Total Knee Arthroplasty in Morbidly Obese Patients*

Winiarsky, Raz; Barth, Patrick; Lotke, Paul A.

doi:10.2106/00004623-199812000-00006

Cited by 320 publications

(245 citation statements)

References 24 publications

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“…We were surprised by the paucity of studies which report specifically on the incidence of acute periprosthetic infection for obese patients after primary TKA and even fewer that review the combined effect of comorbidities with obesity [1,16,17,19,25]. In the current study, we also analyzed other patient and surgical variables also reported to correlate with prosthetic infection.…”

Section: Discussionmentioning

confidence: 97%

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Dowsey

Choong

2008

Clin Orthop Relat Res

225

138

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We conducted a prospective study of 1214 consecutive primary TKAs to compare the deep prosthetic infection rate between obese and nonobese patients during the first 12 months after surgery. We also sought to determine whether patient or surgical variables such as comorbidities, age, gender, blood transfusion, use of surgical drains, and antibiotic-impregnated cement were predictors of subsequent prosthetic infection after primary TKA. The overall prosthetic infection rate was 1.5% (n = 18). The odds for a deep prosthetic infection were greater in patients with morbid obesity (odds ratio [OR], 8.96; 95% confidence interval, 1.59-50.63) and diabetes (OR, 6.87; 95% confidence interval, 2.42-19.56). Men were more likely to have a prosthetic infection develop than women (OR, 5.93; 95% confidence interval, 1.95-18.04) and the prosthetic infection rate was lower (OR, 0.24; 95% confidence interval, 0.06-0.95) in patients when a surgical drain was used. There were no prosthetic infections in patients with diabetes who were not obese.This compares with 11 prosthetic infections in patients who were obese and diabetic and four prosthetic infections in patients who were obese but not diabetic. Morbid obesity and obesity combined with diabetes are risk factors for periprosthetic infection after TKA.

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Section: Discussionmentioning

confidence: 97%

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Dowsey

Choong

2008

Clin Orthop Relat Res

225

138

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“…We found women had higher BMI at surgery; the magnitude of effect is unclear. Winiarsky et al [36] reported lower KSSs for morbidly obese (BMI [ 40) patients, but no difference in ROM or radiographic parameters, when compared with historical, nonmorbidly obese control subjects. The effect of BMI on TKA survivorship is unclear.…”

Section: Discussionmentioning

confidence: 99%

Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty

Kamath

Horneff

Gaffney

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA. Questions/purposes We determined (1) the influence of race, gender, and body mass index (BMI) on primary TKA functional scores and ROM before gender-specific implants; and (2) months).Results African-Americans had longer delays to presentation, higher BMI, and worse 2-year KSS. Women (all races) had higher BMI and worse preoperative flexion/arc ROM. African-American women had worse final ROM and had similar final gains in ROM (postoperative minus preoperative ROM) after controlling for confounders. Conclusions Gender and race affected functional KSS and ROM variables. The worse results experienced by AfricanAmerican women may be attributable to a longer delay to presentation. However, the scores and motion were high for all subgroups, and underuse of TKA in women and AfricanAmericans cannot be justified based on a perception of lesser functional gains. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…This a particular disadvantage in revision TKA in which infection rates are much higher than primary TKA with an incidence of 5.6% in one review [7]. One study has reported an infection rate as high as 10% in revision TKA surgery [15]. In addition, a tourniquet is used and if antibiotics are withheld, there may well not be bactericidal antibiotic levels in the wound until the end of the case.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Antibiotics Do Not Affect Cultures in the Treatment of an Infected TKA: A Prospective Trial

Burnett

Aggarwal

Givens

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Prophylactic antibiotics are frequently withheld until cultures are obtained in revision total knee arthroplasty (TKA). We undertook a prospective study to determine whether prophylactic preoperative intravenous antibiotics would affect the results of cultures obtained intraoperatively. We enrolled 25 patients with 26 infected TKAs, a known preoperative infecting organism, and no recent antibiotic therapy. Reaspiration of the infected TKA was performed after anesthesia and sterile preparation. Intravenous antibiotic prophylaxis was then administered and the tourniquet inflated. Intraoperative culture swabs and tissue were obtained at arthrotomy. The timing of events was recorded. Pre-and postantibiotic culture data were analyzed to determine the effect of intravenous preoperative prophylactic antibiotics on cultures obtained intraoperatively. Infections were acute postoperative (four), chronic (19), and acute hematogenous (three). The most common infecting organism was cloxacillin-sensitive Staphylococcus aureus (nine knees [35%]). Preoperative prophylactic antibiotics did not affect the results of intraoperative cultures and we therefore believe should not be withheld before surgery for an infected TKA when an organism has been identified on aspiration preoperatively, and there has been no recent (4 weeks) antimicrobial therapy.

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Total Knee Arthroplasty in Morbidly Obese Patients*

Cited by 320 publications

References 24 publications

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty

Prophylactic Antibiotics Do Not Affect Cultures in the Treatment of an Infected TKA: A Prospective Trial

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