Should isolated morbid obesity influence the decision to operate in hip and knee arthroplasty?

Crookes, Peter F.; Cassidy, Roslyn; Machowicz, Aleksander; Hill, Janet; McCaffrey, John E.; Turner, Gillian; Beverland, David

doi:10.1302/2633-1462.27.bjo-2021-0062.r1

Cited by 9 publications

(6 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous research on the implications of obesity on THA has been conducted using traditional and contemporary THA approaches, including the direct anterior (DA) approach and posterior approach. [10][11][12] The anteriorbased muscle-sparing (ABMS) approach is a lesserknown comprehensive approach that was described by Rottinger et al in 2004, 13 using the interval between the tensor fasciae latae (TFL) posteriorly and the gluteus medius (GM) muscle anteriorly. [13][14][15] This approach is a safe and effective approach that is muscle-sparing and can be performed in the supine or lateral position.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of morbidly obese patients undergoing total hip arthroplasty with the anterior-based muscle-sparing approach

Shevenell¹,

Mackenzie²,

Fisher³

et al. 2023

Bone Jt Open

View full text Add to dashboard Cite

AimsObesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of total hip arthroplasties (THAs) performed annually. This study examines the peri- and postoperative outcomes of morbidly obese (MO) patients (BMI ≥ 40 kg/m2) compared to healthy weight (HW) patients (BMI 18.5 to < 25 kg/m2) who underwent a THA using the anterior-based muscle-sparing (ABMS) approach.MethodsThis retrospective cohort study observes peri- and postoperative outcomes of MO and HW patients who underwent a primary, unilateral THA with the ABMS approach. Data from surgeries performed by three surgeons at a single institution was collected from January 2013 to August 2020 and analyzed using Microsoft Excel and Stata 17.0.ResultsThis study compares 341 MO to 1,140 HW patients. Anaesthesia, surgery duration, and length of hospital stay was significantly lower in HW patients compared to MO. There was no difference in incidence of pulmonary embolism, periprosthetic fracture, or dislocation between the two groups. The rate of infection in MO patients (1.47%) was significantly higher than HW patients (0.14%). Preoperative patient-reported outcome measures (PROMs) show a significantly higher pain level in MO patients and a significantly lower score in functional abilities. Overall, six-week and one-year postoperative data show higher levels of pain, lower levels of functional improvement, and lower satisfaction scores in the MO group.ConclusionThe comorbidities of obesity are well studied; however, the implications of THA using the ABMS approach have not been studied. Our peri- and postoperative results demonstrate significant improvements in PROMs in MO patients undergoing THA. However, the incidence of deep infection was significantly higher in this group compared with HW patients.Cite this article: Bone Jt Open 2023;4(5):299–305.

show abstract

Section: Introductionmentioning

confidence: 99%

Outcomes of morbidly obese patients undergoing total hip arthroplasty with the anterior-based muscle-sparing approach

Shevenell¹,

Mackenzie²,

Fisher³

et al. 2023

Bone Jt Open

View full text Add to dashboard Cite

show abstract

“… 4 - 6 Morbid obesity is associated with a poorer prognosis and an increased risk of infection in hip and knee arthroplasty (joint arthroplasty surgery). 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Global and local fat effects on bone mass and quality in obesity

Dai,

Liu,

Hou

et al. 2023

Bone Joint Res

View full text Add to dashboard Cite

AimsThe aim of this study was to investigate the global and local impact of fat on bone in obesity by using the diet-induced obese (DIO) mouse model.MethodsIn this study, we generated a diet-induced mouse model of obesity to conduct lipidomic and 3D imaging assessments of bone marrow fat, and evaluated the correlated bone adaptation indices and bone mechanical properties.ResultsOur results indicated that bone mass was reduced and bone mechanical properties were impaired in DIO mice. Lipidomic sequencing and bioinformatic analysis identified 373 differential lipids, 176 of which were upregulated and 197 downregulated. Functional enrichment analysis revealed a significant downregulation of the pathways: fat digestion and absorption (ko04975) and lipolysis regulation in adipocytes (ko04923) in DIO mice, leading to local fat accumulation. The use of 3D imaging confirmed the increase in fat accumulation within the bone marrow cavity of obese mice.ConclusionOur study sheds light on the intricate interplay between fat and bone, and provides a non-toxic and non-invasive method for measuring marrow adipose tissue.Cite this article: Bone Joint Res 2023;12(9):580–589.

show abstract

“…Some recent studies [13][14][15][16][17] have expressed the opposite view that there is no association between BMI and the occurrence of VTE events after TKA and the increased risk of prosthesis revision. Crookes et al [16] showed that there was no significant difference in VTE events between patients with morbidly obese (BMI ≥40 kg/m 2 ) and patients with BMI < 40 kg/m 2 . Tang et al [17] divided the patients into 5 groups according to BMI and found that there was no statistical difference in the incidence of total VTE among different BMI groups.…”

Section: Introductionmentioning

confidence: 99%

Effect of body mass index on symptomatic venous thromboembolism and prosthesis revision risk after total knee arthroplasty: a long-term study from China

Shao

Zhang

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Objective To investigate the effect of body mass index (BMI) on the risk of symptomatic VTE and prosthesis revision after total knee arthroplasty (TKA). Methods Seven thousand one hundred eighty-two patients with primary unilateral TKA treated in our hospital from 2011 to 2020 were divided into four groups according to BMI: BMI < 25 kg/m2, BMI 25 kg/m2–29.9 kg/m2, BMI 30 kg/m2–34.9 kg/m2 and BMI ≥ 35 kg/m2. Incidence, Odds ratio and Kaplan-Meier survival analysis were used to evaluate the effects of BMI on symptomatic VTE and prosthesis revision risk after TKA. Results The incidence of VTE after TKA was 8.9‰(64/7182). There was no significant difference in the incidence of VTE among different BMI groups(P = 0.452). Deep vein thrombosis mainly occurred in the distal lower extremities, especially in intermuscular veins. Revision rate of prosthesis after TKA was 6.4‰(46/7182). There was no significant difference in revision rate among different BMI groups(P = 0.718). In the univariate analysis of TKA, compared with patients with normal BMI, the risk of postoperative VTE and prosthesis revision in patients with overweight, obesity class I and obesity class II did not increase. Higher prosthesis revision rate and lower prosthesis survival rate were observed in BMI ≥ 35 kg/m2 group, although the difference was not statistically significant. Conclusions Through such a retrospective large sample data of long-term follow-up, we believe that the higher BMI was not associated with the increased risk of symptomatic VTE and prosthesis revision after TKA. When TKA was used for appropriate indications, high BMI should not be considered as a contraindication.

show abstract

Should isolated morbid obesity influence the decision to operate in hip and knee arthroplasty?

Cited by 9 publications

References 30 publications

Outcomes of morbidly obese patients undergoing total hip arthroplasty with the anterior-based muscle-sparing approach

Outcomes of morbidly obese patients undergoing total hip arthroplasty with the anterior-based muscle-sparing approach

Global and local fat effects on bone mass and quality in obesity

Effect of body mass index on symptomatic venous thromboembolism and prosthesis revision risk after total knee arthroplasty: a long-term study from China

Contact Info

Product

Resources

About