Total knee replacement in morbidly obese patients

Amin, Anish K.; Clayton, R.A.E.; Patton, James T.; Gaston, Mark S.; Cook, Robert E.; Brenkel, Ivan J.

doi:10.1302/0301-620x.88b10.17697

Cited by 241 publications

(246 citation statements)

References 36 publications

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“…We attribute this difference to the degree of obesity and the limited number of patients who were super obese. Some prior studies on obesity did not report super obesity as a separate category [1,17], and were based on a limited population (41 and 1617 respectively) or defined morbid obesity as a BMI greater than 35 kg/m 2 [5,18]. Michalka et al [18] reported on operative time, blood loss, suboptimal implant placement, the surgeons' perception of operative difficulty, and the six-minute walk test.…”

Section: Discussionmentioning

confidence: 99%

“…There is controversy regarding whether obesity poses additional complications and costs with THA [7,20,28]. Some studies have reported that the risk of postoperative complications after joint arthroplasty in patients who are obese is comparable to the risk in patients who are nonobese as long as their BMI is less than 40 kg/m 2 [1,17]. However, morbid obesity is associated with a higher risk of postoperative complications [6,21,24].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Meller¹,

Toossi

Gonzalez

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patients with morbid obesity, defined as a BMI greater than 40 kg/m 2 , and super obesity, defined as a BMI greater than 50 kg/m 2 , increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/m 2 to delineate risks, complications, and costs for these patients. Questions/purposes We sought to quantify (1) the surgical risk, and (2) the costs associated with complications after THA in patients who were morbidly obesity (BMI C 40 kg/m 2 ) or super obese (BMI C 50 kg/m 2 ). Methods This is a retrospective study of patients, using Medicare hospital claims data, who underwent THA. The ICD-9 Clinical Modification (CM) diagnosis code V85.4x was used to identify patients with morbid obesity and with super obesity from October 1, 2010 through December 31, 2014. Patients without any BMI-related diagnosis codes were used as the control group. Twelve complications occurring during the 90 days after THA were analyzed using multivariate Cox models adjusting for patient demographic, comorbidities, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through the subsequent 90 days.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This study was performed via electronic collaboration at the authors' institutions. (HR, 3.91; 95% CI, 3.14-4.86; p \ 0.001). In addition, patients with morbid obesity had increased risk of deep vein thrombosis (HR, 1.43; 95% CI, 1.14-1.79; p \ 0.002), pulmonary embolism (HR, 1.57; 95% CI, 1.25-1.99; p \ 0.001), implant failure (HR, 1.48; 95% CI, 1.3-1.68; p \ 0.001), acute ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Meller¹,

Toossi

Gonzalez

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Patients were excluded from this study if they had a BMI less than 18.5 kg/m 2 A total of 4796 patients who underwent primary TSA were identified from the ACS-NSQIP 1 database from 2006 to 2013. After applying our exclusion criteria, 4267 were included for final analysis in this study.…”

Section: Methodsmentioning

confidence: 99%

“…Obesity also has been associated with increased difficulty with exposure and longer operative times during lower extremity arthroplasties [2,16,23]. However, studies of TSAs have disagreed regarding whether obesity is associated with increased postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Jiang

Somogyi

Patel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Few studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty (TSA). Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications. We used a national surgical database to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories. Questions/purposes We asked: (1) Is obesity associated with an increased risk of complications within 30 days of primary TSA? (2) Is obesity associated with increased operative time? Methods The American College of Surgeons National Surgical Quality Improvement Program 1 database for 2006 to 2012 was queried to identify all patients who underwent a primary TSA for osteoarthritis of the shoulder. The ACS-NSQIP 1 database was selected for this study as it is a nationally representative database that provides prospectively collected perioperative data and a comprehensive patient medical profile. Exclusion criteria included revision TSA, infection, tumor, or fracture. We analyzed 4796 patients who underwent a primary TSA for osteoarthritis of the shoulder. Patients who underwent a TSA were divided in four BMI categories: normal (18.5-25 kg/m 2 ), overweight (25-30 kg/m 2 ), obesity Class 1 (30-35 kg/m 2 ), and obesity Class 2 or greater ([ 35 kg/m 2 ). Perioperative hospitalization data and 30-day postoperative complications were compared among different BMI classes. Differences in patient demographics, preoperative laboratory values, and preexisting patient comorbidities also were analyzed among different BMI groups, and multivariate analysis was used to adjust for any potential confounding variables.

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“…Increased knee pain and disability in morbidly obese patients leads to knee replacement surgery at earlier ages than less obese patients (3). Unfortunately, morbidly obese patients also experience more disability postsurgery than less obese patients (4). Morbidly obese individuals typically experience higher levels of psychological distress than less obese individuals (5).…”

mentioning

confidence: 99%

Pain Catastrophizing in Borderline Morbidly Obese and Morbidly Obese Individuals with Osteoarthritic Knee Pain

Somers

Keefe

Carson

et al. 2008

Pain Research and Management

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OBJECTIVE: There is limited information about how morbidly obese osteoarthritis (OA) patients cope with the pain they experience. Pain catastrophizing is an important predictor of pain and adjustment in persons with persistent pain. This may be particularly relevant in the morbidly obese (body mass index [BMI] of 40 kg/m 2 or greater) OA population at risk for increased pain. The present study first examined whether borderline morbidly obese and morbidly obese OA patients report higher levels of pain catastrophizing than a sample of OA patients in the overweight and obese category (BMI between 25 kg/m 2 and 34 kg/m 2 ). Next, it examined how pain catastrophizing is related to important indexes of pain and adjustment in borderline morbidly obese and morbidly obese OA patients. METHODS: Participants included 43 individuals with knee OA who were borderline morbidly obese or morbidly obese (BMI of 38 kg/m 2 or greater). Participants completed self-report measures of pain catastrophizing, pain, psychological distress, quality of life, binge eating and eating self-efficacy. RESULTS: The sample of borderline morbidly obese and morbidly obese OA patients reported significantly higher levels of pain catastrophizing (P=0.007) than a comparison sample of overweight and obese OA patients. Results suggested that patients who engaged in a high level of pain catastrophizing reported having much more intense and unpleasant pain, higher levels of binge eating, lower self-efficacy for controlling their eating and lower weight-related quality of life (P<0.05 for all). CONCLUSIONS: Pain catastrophizing is related to pain and adjustment in borderline morbidly obese and morbidly obese OA patients. Clinicians working with this population should consider assessing pain catastrophizing in the patients they treat.Key Words: Morbidly obese; Osteoarthritis; Pain catastrophizing La dramatisation de la douleur chez les personnes à la limite de l'obésité morbide ou présen-tant une morbidité morbide et souffrant de douleurs causées par l'arthrose du genou OBJECTIF : On possède peu d'information sur la manière dont les obèses morbides atteints d'arthrose affrontent les douleurs dont ils souffrent. La dramatisation de la douleur est un important prédicteur de la douleur et de l'adaptation chez les personnes souffrant de douleurs persistantes. Ce peut être particulièrement pertinent chez les patients atteints d'arthrose présentant une obésité morbide (indice de masse corporelle [IMC] d'au moins 40 kg/m 2 ) vulnérables à une douleur plus marquée. Dans la présente étude, les auteurs ont d'abord évalué si les patients atteints d'arthrose à la limite de l'obésité morbide ou présentant une obésité morbide déclaraient un plus fort taux de dramatisation de la douleur qu'un échantillon de patients atteints d'arthrose obèses ou faisant de l'embonpoint (IMC de 25 kg/m 2 à 34 kg/m 2 ). Ils ont ensuite examiné dans quelle mesure la dramatisation de la douleur est reliée aux importants indices de la douleur et de l'adaptation chez les patients atteints d'ar...

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Total knee replacement in morbidly obese patients

Cited by 241 publications

References 36 publications

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Pain Catastrophizing in Borderline Morbidly Obese and Morbidly Obese Individuals with Osteoarthritic Knee Pain

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