Patterns of Weight Change and Their Effects on Clinical Outcomes Following Total Knee Arthroplasty in an Asian Population

Razzaki, Tanzib; Mak, Wai Keong; Razak, Hamid Rahmatullah Bin Abd; Tan, Hwee-Chye Andrew

doi:10.1016/j.arth.2019.09.003

Cited by 14 publications

(7 citation statements)

References 23 publications

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“…However, similar to other authors [3,21], we likewise discovered that initially obese patients were more likely to lose weight in comparison to TKA patients with normal-to pre-obese BMI [6,36]. Nevertheless, still 62.4% of patients in our study did not lose or did even gain weight following TKA, a finding also reported by Razzaki et al [23]. This observation may raise concerns, as obese patients are in general at higher risk for complications following TKA including periprosthetic joint infection, superficial wound healing deficit, venous thrombosis, and injuries of ligamentous structures in comparison to normal-weight patients [3-5, 7, 12, 20, 26, 30, 32, 35].…”

Section: Discussionsupporting

confidence: 91%

Patients successfully lose body weight after primary total knee arthroplasty but not more than a matched general population

Smolle

Musser

Hauer

et al. 2022

Arch Orthop Trauma Surg

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Introduction High BMI is associated with increased risk for knee osteoarthritis, ultimately necessitating total knee arthroplasty (TKA). The aim of this retrospective study was to (1) analyse the amount of postoperative long-term weight loss as reflected by BMI change in TKA patients, (2) identify factors associated with increased change in BMI, and to (3) compare changes with BMI trends of a general population. Materials and methods Overall, 298 TKA patients [198 females; mean age: 65.1 ± 7.9 years, median follow-up 8.8 (interquartile range: 5.9–10.8 years)] were included in the final evaluation and compared with an age group-matched control group from the general population regarding weight trends between 2006 and 2014. Main variable of interest in both cohorts was body mass index (BMI). Linear regression analyses were performed to assess changes in weight and BMI over time between TKA patients and the general population. Furthermore, mixed linear-effects models were constructed to analyse the potential change in BMI independent from age and gender. Results In TKA patients, a significant drop in BMI by 0.8 ± 3.2 points from postoperative to final follow-up was observed (p < 0.001), with reduction being significant independently from age (p = 0.382), gender (p = 0.310), or revision surgery (p = 0.195). In the general population, likewise a significant BMI-decrease by 0.7 ± 6.1 points was observed between 2006 and 2014, with younger people (p = 0.004) and females (p < 0.001) being more likely to reduce BMI. Yet, BMI-decrease between TKA patients and the general population over time was comparable (p = 0.734). Notably, patients with initially higher BMI were significantly more likely to lose weight postoperatively than normal-weight patients (p < 0.001). Conclusions Our results point against the notion that TKA patients lose a considerable amount of weight in comparison to the general population as soon as improved joint function and pain relief have been achieved. Thus, individualized patient education programmes should be reinforced, promoting a healthy lifestyle.

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Section: Discussionsupporting

confidence: 91%

Patients successfully lose body weight after primary total knee arthroplasty but not more than a matched general population

Smolle

Musser

Hauer

et al. 2022

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

show abstract

“…Similar investigations analyzing weight loss after hip and knee arthroplasty have demonstrated conflicting results. 1 , 5 , 13 , 16 , 23 Similar to our findings, Ast et al 1 demonstrated that patients with higher preoperative body weights were more likely to lose weight after lower-extremity arthroplasty. The reasons for our observed weight loss are likely multifactorial.…”

Section: Discussionsupporting

confidence: 88%

“…Despite a number of investigations aiming to determine if patients lose weight after elective hip or knee arthroplasty, there have been conflicting results. 1 , 5 , 13 , 16 , 23 Recent systematic review have demonstrated insufficient evidence to determine if there are any clinically meaningful changes in body weight after lower-extremity arthroplasty. 10 There is a paucity of literature analyzing weight changes after SA, and it remains uncertain if patients with obesity undergoing primary, elective SA lose weight after surgery.…”

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confidence: 99%

An analysis of body weight changes after shoulder arthroplasty

et al. 2021

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Background To determine if there are postoperative weight changes for patients undergoing primary shoulder arthroplasty (SA). In addition, we aimed to determine if glycemic control (hemoglobin A1C levels) change postoperatively for patients undergoing SA. Methods All patients 18 years of age or older who had undergone primary SA over a 12-year period were analyzed. Patients were excluded if they did not have a preoperative body mass index or if they had less than 1-year follow-up. Baseline demographics were recorded for all patients and comparisons were made between the obese and nonobese groups. Clinically meaningful weight loss was defined as a ≥ 5% reduction in body weight postoperatively. Results A total of 469 patients met inclusion criteria. Of them, 65% of patients were obese, and the mean preoperative body mass index for all patients was 33. With a mean follow-up of 40 months, 70% of patients demonstrated clinically significant weight loss. Compared with patients without obesity, patients with obesity lost significantly more weight (10 vs. 6 kg) and demonstrated significantly greater postoperative body mass index reductions (4 vs. 2). Overall, 72% of patients with obesity demonstrated clinically meaningful postoperative weight loss of ≥5% body weight. Patients with obesity who lost weight also saw a decrease in their postoperative hemoglobin A1C: for every 10 pounds of weight loss, A1C decreased by 0.08 units. Conclusions In our series, 72% of patients with obesity undergoing primary SA achieved clinically meaningful weight loss, with a mean follow-up of more than 3 years. Patients who lose weight after SA additionally demonstrate improved glycemic control. Surgeons and patients should balance the association between postoperative weight loss after SA with the potential increased risks of operative complications, particularly for severely obese patients.

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“…This is potentially important in the light that patients who underwent TKA and lost weight thereafter were reported to have better clinical outcome scores than patients who gained weight in the postoperative period [48]. However, recent literature indicates the patient's bodyweight to be maintained after TKA [49][50][51], suggesting a minor possible impact of weight change on our results. The percentage of patients in obesity class II and III was relatively low, compared to reports in other countries with two-thirds of our patient cohort clustered in the overweight / pre-obese and class I obese categories.…”

Section: Discussionmentioning

confidence: 79%

Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

Giesinger

Hamilton

et al. 2021

BMC Musculoskelet Disord

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Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

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Patterns of Weight Change and Their Effects on Clinical Outcomes Following Total Knee Arthroplasty in an Asian Population

Cited by 14 publications

References 23 publications

Patients successfully lose body weight after primary total knee arthroplasty but not more than a matched general population

Patients successfully lose body weight after primary total knee arthroplasty but not more than a matched general population

An analysis of body weight changes after shoulder arthroplasty

Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

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