Does body mass index affect the rate of adverse outcomes in total hip and knee arthroplasty? A retrospective review of a total joint replacement database

Abstract

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are reliable surgical options to treat pain and disability resulting from degenerative conditions around the hip and knee. Obesity is a modifiable risk factor that contributes to significant morbidity. The purpose of this study was to retrospectively compare outcomes in primary hip and knee arthroplasty for patients with increased body mass index (BMI) and those with normal BMI, using data from the registry of the Alberta Bone and Joint Health Institute (ABJHI). Methods:We retrospectively reviewed the data compiled in the ABJHI registry between March 2010 and July 2016. We reviewed outcomes with respect to length of stay, discharge destination, 30-day readmission, postoperative infection, postoperative transfusion requirements, postoperative adverse events and in-hospital postoperative mechanical complications.Results: A total of 10 902 patients (6076 women, 4826 men) who underwent THA and 16 485 patients (10 057 women, 6428 men) who underwent TKA were included in the study. For both THA and TKA, patients with increased BMI had an increased number of in-hospital medical events, had an increased rate of deep infection, were less likely to be discharged home (p < 0.001) and had decreased transfusion requirements (p < 0.001) than patients whose weight was in the normal range. Increased BMI increased the rate of 30-day readmission and length of stay in the THA cohort but not in the TKA cohort. Increased BMI had no effect on acute postoperative dislocation or periprosthetic fractures. Patients with a BMI of 30 kg/m2 or greater required a THA 1.7 years earlier than patients of normal weight, patients whose BMI was 35 kg/m2 or greater required a THA 3.4 years earlier, and patients whose BMI was 40 kg/m2 or greater required a THA 5.8 years earlier. In the TKA cohort, patients with a BMI of 30 kg/m2 or greater required a TKA 2.7 years earlier than patients whose weight was in the normal range, patients with a BMI of 35 kg/m2 or greater required a TKA 4.6 years earlier, and patients whose BMI was 40 kg/m2 or greater required a TKA 7.6 years earlier. Conclusion:Our study quantifies the effects of obesity in primary hip and knee arthroplasty. It provides a greater understanding of the risks in the obese population when contemplating joint arthroplasty.Contexte : La prothèse totale de la hanche (PTH) et la prothèse totale du genou (PTG) sont des options chirurgicales fiables pour traiter la douleur et l'invalidité résultant de maladies dégénératives de la hanche et du genou. L'obésité est un facteur de risque modifiable qui contribue significativement à la morbidité. Le but de cette étude était de comparer de manière rétrospective le résultat des interventions primaires pour prothèses de la hanche et du genou selon que les patients avaient un indice de masse corporelle (IMC) normal ou élevé à partir des données du registre de l'Alberta Bone and Joint Health Institute (ABJHI).Méthodes : Nous avons analysé de manière rétrospective les données compilées p...

The impact of obesity on total knee arthroplasty outcomes: A retrospective matched cohort study

“…Using two, five, and 10 years as time points to quantify how many patients underwent a revision, we found that obese patients had significantly more revisions across all time points, consistent with past studies. 36,37 Revisions can be caused by various complications, however the most common is periprosthetic joint infection. 38 The PearlDiver database does not allow for investigating the specific causes of revision in either the obese or non-obese group.…”

Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results

“…Obesity is known as a major risk factor for complications and impaired clinical outcome following different types of knee surgery [ 1 , 15 ]. Registry-based data have indicated higher complication rates in overweight patients after total knee arthroplasty and particularly in frequent periprosthetic joint infections [ 1 , 36 ].…”

“…Obesity is known as a major risk factor for complications and impaired clinical outcome following different types of knee surgery [ 1 , 15 ]. Registry-based data have indicated higher complication rates in overweight patients after total knee arthroplasty and particularly in frequent periprosthetic joint infections [ 1 , 36 ]. Studies on unicompartmental knee arthroplasty have found a fivefold increase in failure rate in morbidly obese patients due to disease progression in other compartments or mobile bearing instability [ 26 ].…”

Obesity trends over 10 years in primary hip and knee arthroplasty—a study of 12,000 patients

“…From an orthopaedic perspective, the increased risk of perioperative complications associated with obesity has been described by Abdulla et al in 2020 in both TKR and THR patients. The authors highlighted that, in this patient group, increase in BMI was associated with increased inpatient medical events and 30-day readmission rates when compared to those patients who were of a normal BMI [13]. Xu et al have further shown that rates of wound infection also correlated with increases in BMI in the total joint arthroplasty cohort [14].…”