Functional Outcomes with Primary Total Knee Replacement in Respect to Body Mass Index
DOI:
https://doi.org/10.36283/ziun-pjmd14-1/017Keywords:
Outcome Assessment, Patient, Total Knee Arthroplasty, Total Knee Replacement, BMI, Osteoarthritis, Arthroplasties, Replacement, KneeAbstract
Background: Osteoarthritis (OA) is a prevalent condition and the leading disability among the elderly. Obesity, linked to a sedentary lifestyle, increases the risk of OA. Knee Osteoarthritis has improved functional outcomes after Total Knee Replacement (TKR). This study aimed to determine the functional outcomes of primary TKR based on BMI.
Methods: This Prospective Cohort Study, was conducted at Dr. Ziauddin Hospital Karachi, from October 2019 to October 2020. Patients of both genders, above the age of 45 years, with knee joint osteoarthritis grade III and IV advised primary TKR, were included. Functional outcomes were assessed using the Knee Society Score, preoperatively and postoperatively, in obese and non-obese groups. The non-probability Convenience Sampling technique was used. SPSS v25.0 and Microsoft Excel 2016 were used for analysis. Chi-square and t-tests were applied, with significance set at p < 0.05.
Results: The study included 98 knees in 66 cases, with 30 patients in the obese group and 36 patients in the non-obese group. In the obese group, 28 (93.3%) were over 60 years old, compared to 35 (97.2%) in the non-obese group. The obese group had 23 (76.7%) female patients, while the non-obese group had 22 (61.1%). Postoperative Knee Society Scores were 84.83±4.71 for the obese group and 87.08±4.07 for the non-obese group. Excellent functional outcomes were achieved by 17 (56.6%) obese and 22 (61.1%) non-obese patients.
Conclusion: BMI should not exclude patients from TKR, but they should be informed of the associated risks, considering the difference in postoperative functional outcomes in both groups.
References
Shichman I, Askew N, Habibi A, Nherera L, Macaulay W, Seyler T, Schwarzkopf R. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2040-2060. Arthroplasty Today. 2023 Jun 1;21:101152.https://doi.org/10.1016/j.artd.2023.101152
O’Sullivan O. Osteoarthritis: Pathophysiology and Classification of a Common Disabling Condition. In The Palgrave Encyclopedia of Disability 2024 Aug 25 (pp. 1-11). Cham: Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-40858-8_286-1
Muthusamy N, Singh V, Sicat CS, Rozell JC, Lajam CM, Schwarzkopf R. Trends of obesity rates between patients undergoing primary total knee arthroplasty and the general population from 2013 to 2020. JBJS. 2022 Mar 16;104(6):537-43. DOI: 10.2106/JBJS.21.00514
Giesinger K, Giesinger JM, Hamilton DF, Rechsteiner J, Ladurner A. Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty. BMC Musculoskelet Disord. 2021 Jul 24;22(1):635. doi: 10.1186/s12891-021-04512-1.
Jawed M, Inam S, Shah N, Shafique K. Association of obesity measures and multimorbidity in Pakistan: findings from the IMPACT study. Public Health. 2020 Mar 1;180:51-6.https://doi.org/10.1016/j.puhe.2019.10.017.
Garval M, Maribo T, Mikkelsen R, Beck J, Schmidt AM. Impact of obesity on patient-reported physical activity level, knee pain, and functional capacity 12 months after unicompartmental or total knee arthroplasty. International Journal of Orthopaedic and Trauma Nursing. 2024 May 1;53:101084. https://doi.org/10.1016/j.ijotn.2024.101084
van Tilburg J, Rathsach Andersen M. Mid- to long-term complications and outcome for morbidly obese patients after total knee arthroplasty: a systematic review and meta-analysis. EFORT Open Rev. 2022 May 5;7(5):295-304. doi: 10.1530/EOR-21-0090.
Soutakbar H, Lamb SE, Silman AJ. The different influence of high levels of physical activity on the incidence of knee OA in overweight and obese men and women-a gender specific analysis. Osteoarthritis Cartilage. 2019 Oct;27(10):1430-1436.. https://doi.org/10.1016/j.joca.2019.05.025
Jester R, Rodney A. The relationship between obesity and primary Total Knee Replacement: A scoping review of the literature. Int J Orthop Trauma Nurs. 2021 Jul;42:100850.https://doi.org/10.1016/j.ijotn.2021.100850
Irwin MR, Straub RH, Smith MT. Heat of the night: sleep disturbance activates inflammatory mechanisms and induces pain in rheumatoid arthritis. Nature Reviews Rheumatology. 2023 Sep;19(9):545-59.https://doi.org/10.1038/s41584-023-00997-3
Bosler AC, Deckard ER, Buller LT, Meneghini RM. Obesity is Associated With Greater Improvement in Patient-Reported Outcomes Following Primary Total Knee Arthroplasty. J Arthroplasty. 2023 Dec;38(12):2484-2491. https://doi.org/10.1016/j.arth.2023.08.031
Taunton MJ. What's New in Adult Reconstructive Knee Surgery. J Bone Joint Surg Am. 2020 Jan 15;102(2):91-100. doi: 10.2106/JBJS.19.01063.
Body mass index as a predictor of outcome in total knee replacement, International Orthopaedics (SICOT) (2001) 25:246–249 DOI 10.1007/s002640100255.
Miralles‐Muñoz FA, Gonzalez‐Parreño S, Martinez‐Mendez D, Gonzalez‐Navarro B, Ruiz‐Lozano M, Lizaur‐Utrilla A, Alonso‐Montero C. A validated outcome categorization of the knee society score for total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Apr;30(4):1266-72. https://doi.org/10.1007/s00167-021-06563-2.
Moon YW, Park JH, Lee SS, Kang JW, Lee DH. Distal femoral phenotypes in Asian varus osteoarthritic knees. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Feb;30(2):456-63. https://doi.org/10.1007/s00167-020-06131-0
Baghbani-Naghadehi F, Armijo-Olivo S, Prado CM, Gramlich L, Woodhouse LJ. Does obesity affect patient-reported outcomes following total knee arthroplasty? BMC musculoskeletal disorders. 2022 Jan 17;23(1):55. https://doi.org/10.1186/s12891-022-04997-4
Haykal T, Adam S, Bala A, Zayed Y, Deliwala S, Kerbage J, Ponnapalli A, Malladi S, Samji V, Ortel TL. Thromboprophylaxis for orthopedic surgery; An updated meta-analysis. Thrombosis Research. 2021 Mar 1;199:43-53. https://doi.org/10.1016/j.thromres.2020.12.007
Clement ND, Scott CE, Hamilton DF, MacDonald D, Howie CR. Meaningful values in the Forgotten Joint Score after total knee arthroplasty: minimal clinically important difference, minimal important and detectable changes, and patient-acceptable symptom state. The Bone & Joint Journal. 2021 May 3;103(5):846-54. https://doi.org/10.1302/0301-620X.103B5.BJJ-2020-0396.R1
Huddleston HP, Chahla J, Gursoy S, Williams BT, Dandu N, Malloy P, Naveen NB, Cole BJ, Yanke AB. A comprehensive description of the lateral patellofemoral complex: anatomy and anisometry. The American Journal of Sports Medicine. 2022 Mar;50(4):984-93. https://doi.org/10.1177/03635465221078033
Huber C, Zhang Q, Taylor WR, Amis AA, Smith C, Hosseini Nasab SH. Properties and function of the medial patellofemoral ligament: a systematic review. The American journal of sports medicine. 2020 Mar;48(3):754-66. https://doi.org/10.1177/0363546519841304
Shatrov J, Coolican MR. Isolated patellofemoral arthroplasty-surgical technique and tips: current concepts. Journal of ISAKOS. 2024 Aug 1;9(4):814-21.https://doi.org/10.1016/j.jisako.2023.11.009
Shumnalieva R, Kotov G, Monov S. Obesity-Related Knee Osteoarthritis-Current Concepts. Life (Basel). 2023 Jul 28;13(8):1650. doi: 10.3390/life13081650.
Kazmi T, Nagi LF, Iqbal SP, Razzaq S, Hassnain S, Khan S, Shahid N. Relationship Between Physical Inactivity and Obesity in the Urban Slums of Lahore. Cureus. 2022 Apr 1;14(4):e23719. doi: 10.7759/cureus.23719.
Borda MG, Venegas-Sanabria LC, Garcia-Cifuentes E, Gomez RC, Cano-Gutierrez CA, Tovar-Rios DA, Aarsland V, Khalifa K, Jaramillo-Jimenez A, Aarsland D, Soennesyn H. Body mass index, performance on activities of daily living and cognition: analysis in two different populations. BMC geriatrics. 2021 Dec;21:1-1. doi.org/10.1186/s12877-021-02127-8
Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020 Nov 26;29-30:100587. doi: 10.1016/j.eclinm.2020.100587. DOI: 10.1016/j.eclinm.2020.100587
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