Factors Influencing Health-related Quality of Life after TKA in Patients who are Obese

Abstract

Background Although the health-related quality of life (HRQL) for patients who are obese seems to improve after TKA, the magnitude of improvement and the associated factors remain controversial. We previously found body mass index was not associated with changes in HRQL after TKA. Questions/purposes The purposes of this secondary analysis were to determine which patient characteristics and surgical factors were associated with worse health status after TKA in patients who are severe or morbidly obese. Methods We assessed 60 patients (53 females; mean age, 70 years) 12 months after surgery. The mean number of comorbidities was 2.5. Mean lower limb anthropometric index scores were: suprapatellar, 1.6; infrapatellar, 2; and suprapatellar/infrapatellar, 1.2. Intraoperative difficulty (IOD) was Grade 0, 40%; Grade 1, 48%; and Grade 2, 12%. Ten patients (17%) had complications. We measured HRQL using the disease-specific WOMAC questionnaire. Patient characteristics (sociodemographic variables, BMI, comorbidity, lower limb anthropometry) and surgical factors (IOD, complications, postoperative medical data) were collected. Associations between WOMAC dimension scores at 12 months and patient characteristics and surgical factors were analyzed using linear regression models. Results Factors associated with worse WOMAC dimension scores in patients who were obese included the number of comorbidities, an infrapatellar index percentile less than 75, IOD Grade 2, and the number of complications after discharge. Conclusions For patients with knee osteoarthritis who were severe or morbidly obese, various lower limb anthropometric features, degree of IOD, and postoperative complications negatively influenced postoperative WOMAC scores. Level of EvidenceLevel II Prognostic Study. See Guidelines for a complete description of levels of evidence.

Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study

“…Although for some outcomes (e.g. WOMAC pain score) the explained variance was small, these results are in accordance with those of other studies that used the WOMAC and SF-36 to model determinants of post-surgery outcomes [10,12,13,16]. It is important to point out that the magnitude of the associations found in this study, if taken separately, may not be clinically important, but if more than one of these characteristics is present in a patient, they are likely to have a clinically important impact [49].…”

Overweight preoperatively impairs clinical outcome after knee arthroplasty

“…Some studies have shown that overweight and obesity have no effect on pain and mobility after TKA (Amin et al 2006, Hamoui et al 2006, Krushell and Fingeroth 2007). Other studies have shown that obese patients with a body mass index (BMI) of > 30 have worse quality of life (QoL) (Stickles et al 2001, Nunez et al 2011a), poorer mobility (Mulhall et al 2007), and less range of motion (ROM) after surgery than patients with a BMI of < 30 (Gadinsky et al 2011). They also have more pain 6 and 12 months after surgery than patients with a BMI of < 30 (Naylor et al 2011).…”

“…Increased use of analgesics, problems with scarring (Patel and Albrizio 2008, Nunez et al 2011a), and a correlation between obesity and deep infection after TKA (Chesney et al 2008, Malinzak et al 2009) have been reported. In contrast, Suleiman et al (2012) found no difference in perioperative complication rates in patients undergoing TKA or total hip arthroplasty, based on BMI.…”

“Total Knee Arthroplasty in the Context of Severe and Morbid Obesity in Adults”

“…An index below 1.6 corresponds to a wide knee with thicker subcutaneous cell tissue. In this same group of obese patients a relationship was found between anthropometric knee data and the functional outcomes of knee arthroplasty [41]. An infrapatellar index below 1.75 was associated with poorer functional outcomes and more pain one year after the TKA.…”

“…2). The aim of another study by our group at the Hospital Clinic in Barcelona was to compare the health-related quality of life (HRQOL) preoperatively and at one-year follow-up in severely and morbidly obese patients undergoing total knee arthroplasty [41]. These patients had similar preoperative WOMAC scores, the only difference being in their BMI.…”