Go Big or Go Home: Obesity and Total Joint Arthroplasty

Blankstein, Michael; Browne, James A.; Sonn, Kevin A.; Schwarzkopf, Ran

doi:10.1016/j.arth.2023.07.001

Cited by 8 publications

(6 citation statements)

References 132 publications

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“…Gegebenenfalls müssen die Patient*innen über diesen Off-Label-Use aufgeklärt werden [27]. Da der funktionelle Gewinn und die Zufriedenheit durch eine Knieendoprothese bei adipösen und normalgewichtigen Patient*innen vergleichbar ist, erscheint es trotz des erhöhten Risikos ethisch nicht vertretbar, diesen Patient*innen eine Knieendoprothese generell vorzuenthalten [28,29,30].…”

Section: Einschränkung Der Gesundheitsbezogenen Lebensqualität Und Su...unclassified

Evidenzbasierte und patientenorientierte Indikationsstellung zur Knieendoprothese – Update der Leitlinie

Lützner,

Deckert,

Lange

et al. 2024

Z Orthop Unfall

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ZusammenfassungDie Implantation einer Knieendoprothese zählt mit ca. 170000 Eingriffen pro Jahr zu den am häufigsten stationär durchgeführten Operationen in Deutschland. Eine einheitliche, angemessene und patientenorientierte ärztliche Indikationsstellung ist bei einem solchen Eingriff unerlässlich. Das Update der S2k-Leitlinie „Indikation Knieendoprothese“ beinhaltet auf aktueller Evidenz basierende und im breiten Konsens abgestimmte Empfehlungen und eine Checkliste im praxistauglichen Format.Für dieses Leitlinien-Update wurde eine systematische Literaturrecherche nach (inter-)nationalen Leitlinien und systematischen Übersichtsarbeiten zur Gonarthrose und Knieendoprothetik durchgeführt, um klinisch relevante Fragestellungen zu Diagnostik, Prädiktoren für das Outcome, Risikofaktoren und Kontraindikatoren zu beantworten.Eine Knieendoprothese soll nur bei radiologisch nachgewiesener fortgeschrittener Gonarthrose (Kellgren-Lawrence-Grad 3 oder 4), nach vorangegangener konservativer Therapie über mindestens 3 Monate sowie bei hohem subjektivem Leidensdruck hinsichtlich der kniebezogenen Beschwerden und nach Ausschluss möglicher Kontraindikationen (Infektionen, Begleiterkrankungen, BMI ≥ 40 kg/m2) erfolgen. Modifizierbare Risikofaktoren (wie Rauchen, Diabetes mellitus, Anämie) sollen zuvor adressiert und ggf. optimiert werden. Die Ziele der Patient*innen sollen erfragt und deren Eintrittswahrscheinlichkeit gemeinsam besprochen werden. Schließlich ist die Entscheidung zur Knieendoprothese von Patient*in und Operateur*in gemeinsam zu treffen, wenn der zu erwartende Nutzen die möglichen Risiken überwiegt.Das Update der S2k-Leitlinie wurde um die unikondyläre Knieendoprothese erweitert, die präoperative Optimierung modifizierbarer Risikofaktoren ergänzt sowie Konkretisierungen der Hauptindikationskriterien vorgenommen.

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Section: Einschränkung Der Gesundheitsbezogenen Lebensqualität Und Su...unclassified

Evidenzbasierte und patientenorientierte Indikationsstellung zur Knieendoprothese – Update der Leitlinie

Lützner,

Deckert,

Lange

et al. 2024

Z Orthop Unfall

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“…Although complications are associated with increasing BMI, a specific BMI cut-off prior to surgery has not been agreed upon ( 56 ). Ward et al found that BMI >40 kg/m 2 was an independent risk factor for complications such as acute kidney injury, cardiac arrest, infection, and revision surgery ( 49 ).…”

Section: Definitionmentioning

confidence: 99%

“…There is no consensus regarding the optimal weight loss strategy for pre-operative optimisation, with options including nutritional specialist consults, weight loss programmes, pharmacotherapy, and bariatric surgery (BS) ( 12 , 45 , 51 , 57 ). Non-surgical weight loss techniques have been reported to result in reduction of approximately 3 kg/m 2 ( 56 ).…”

Section: Definitionmentioning

confidence: 99%

“…BS can result in a total mean weight loss exceeding 31%, although its use in TJA remains controversial as malabsorption secondary to the procedure may lead to other complications ( 17 , 47 , 58 ). BS techniques include gastric banding, Roux-en-Y, and sleeve gastrectomy ( 56 , 59 ). The average weight loss with the use of bariatric surgery prior to TJA is approximately 14 kg/m 2 ( 56 ).…”

Section: Definitionmentioning

confidence: 99%

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Malnutrition in total joint arthroplasty: what should the orthopaedic surgeon consider?

Almeida,

Mokete,

Sikhauli

et al. 2024

EFORT Open Reviews

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Total joint arthroplasty (TJA) is rising globally, with an associated increase in associated complications, necessitating increased efforts in prevention of these complications with pre-operative optimisation. Malnutrition has been highlighted as one of the most important pre-operative modifiable risk factors to be addressed in TJA, with the term malnutrition in orthopaedic surgery having a broad definition that encompasses a wide range of nutritional abnormalities from undernutrition to overnutrition contributing to the outcomes of TJA. Complications associated with malnutrition include periprosthetic joint infection (PJI), periprosthetic fracture, dislocations, aseptic loosening, anaemia, prolonged length of stay (LOS), increased mortality, and raised health care costs. Standardised nutritional scoring tools, anthropometric measurements, and serological markers are all options available in pre-operative nutritional assessment in TJA, but there is no consensus yet regarding the standardisation of what parameters to assess and how to assess them. Abnormal parameters identified using any of the assessment methods results in the diagnosis of malnutrition, and correction of these parameters of overnutrition or undernutrition have shown to improve outcomes in TJA. With the multiple nutritional parameters contributing to the success of total joint arthroplasty, it is imperative that orthopaedic surgeon has a thorough knowledge regarding nutritional peri-operative optimisation in TJA.

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“…In the limited available literature, there is conflicting evidence on the impact of postoperative weight change on PROMs [15][16][17]. Confounding variables may play a large role in the reason why there are many inconsistencies between studies [18].…”

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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Go Big or Go Home: Obesity and Total Joint Arthroplasty

Cited by 8 publications

References 132 publications

Evidenzbasierte und patientenorientierte Indikationsstellung zur Knieendoprothese – Update der Leitlinie

Evidenzbasierte und patientenorientierte Indikationsstellung zur Knieendoprothese – Update der Leitlinie

Malnutrition in total joint arthroplasty: what should the orthopaedic surgeon consider?

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

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