Increased Aseptic Tibial Failures in Patients With a BMI ≥35 and Well-Aligned Total Knee Arthroplasties

CORR Insights®: Do Stemmed Tibial Components in Total Knee Arthroplasty Improve Outcomes in Patients With Obesity?

“…Previous reports [1,2] have documented the association of obesity and tibial component loosening and suggest consideration of a tibial stem extension to enhance long term fixation [1]. The current report found improved clinical scores and less pain in patients with obesity (BMI > 30kg/ m 2 ) by using a tibial component with a 100 mm stem extension (10 mm diameter) compared to using a standard tibial component.…”

“…Obesity is also considered a major factor in the increasing need for TKA [5]. Patients who are obese and have undergone TKAs have been associated with an increased incidence of complications including cardiopulmonary events [7,13], wound healing difficulties [16], infection [6], thromboembolic disease [14], and prosthetic loosening resulting in inferior survivorship [1]. Patients with obesity often have multiple medical comorbidities such as diabetes mellitus, cardiopulmonary disease, and malnutrition that can negatively impact the results after TKA.…”

Do Stemmed Tibial Components in Total Knee Arthroplasty Improve Outcomes in Patients With Obesity?

“…Therefore, it seems important to see whether there are any implant-related choices that can improve the likelihood that a patient with obesity will achieve high scores for function and quality of life after TKA. Stems on tibial components may limit the micromotion and improve the load distribution, particularly on patients with obesity [23], so stemmed tibial components may represent one such choice [1,6,23]. Based on our clinical experience [2] and the results of those other studies [1,6,23], we hypothesized that a stemmed tibial component would improve patientreported outcomes for function and quality of life after TKA in patients with obesity.…”

“…Stems on tibial components may limit the micromotion and improve the load distribution, particularly on patients with obesity [23], so stemmed tibial components may represent one such choice [1,6,23]. Based on our clinical experience [2] and the results of those other studies [1,6,23], we hypothesized that a stemmed tibial component would improve patientreported outcomes for function and quality of life after TKA in patients with obesity. Because particular complications such as intraoperative fractures have been described in patients treated with stemmed components [7], we felt it important also to investigate potential drawbacks of stemmed tibial components as well.…”

“…Studies have disagreed about whether obesity results in lower scores for pain and function [4], but much of the recent evidence suggests that it may indeed be a risk factor for persistent pain and lower levels of function after TKA [6,11,14,17]. One recent study concluded that consideration should be given to additional tibial fixation in patients with obesity [1]. Therefore, it seems important to see whether there are any implant-related choices that can improve the likelihood that a patient with obesity will achieve high scores for function and quality of life after TKA.…”