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J Arthroplasty. 2019 May;34(5):932-938. doi: 10.1016/j.arth.2019.01.010. Epub 2019 Jan 14.

Morbid Obesity in Revision Total Knee Arthroplasty: A Significant Risk Factor for Re-Operation.

Author information

1
Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Pittsburgh Bone, Joint & Spine, Inc., Allegheny Health Network, Jefferson Hills, Pennsylvania.
2
Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.

Abstract

BACKGROUND:

The purpose of this study is to compare surgical and clinical outcomes between matched groups of morbidly obese (body mass index [BMI] >40 kg/m2) and non-morbidly obese (BMI <40 kg/m2) patients undergoing first-time revision total knee arthroplasty with a minimum 5-year follow-up.

METHODS:

Two groups of 87 patients (BMI >40 or <40 kg/m2) were matched 1:1 based on age at the time of revision, gender, and diagnosis for revision (aseptic or septic causes).

RESULTS:

The morbidly obese group had a significantly greater incidence of re-operation (34.5% [30/87] vs 16.1% [14/87], P = .005) and re-revision (27.6% [24/87] vs 12.6% [11/87], P = .014) with a significantly lower 10-year survivorship for re-operation (P = .05) and subsequent revision (P = .014). In particular, the aseptic sub-group had a greater incidence of re-operation (29.9% [20/67] vs 13.4% [9/67], P = .021) and re-revision (26.9% [18/67] vs 11.9% [8/67], P = .029). The non-morbidly obese group demonstrated higher final Western Ontario and McMaster Universities Index scores (63.1 ± 19.5 vs 55.5 ± 22.5, P = .030) and a greater change between pre-operative and final KSS (45.6 ± 44.3 vs 39.7 ± 48.4, P = .040) and SF-12 Mental component (3.6 ± 10.8 vs -1.4 ± 10.3, P = .013).

CONCLUSION:

Morbidly obese patients undergoing revision total knee arthroplasty have a greater risk of re-operation and re-revision while experiencing lower clinical outcome scores compared to non-morbidly obese patients. These patients should be informed of the higher potential for re-operation and the possibility of poor results.

KEYWORDS:

aseptic loosening; complications; infection; morbid obesity; revision knee arthroplasty; risk factors

PMID:
30745083
DOI:
10.1016/j.arth.2019.01.010

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