Trends of Obese and Morbidly Obese Patients in Same-Day Bilateral Total Knee Arthroplasty from 2009 to 2016

Remily, Ethan A.; Wilkie, Wayne A.; Mohamed, Nequesha S.; Pastore, Mark; Viola, Anthony; Cho, Abraham H.; Nace, James; Delanois, Ronald E.

doi:10.1055/s-0040-1708038

Cited by 3 publications

(2 citation statements)

References 34 publications

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“…In our study, general and systemic complications such as DVT, AKI, and PE were observed. Remily et al reported that orthopedists should review the risks and benefits of SBTKA in detail, since the overall complication rates are high in both O and MO patients and will cause a long hospital stay [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Is there an indication for simultaneous bilateral knee arthroplasty in morbidly obese patients? Should the patients’ request for simultaneous operation be considered?

Akar

2023

PLoS ONE

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Purpose This study aimed to analyse the safety of simultaneous bilateral total knee arthroplasty (SBTKA) surgery by comparing morbidly obese (MO) patients with obese patients. Methods SBTKA was performed to 494 patients by a single surgeon in a single center between 2014–2020. The patients followed for a mean of 26 months. They were divided into two groups according to body mass index (BMI) as MO (BMI> 40 kg/m2, n = 65) and obese(O) (BMI = 30–39.9 kg/m2, n = 429 patients). The groups were compared in terms of wound healing problems (WHP), mobilization time (MT), operation time (OT), prosthesis infection, aseptic loosening (AL), early complications, revision, and length of hospitalization using univariate and multivariate logistic regression analyses. Results Logistic regression analysis revealed significant differences in the clinical outcomes and complications between MO and O patients. Parameters such as length of stay, OT, MT, WHP, debridement, medial retinaculum detachment (MRD) and AL, and short-term complications such as acute kidney injury (AKI), and pulmonary embolism (PE) incidence were significantly higher in the MO group. Among the MO patients, the clinical outcomes were worse than those among the O patients, and the complication incidence was higher. Conclusion We do not find SBTKA surgery feasible in morbidly obese patients due to the high complication rate and unsatisfactory clinical outcomes. We suggest that the patient’s request to undergo SBTKA should not be taken into account, and that staged surgery be preferred.

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Section: Discussionmentioning

confidence: 99%

“…since the overall complication rates are high in both O and MO patients and will cause a long hospital stay [18].…”

Section: Plos Onementioning

confidence: 99%

Is there an indication for simultaneous bilateral knee arthroplasty in morbidly obese patients? Should the patients’ request for simultaneous operation be considered?

Akar

2023

PLoS ONE

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Open versus arthroscopic treatment of the rheumatoid elbow arthritis: a comparison of complications at two years utilizing a nationally representative database

Remily,

Bains,

Dubin

et al. 2024

Eur J Orthop Surg Traumatol

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Body Mass Index and the Risk of Postoperative Complications After Total Knee Arthroplasty

Telang,

Yoshida,

Burdick

et al. 2024

J Am Acad Orthop Surg

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Introduction: Given the growing prevalence of obesity, it is crucial to understand the effect of obesity on complications after total knee arthroplasty (TKA). This study aims to assess the relationship between body mass index (BMI) and postoperative periprosthetic joint infection (PJI), medical complications, and surgical complications after TKA. Methods: The Premier Healthcare Database was used to identify all primary elective TKAs between 2016 and 2021. The primary outcome was risk of PJI within 90 days of surgery. Using logistic regression, restricted cubic splines were generated to assess the relationship between BMI as a continuous variable and PJI risk. Bootstrap simulation was then done to identify a BMI inflection point on the final restricted cubic spline model past which the risk of PJI increased. The relationship between BMI and composite 90-day medical and surgical complications was also assessed. Results: A direct relationship was observed between increasing BMI and increasing risk of PJI with a BMI changepoint of 31 kg/m2 identified as being associated with increased risk. Above a BMI of 31 kg/m2, there was an average relative risk increase of PJI of 13.6% for every unit BMI. This relative risk per unit BMI increased from 5.8% for BMI 31 to 39 to 11.5% between BMI 40 and 49 kg/m2, and 21.3% for BMIs ≥50 kg/m2. Similarly, a direct relationship was also found between increasing BMI and both medical and surgical complications with BMI changepoints of 34 and 32 kg/m2 identified, respectively. Discussion: Obese patients with a BMI >31 kg/m2 were at increased risk of PJI. Although the relative risk increase was small per unit BMI above 31 kg/m2, the cumulative increase in risk may be marked for patients with higher BMIs. Conclusion: These data should be used to inform discussions that involve shared decision making between patients and surgeons who weigh the risks and benefits of surgery.

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Trends of Obese and Morbidly Obese Patients in Same-Day Bilateral Total Knee Arthroplasty from 2009 to 2016

Cited by 3 publications

References 34 publications

Is there an indication for simultaneous bilateral knee arthroplasty in morbidly obese patients? Should the patients’ request for simultaneous operation be considered?

Is there an indication for simultaneous bilateral knee arthroplasty in morbidly obese patients? Should the patients’ request for simultaneous operation be considered?

Open versus arthroscopic treatment of the rheumatoid elbow arthritis: a comparison of complications at two years utilizing a nationally representative database

Body Mass Index and the Risk of Postoperative Complications After Total Knee Arthroplasty

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