The outcomes of total knee arthroplasty in morbidly obese patients : a systematic review of the literature
INTRODUCTION: The increasing prevalence of obesity has led to an increase in total knee arthroplasties (TKAs) being undertaken in patients with a higher body mass index (BMI). TKA in morbidly obese patients can be technically challenging due to numerous anatomical factors and patient co-morbidities. The long-term outcomes in this patient group are unclear. This systematic review aims to compare the long-term revision rates, functional outcomes and complication rates of TKAs in morbidly obese versus non-obese patients.
METHODS: A search of PubMed, EMBASE and PubMed Central was conducted to identify studies that reported revision rates in a cohort of morbidly obese patients (BMI ≥ 40 kg/m2) that underwent primary TKA, compared to non-obese patients (BMI ≤ 30 kg/m2). Secondary outcomes included Knee Society Objective Scores (KSOS), Knee Society Functional Scores (KSFS), and complication rates between the two groups. The difference in revision rates was assessed using the Chi-squared test. The Wilcoxon signed-rank test was used to compare pre-operative and post-operative functional scores for each group. KSOS and KSFS for morbidly obese and non-obese patients were compared using the Mann-Whitney test. Statistical significance was defined as p ≤ 0.05.
RESULTS: Nine studies were included in this review. There were 624 TKAs in morbidly obese patients and 9,449 TKAs in non-obese patients, average BMI values were 45.0 kg/m2 (range 40-66 kg/m2) and 26.5 kg/m2 (range 11-30 kg/m2) respectively. The average follow-up time was 4.8 years (range 0.5-14.1) and 5.2 years (range 0.5-13.2) respectively, with a revision rate of 7% and 2% (p < 0.001) respectively. All functional scores improved after TKA (p < 0.001). Pre- and post-operative KSOS and KSFS were poorer in morbidly obese patients, however, mean improvement in KSOS was the same in both groups and comparable between groups for KSFS (p = 0.78). Overall complication rates, including infection, were higher in morbidly obese patients.
CONCLUSIONS: This review suggests an increased mid to long-term revision rate following primary TKA in morbidly obese patients, however, these patients have a functional recovery which is comparable to non-obese individuals. There is also an increased risk of perioperative complications, such as superficial wound infection. Morbidly obese patients should be fully informed of these issues prior to undergoing primary TKA.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2019 |
---|---|
Erschienen: |
2019 |
Enthalten in: |
Zur Gesamtaufnahme - volume:139 |
---|---|
Enthalten in: |
Archives of orthopaedic and trauma surgery - 139(2019), 4 vom: 18. Apr., Seite 553-560 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Boyce, Louis [VerfasserIn] |
---|
Links: |
---|
Anmerkungen: |
Date Completed 08.05.2019 Date Revised 25.02.2020 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1007/s00402-019-03127-5 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM294040412 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM294040412 | ||
003 | DE-627 | ||
005 | 20231225080633.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231225s2019 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1007/s00402-019-03127-5 |2 doi | |
028 | 5 | 2 | |a pubmed24n0980.xml |
035 | |a (DE-627)NLM294040412 | ||
035 | |a (NLM)30778723 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Boyce, Louis |e verfasserin |4 aut | |
245 | 1 | 4 | |a The outcomes of total knee arthroplasty in morbidly obese patients |b a systematic review of the literature |
264 | 1 | |c 2019 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 08.05.2019 | ||
500 | |a Date Revised 25.02.2020 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a INTRODUCTION: The increasing prevalence of obesity has led to an increase in total knee arthroplasties (TKAs) being undertaken in patients with a higher body mass index (BMI). TKA in morbidly obese patients can be technically challenging due to numerous anatomical factors and patient co-morbidities. The long-term outcomes in this patient group are unclear. This systematic review aims to compare the long-term revision rates, functional outcomes and complication rates of TKAs in morbidly obese versus non-obese patients | ||
520 | |a METHODS: A search of PubMed, EMBASE and PubMed Central was conducted to identify studies that reported revision rates in a cohort of morbidly obese patients (BMI ≥ 40 kg/m2) that underwent primary TKA, compared to non-obese patients (BMI ≤ 30 kg/m2). Secondary outcomes included Knee Society Objective Scores (KSOS), Knee Society Functional Scores (KSFS), and complication rates between the two groups. The difference in revision rates was assessed using the Chi-squared test. The Wilcoxon signed-rank test was used to compare pre-operative and post-operative functional scores for each group. KSOS and KSFS for morbidly obese and non-obese patients were compared using the Mann-Whitney test. Statistical significance was defined as p ≤ 0.05 | ||
520 | |a RESULTS: Nine studies were included in this review. There were 624 TKAs in morbidly obese patients and 9,449 TKAs in non-obese patients, average BMI values were 45.0 kg/m2 (range 40-66 kg/m2) and 26.5 kg/m2 (range 11-30 kg/m2) respectively. The average follow-up time was 4.8 years (range 0.5-14.1) and 5.2 years (range 0.5-13.2) respectively, with a revision rate of 7% and 2% (p < 0.001) respectively. All functional scores improved after TKA (p < 0.001). Pre- and post-operative KSOS and KSFS were poorer in morbidly obese patients, however, mean improvement in KSOS was the same in both groups and comparable between groups for KSFS (p = 0.78). Overall complication rates, including infection, were higher in morbidly obese patients | ||
520 | |a CONCLUSIONS: This review suggests an increased mid to long-term revision rate following primary TKA in morbidly obese patients, however, these patients have a functional recovery which is comparable to non-obese individuals. There is also an increased risk of perioperative complications, such as superficial wound infection. Morbidly obese patients should be fully informed of these issues prior to undergoing primary TKA | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Systematic Review | |
650 | 4 | |a Complication rates | |
650 | 4 | |a Complications | |
650 | 4 | |a Functional outcome | |
650 | 4 | |a Infection | |
650 | 4 | |a Infection rates | |
650 | 4 | |a KSFS | |
650 | 4 | |a KSOS | |
650 | 4 | |a Knee Society Functional scores | |
650 | 4 | |a Knee Society Objective scores | |
650 | 4 | |a Morbid obesity | |
650 | 4 | |a Non-obese | |
650 | 4 | |a Obesity | |
650 | 4 | |a Prosthetic infection | |
650 | 4 | |a Quality of life | |
650 | 4 | |a Revision rate | |
650 | 4 | |a Superficial wound infection | |
650 | 4 | |a TKA | |
650 | 4 | |a TKR | |
650 | 4 | |a Total knee arthroplasty | |
650 | 4 | |a Total knee replacement | |
650 | 4 | |a Wound healing delay | |
650 | 4 | |a Wound healing problems | |
700 | 1 | |a Prasad, Anoop |e verfasserin |4 aut | |
700 | 1 | |a Barrett, Matthew |e verfasserin |4 aut | |
700 | 1 | |a Dawson-Bowling, Sebastian |e verfasserin |4 aut | |
700 | 1 | |a Millington, Steven |e verfasserin |4 aut | |
700 | 1 | |a Hanna, Sammy A |e verfasserin |4 aut | |
700 | 1 | |a Achan, Pramod |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Archives of orthopaedic and trauma surgery |d 1996 |g 139(2019), 4 vom: 18. Apr., Seite 553-560 |w (DE-627)NLM01295120X |x 1434-3916 |7 nnns |
773 | 1 | 8 | |g volume:139 |g year:2019 |g number:4 |g day:18 |g month:04 |g pages:553-560 |
856 | 4 | 0 | |u http://dx.doi.org/10.1007/s00402-019-03127-5 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 139 |j 2019 |e 4 |b 18 |c 04 |h 553-560 |