Obesity Does Not Imply Poor Outcomes in Asians after Total Knee Arthroplasty

Razak, Hamid Rahmatullah Bin Abd; Chong, Hwei Chi; Tan, Andrew Hwee Chye

doi:10.1007/s11999-012-2721-9

Cited by 42 publications

(36 citation statements)

References 28 publications

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“…There have been conflicting studies regarding the association of morbid obesity with increases in short-term and long-term complications after TKA [3,6,10,13,14,16,18,19,[23][24][25]. Multivariate analyses to determine specifically whether morbid obesity alone or other comorbid conditions such as malnutrition are the primary factors associated with the increased risk of complications were not performed in some of these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Benefits of TKA in populations at greater risk for complications are less well defined. Morbid obesity and malnutrition have been shown to be associated with increased perioperative complications after TKA [5,6,10,12,16,18,19,27,32]; however, some studies have not shown an increased risk of perioperative complications in patients who are morbidly obese [3,13,14,23,25]. In addition, patients with morbid obesity are more likely to be malnourished than patients who are not obese, raising the question whether morbid obesity, malnutrition, or both, are independently associated with increased perioperative complications [12].…”

Section: Introductionmentioning

confidence: 99%

“…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%

See 2 more Smart Citations

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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Nelson

Elkassabany

Kamath

et al. 2015

Clin Orthop Relat Res

140

View full text Add to dashboard Cite

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“…Констатировано, что ожирение несомненно раньше приводит к необходимости радикальных вмешательств по поводу остеоартроза, а клинико-функциональ-ные результаты в раннем послеоперационном периоде статистически значимо хуже у тучных пациентов [31]. При этом, пери-и послеопера-ционные осложнения были схожи как по форме, так и по количеству в рецензируемых группах [13][14][15].…”

Section: ожирение и радикальный подход в лечении остеоартритаunclassified

The effect of body weight on the choice of material for the bearing couple in artificial hip joints

Hothan

Morlock

Hoenig

2013

Seminars in Arthroplasty

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“…Previous studies have shown that a high BMI is associated with the risk of TKR failure, with regard to both clinical outcome and quality-of-life indicators (12)(13)(14)(15). However, other studies have shown that BMI is not associated with post-TKR outcomes (16,17). Mizner et al showed that both performance-based mobility tests and self-report questionnaires are required for the reliable assessment of short-term post-TKR outcomes (18).…”

Section: Introductionmentioning

confidence: 99%

Body Mass Index and Functional Mobility Outcome Following Early Rehabilitation After a Total Knee Replacement: A Retrospective Study in Taiwan

Liao

Huang

et al. 2015

Arthritis Care & Research

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ObjectiveObesity is associated with an increased risk of osteoarthritis, and the incidence of obese patients requiring a total knee replacement (TKR) has increased in recent years. A high body mass index (BMI) may influence post‐TKR rehabilitation outcomes. We investigated the effects of obesity on functional mobility outcomes following post‐TKR rehabilitation in Asian patients whose BMIs were not as high as those reported in similar studies performed in non‐Asian countries.MethodsA total of 113 patients were categorized as normal weight (n = 23), overweight (n = 32), class I obese (n = 31), or class II/III obese (n = 27). Patients were retrospectively followed up for 6 months after undergoing TKR followed by 2 months of active rehabilitation. Outcome measures were recorded at baseline and at the 2‐month and 6‐month followup assessments and included the Western Ontario and McMaster Universities Osteoarthritis Index and the following tests: functional reach, single‐leg stance, ten‐meter walk, timed up and go, chair rise, and stair climbing.ResultsA 4 × 3 (group × time) repeated‐measures analysis of variance showed significant improvement in all of the outcome measures for all of the BMI groups at the 2‐month and 6‐month followup assessments (P < 0.05 for all). No significant intergroup differences at the 2‐month and 6‐month followup assessments were observed for any of the mobility measures except the functional reach and single‐leg stance (P < 0.05).ConclusionPatients with class II/III obesity benefit from early post‐TKR outpatient rehabilitation and respond as well as patients with lower BMIs.

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Obesity Does Not Imply Poor Outcomes in Asians after Total Knee Arthroplasty

Cited by 42 publications

References 28 publications

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

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

The effect of body weight on the choice of material for the bearing couple in artificial hip joints

Body Mass Index and Functional Mobility Outcome Following Early Rehabilitation After a Total Knee Replacement: A Retrospective Study in Taiwan

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