Implant Durability and Knee Function After Total Knee Arthroplasty in the Morbidly Obese Patient

Dewan, Ashvin K.; Bertolusso, Roberto; Karastinos, Anatassios; Conditt, Michael A.; Noble, Philip C.; Parsley, Brian S.

doi:10.1016/j.arth.2009.04.024

Cited by 72 publications

(82 citation statements)

References 21 publications

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“…For most obese patients, as for any patient, TKA results in improved pain and function scores with high satisfaction rates [2,12,26,30,33,37,49]. MBT components and modern APT components both have been shown to be successful in the general population; however, the use of APT components specifically in obese patients has not been well studied.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies of cemented TKA in obese patients report increased radiolucent lines around the components [2,12,24] or increased osteolysis in obese patients [43], whereas others show no radiographic differences between obese and nonobese patients [18,30,48]. However, those studies [12,24] used MBT, not APT, components. Previous reports of APT components have focused mainly on clinical and radiographic evaluation in elderly [11,22,27,35,36] or sedentary patients [11].…”

Section: Introductionmentioning

confidence: 97%

“…Studies focusing on the obese patient population show most patients show improvements in outcome scores and are satisfied with TKA [1,2,12,18,19,24,26,30,33,37,43,44,48,49]. However, high body weight amplifies the magnitude of joint load per step and may adversely affect polyethylene wear performance and the rate of aseptic loosening.…”

Section: Introductionmentioning

confidence: 99%

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All-Polyethylene Tibial Components in Obese Patients Are Associated With Low Failure at Midterm Followup

Dalury¹,

Tucker²,

Kelley³

2012

Clinical Orthopaedics &Amp; Related Research

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Background In the United States, the obese population has increased markedly over the last four decades, and this trend continues. High patient weight places additional stress on TKA components, which may lead to increased polyethylene wear, osteolysis, radiolucencies, and clinical failure. Metalbacked tibial components and all-polyethylene tibial components in the general population have comparable osteolysis and failure, but it is unclear whether these components yield similar osteolysis and failure in obese patients.Questions/purposes We therefore determined the (1) function, (2) occurrence of osteolysis, and (3) complications in a cohort of obese patients receiving allpolyethylene tibial components.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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All-Polyethylene Tibial Components in Obese Patients Are Associated With Low Failure at Midterm Followup

Dalury¹,

Tucker²,

Kelley³

2012

Clinical Orthopaedics &Amp; Related Research

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“…Restricting patients with morbid obesity from undergoing TKA would prevent many patients who are severely disabled from having access to a highly successful and cost-effective intervention. Furthermore, although some studies have shown inferior functional outcomes in patients with morbid obesity, numerous investigators have reported that these patients have equal or better satisfaction and functional improvement after TKA, with acceptable long-term outcomes [3,8,14,20,26,28], compared with patients not so affected.…”

Section: Introductionmentioning

confidence: 99%

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Nelson

Elkassabany

Kamath

et al. 2015

Clin Orthop Relat Res

140

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Background Morbid obesity and malnutrition are thought to be associated with more frequent perioperative complications after TKA. However, morbid obesity and malnutrition often are co-occurring conditions. Therefore it is important to understand whether morbid obesity, malnutrition, or both are independently associated with more frequent perioperative complications. In addition, assessing the magnitude of an increase in complications and whether these complications are major or minor is important for both conditions. Questions/purposes We asked: (1) Is morbid obesity independently associated with more frequent major perioperative complications after TKA? (2) Are major perioperative complications after TKA more prevalent among patients with a low serum albumin? Methods The National Surgical Quality Improvement Program (NSQIP) database was analyzed from 2006 to 2013. Patients were grouped as morbidly obese (BMI C 40 kg/m 2 ) or nonmorbidly obese (BMI C 18.5 kg/m 2 to \ 40 kg/m 2 ), or by low serum albumin (serum albumin level \ 3.5 mg/dL) or normal serum albumin (serum albumin level C 3.5 mg/dL). The study cohort included 77,785 patients, including 35,573 patients with a serum albumin level of 3.5 g/dL or greater and 1570 patients with a serum albumin level less than 3.5 g/dL. Therefore, serum albumin levels were available for only 37,173 of the 77,785 of the patients (48%). There were 66,382 patients with a BMI between 18.5 kg/m 2 and 40 kg/m 2 and 11,403 patients with a BMI greater than 40 kg/m 2 . Data were recorded on patient mortality along with 21 complications reported in the NSQIP. We also developed three composite complication variables to represent risk of any infections, cardiac or pulmonary complications, and any major complications. For each complication, multivariate logistic regression analysis was performed. Independent variables included patient age, sex, race, BMI, American Society of Anesthesiologists classification, year of surgery, and Charlson comorbidity index score. Results Mortality was not increased in the morbidly obese group (0.14% vs 0.14%; p = 0.942). Patients who were morbidly obese were more likely to have progressive renal insufficiency (0.30% vs 0.10%; odds ratio [OR], 2.47; 95% CI, 1.27-4.29; p \ 0.001), superficial infection (1.07% vs 0.55%; OR, 1.87; 95% CI, 1.39-2.51; p \ 0.001), and sepsis (0.36% vs 0.23%; OR, 1.70; 95% CI, 1.04-2.53; p = 0.034) compared with patients who were not morbidly obese. Patients who were morbidly obese were less likely to require blood transfusion (8.68% vs One of the authors certifies that he (CLN), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Zimmer Inc (Warsaw, IN, USA 12.06%; OR, 0.70; 95% CI, 0.63-0.77; p \ 0.001) compared with patients who were not morbidly obese. Morbid obesity was not associated with any of the other 21 perioperative complications recorded in the NSQIP database. With respect to the composite complication variable...

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“…In addition, there was marked variation in language used to describe other angular measurements (eg, hip-knee-ankle, component angles), and reference points (eg, differing points at either the distal femoral surface or proximal tibial surface for the ''center'' of the knee). Four percent of papers were classified as using either a combination of systems or a distinct system [4,11]. Moreover, there was no consistent notation whether radiographs were taken with weightbearing.…”

mentioning

confidence: 99%

Editorial: What is Varus or Valgus Knee Alignment?

Kamath

Israelite

Horneff

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Implant Durability and Knee Function After Total Knee Arthroplasty in the Morbidly Obese Patient

Cited by 72 publications

References 21 publications

All-Polyethylene Tibial Components in Obese Patients Are Associated With Low Failure at Midterm Followup

All-Polyethylene Tibial Components in Obese Patients Are Associated With Low Failure at Midterm Followup

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Editorial: What is Varus or Valgus Knee Alignment?

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