complications including infection [7], component malpositioning [8], reoperation [9], venous thromboembolism [10], longer operating time [11,12], and readmission [11,13].…”

Section: Introductionmentioning

confidence: 99%

Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty

Tidd,

Huffman,

Oyem

et al. 2023

J Knee Surg

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Introduction: As obesity becomes more prevalent, more patients are at risk of lower extremity osteoarthritis and subsequent total knee arthroplasty (TKA). This study aimed to test 1) the association of preoperative weight change with healthcare utilization; and 2) the association of pre- and postoperative weight changes with failure to achieve satisfaction and minimal clinically important difference (MCID) in Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and function (KOOS-PS) 1-year after TKA. Methods: Prospectively collected monocentric data on patients who underwent primary TKA was retrospectively reviewed. Multivariable logistic regression assessed the influence of BMI and weight change on outcomes while controlling for confounding variables. Outcomes included prolonged length of stay (LOS >3 days), non-home discharge, 90-day readmission rate, satisfaction, and achievement of MCID for KOOS-Pain and KOOS-PS. Results: Preoperative weight change had no impact on prolonged LOS (gain, p=0.173; loss, p=0.599). Preoperative weight loss was associated with increased risk of non-home discharge (OR 1.47, p=0.003). There was also increased risk of 90-day readmission with preoperative weight gain (OR 1.27, p=0.047) and decreased risk with weight loss (OR 0.73, p=0.033). There was increased risk of non-home discharge with obesity class II (OR 1.6, p=0.016) and III (OR 2.21, p<0.001). Weight change was not associated with failure to achieve satisfaction, MCID in KOOS-Pain, or MCID in KOOS-PS. Obesity class III patients had decreased risk of failure to reach MCID in KOOS-Pain (OR 0.43, p=0.005) and KOOS-PS (OR 0.7, p=0.007). Conclusion: Pre- and postoperative weight change has little impact on the achievement of satisfaction and clinically relevant differences in pain and function at 1-year. However, preoperative weight gain was associated with a higher risk of 90-day readmissions after TKA. Furthermore, patients categorized in Class III obesity were at increased risk of non-home discharge but experienced a greater likelihood of achieving MCID in KOOS-Pain and KOOS-PS. Our results raise awareness of the dangers of using weight changes and BMI alone as a measure of TKA eligibility.

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Complication rates and resource utilization after total hip and knee arthroplasty stratified by body mass index

Cited by 19 publications

References 32 publications

Optimizing Total Joint Arthroplasty for Patients Living With Human Immunodeficiency Virus

Optimizing Total Joint Arthroplasty for Patients Living With Human Immunodeficiency Virus

A Longitudinal Analysis of Weight Changes before and after Total Knee Arthroplasty: Weight Trends, Patterns, and Predictors

Preoperative and Postoperative Weight Change has Minimal Influence on Health Care Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty

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