Relationship between obesity and early failure of total knee prostheses

Bordini, Barbara; Stea, Susanna; Cremonini, Sara; Viceconti, Marco; Palma, Rossana De; Toni, Aldo

doi:10.1186/1471-2474-10-29

Cited by 82 publications

(71 citation statements)

References 29 publications

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“…We studied a large number of morbidly obese patients (the largest group studied to date in this area), who are not routinely examined as a discrete population in clinical trials. Because few patients will lose a significant amount of weight before surgery, surgeons often operate on morbidly obese patients [2]. Consequently, surgeons and patients should know and understand the potential complications, which should be part of the informed consent process and discussion of these risks.…”

Section: Discussionmentioning

confidence: 99%

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Friedman¹,

Hess

Berkowitz

et al. 2013

Clinical Orthopaedics &Amp; Related Research

173

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Background Morbid obesity has been shown to be a risk factor for increased complications after THA and TKA; however, large studies that would determine the effect size are lacking. Questions/purposes The purposes of this study were to determine whether morbid obesity increased the risk of: (1) venous thromboembolism (VTE), (2) bleeding, (3) other adverse events, and (4) infections during the early postoperative period (up to 6 to 8 weeks) after THA or TKA? Methods Data from the REgulation of Coagulation in ORthopaedic surgery to prevent Deep vein thrombosis and pulmonary embolism (RECORD) clinical trial program of rivaroxaban for prevention of VTE after THA or TKA were analyzed retrospectively. Data for 12,355 patients were reviewed to identify complication rates in morbidly obese patients (BMI C 40 kg/m 2 ) compared with patients with a BMI less than 40 kg/m 2 . Explorative analyses compared the rates of asymptomatic deep vein thrombosis (DVT), symptomatic DVT, symptomatic pulmonary embolism, bleeding, and other adverse events by BMI group. Results There were no significant differences in asymptomatic DVT, symptomatic DVT, symptomatic pulmonary embolism, or bleeding, but there were increases in other adverse events (including receipt of blood transfusion, erythema, peripheral edema, diarrhea, gastrointestinal or abdominal pain) and infections (including respiratory tract or lung infections, wound inflammation or infection, and extrasurgical-site infections), in patients with a BMI of 40 kg/m 2 or greater compared with patients with a BMI less than 40 kg/m 2 . Conclusions After THA or TKA, morbid obesity is not associated with an increased risk of VTE or bleeding but is associated with increased early postoperative complications, including erythema, peripheral edema, diarrhea and gastrointestinal or abdominal pain, wound inflammation or infection, extrasurgical-site infections, and respiratory tract or lung infections.

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Section: Discussionmentioning

confidence: 99%

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Friedman¹,

Hess

Berkowitz

et al. 2013

Clinical Orthopaedics &Amp; Related Research

173

View full text Add to dashboard Cite

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“…39 One metaanalysis reported an obese or overweight body type conferred a threefold increased risk in developing KOA. 40 While not all studies agree, 41 data has demonstrated an increased rate of peri-operative complication in obese patients and an increased risk of premature joint failure and revision. 42 The majority of patients in our study were classified as obese.…”

Section: Discussionmentioning

confidence: 99%

A new treatment for knee osteoarthritis: Clinical evidence for the efficacy of Arthrokinex™ autologous conditioned serum

Barreto

Braun

2017

Journal of Orthopaedics

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“…In a systematic review by Gillespie and Porteous [9], there was some evidence for an increased risk for early implant failure among obese subjects. However, in a study of 9735 patients undergoing TKAs, no such risk was found [2]. Furthermore, in clinical practice, we believe it is improbable that obesity is a decisive factor when choosing between endoprosthesis models.…”

Section: Discussionmentioning

confidence: 96%

Introducing a Knee Endoprosthesis Model Increases Risk of Early Revision Surgery

Peltola

Malmivaara

Paavola

2012

Clinical Orthopaedics &Amp; Related Research

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Background New equipment and techniques often are used in clinical practice, occasionally without evidence of effectiveness and safety. Questions/purposes We asked whether the stage of introduction of an endoprosthesis model for TKA affected the risk of early revision. Methods We studied mandatory registry data from all centers in Finland (n = 69) that performed TKAs for primary osteoarthritis between 1998 and 2004. Of the total of 23,707 patients (28,760 TKAs), 22,551 patients (27,105 TKAs) had a followup of 5 years; we excluded longer followup from the analysis as subsequent revisions might result from wear rather than early technical failures. We used proportional hazards modeling for calculating the hazard ratios for the first 15 operations and subsequent increments of numbers of operations while adjusting for potentially confounding variables. Results For the first 15 operations with a new endoprosthesis, the risk was elevated (hazard ratio, 1.48; 95% confidence interval, 1.14-1.91). Absolute risk increase of early revision for the first 15 patients was 1.7% (95% confidence interval, 0.7-2.7). The risk was not increased as the numbers of TKAs incrementally performed increased. Conclusions Our data show an increased risk of early revision surgery for the first patients obtaining a knee endoprosthesis model previously unused in the hospital. Patients should be informed if there is a plan to introduce a new model of endoprosthesis in the hospital and offered the possibility to choose a conventional endoprosthesis instead.

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Relationship between obesity and early failure of total knee prostheses

Cited by 82 publications

References 29 publications

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

A new treatment for knee osteoarthritis: Clinical evidence for the efficacy of Arthrokinex™ autologous conditioned serum

Introducing a Knee Endoprosthesis Model Increases Risk of Early Revision Surgery

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