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Toale J, Stanley C, Quinlan JF. Weight changes following total hip and total knee arthroplasty - A systematic review. Surgeon 2025; 23:180-186. [PMID: 40050181 DOI: 10.1016/j.surge.2025.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 02/15/2025] [Accepted: 02/21/2025] [Indexed: 05/20/2025]
Abstract
THE BACKGROUND AND PURPOSE OF THE STUDY Symptomatic osteoarthritis can result in reduced mobility and exercise tolerance, leading to weight gain. Patients often feel that arthroplasty will result in improved mobility, reduced pain, and subsequent weight loss. The purpose of this systematic review was to assess weight changes following lower limb arthroplasty from available published literature. METHODS A systematic review of PubMed, EMBASE and Cochrane Library databases were performed in accordance to PRISMA guidelines. Studies reporting significant weight changes of 5 % of pre-operative weight, 5 % of BMI and total weight change in kilograms following hip and knee arthroplasty were included. Outcomes assessed were weight changes according to groupings 'weight gain', 'maintained weight' and 'weight loss'. Secondarily we assessed weight changes in kilograms. Methodological quality of evidence was assessed using MINORS criteria. RESULTS In total, 21 studies were included with a total of 55,245 patients. In the '5 % of total weight' group 12.5 % gained weight, 74.2 % maintained weight and 13.3 % lost weight (weighted means). In the '5 % of BMI' group 22.1 % gained weight, 66.3 % maintained weight and 13.9 % lost weight (weighted means). Overall, 13 studies reported a weighted mean weight change of +0.7 kg. The majority of studies were of moderate/poor quality using MINORS criteria. CONCLUSIONS This systematic review found that the majority of patients maintain their preoperative weight following hip and knee arthroplasty. This study suggests that arthroplasty does not lead to weight loss from improved pain and mobility in the majority of patients. This study presents data that is important for surgeons and patients alike when considering potential weight changes following arthroplasty.
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Affiliation(s)
- James Toale
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland; Department of Medicine, University of Galway, Ireland.
| | - Ciarán Stanley
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland.
| | - John F Quinlan
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland.
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Ramos MS, Hale ME, Rullán PJ, Kunze KN, Nair N, Piuzzi NS. Do Overall Weight, Body Mass Index, or Clinically Meaningful Weight Changes Occur After Total Joint Arthroplasty? A Meta-Analysis of 60,837 Patients. J Arthroplasty 2025; 40:1083-1096.e1. [PMID: 39424245 DOI: 10.1016/j.arth.2024.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 10/07/2024] [Accepted: 10/10/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND Total joint arthroplasty (TJA) is well-recognized for improving quality of life and functional outcomes of patients with osteoarthritis; however, TJA's impact on body weight remains unclear. Recent trends have demonstrated a shift among TJA patients, such that patients who have higher body mass indices (BMIs) are undergoing this common surgery. Given this trend, it is critical to characterize the impact TJA has on body weight or BMI. This meta-analysis aimed to quantitatively assess whether patients lose, gain, or maintain body weight or BMI after TJA. METHODS This study followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were queried from inception through July 2022. The included studies: (1) reported on weight or BMI after elective, primary total hip arthroplasty (THA) or total knee arthroplasty (TKA); and (2) weight or BMI change was deemed to be associated with THA or TKA. The excluded studies: (1) included weight or BMI interventions; and (2) reported on unicompartmental, partial, or revision arthroplasty or joint arthroscopy. Meta-analyses for weight change, BMI change, and proportion of patients achieving clinically significant change were performed using random-effects models. Factors associated with clinically significant change were systematically reported. A total of 60,837 patients from 39 studies were included. RESULTS No significant differences existed between preoperative and postoperative weights (P = 1.0; P = 0.28) or BMIs (P = 1.0; P = 1.0) after THA or TKA, respectively. Overall, 66% of THA patients (P < 0.01) and 65% of TKA patients (P < 0.01) did not experience clinically significant weight change. CONCLUSIONS Among a TJA cohort, two-thirds of the patients maintained their preoperative body weight or BMI after surgery. With these results, orthopaedic surgeons can better manage patient expectations of TJA.
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Affiliation(s)
- Michael S Ramos
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Martina E Hale
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Nikhil Nair
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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Scheinberg M, Dan Zhang T, Galloway J, Campos J, Kalluraya S, Bernstein M, Shah A. Weight changes following Achilles debridement with flexor hallucis longus transfer: A retrospective analysis. J Foot Ankle Surg 2025; 64:131-135. [PMID: 39245433 DOI: 10.1053/j.jfas.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/28/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
Obesity poses a growing concern, with global predictions estimating over half the population to be overweight or obese by 2030 (1). While prior research has extensively explored the impact of obesity on hip and knee surgeries, a notable gap persists in understanding weight changes following foot and ankle procedures. This retrospective study focuses on the relationship between Body Mass Index (BMI) and Achilles debridement with flexor hallucis longus (FHL) transfer. Despite prevailing research on the adverse effects of obesity on orthopedic outcomes, few studies examine the reciprocal influence of surgeries on weight. A retrospective analysis of 136 patients undergoing primary Achilles debridement with FHL transfer was conducted. Data encompassing BMI, demographic information, and medical comorbidities were extracted from electronic medical records (EMRs). A clinically meaningful BMI change was considered as a 5 % variation. Inferential statistics in the form of analysis of variance, t-test, and linear regression were employed for data analysis. Among the 136 patients in the study, no statistically significant BMI changes were noted up to two years after surgery (p = 0.9967). While obesity remains a significant factor in foot and ankle surgery complications, our study suggests that Achilles debridement with FHL transfer does not induce significant weight changes. Further research exploring factors influencing weight changes and varying outcomes across demographics is warranted.
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Affiliation(s)
- Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Ting Dan Zhang
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - John Galloway
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Juan Campos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Swathi Kalluraya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Marc Bernstein
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, United States.
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Tracey OC, Nagra K, Levine K, Adhiyaman A, McBoyle P, Nichols E, Prior M, Sink EL, Scher D, Doyle SM, Dodwell E. Weight Percentile Is Maintained During Spica Casting: A Retrospective Cohort Study of Patients Treated with Closed or Open Reduction for Developmental Dysplasia of the Hip. JOURNAL OF THE PEDIATRIC ORTHOPAEDIC SOCIETY OF NORTH AMERICA 2024; 9:100125. [PMID: 40432667 PMCID: PMC12088345 DOI: 10.1016/j.jposna.2024.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/13/2024] [Accepted: 09/14/2024] [Indexed: 05/29/2025]
Abstract
Background Weight changes during spica casting previously have not been reported. The primary aim of this study was to determine weight percentile change from cast initiation to cast removal. Secondary aims were to assess weight percentile changes from initiation to mid-term follow-up visits after cast removal and to assess the mean weight change from cast initiation to cast removal. Methods Patients with developmental dysplasia of the hip (DDH) treated with closed or open reduction (± femoral/pelvic osteotomy) and spica cast were retrospectively reviewed from 2/2016-6/2023. Patients aged <4 years treated for ≥6 weeks in spica cast were included. Patients lacking weight measurements within the 4 weeks prior to cast initiation or within 2 weeks following cast removal were excluded. Demographics, weight, and weight percentiles at cast initiation, cast removal, and at follow-ups were collected. Mean weights and mean weight percentiles were compared across visits with dependent sample t-tests and one-way analysis of variance tests based on normality, with a significance threshold of P ≤ .05. Results Thirty-six hips in 31 infants (median age: 10.4 [interquartile range {IQR}: 9, 16.3] months, 86% female) were included. The median duration of casting was 9.2 [IQR: 7.9, 12.6] weeks; 2 hips had midpoint cast change. The mean weight was 9.8 ± 2.3 kg at cast initiation and 10.1 ± 1.9 kg at final cast removal, with a mean change of 0.3 ± 0.4 kg (P = .527). Mean weight percentiles did not differ during or after treatment (range: 55-61st percentile, P = .974). Conclusion Weight percentiles were maintained during spica casting in the patients examined in this study, which should be reassuring to the family and treatment team; our study did not find that spica casting stunts weight gain. For surgeons who may consider maintaining the original spica cast throughout treatment, without cast change, a mean weight gain of 0.3 kg for a mean casting length of 9 weeks in infants of median age 10.4 months should be reassuring; many infants/toddlers may not require a cast change due to growth. Key Concepts (1)Spica casting does not appear to stunt weight gain.(2)The weight percentile did not change during spica casting following open or closed reduction for developmental dysplasia of the hip.(3)The mean weight gain during typical spica casting is 0.3 kg, which was not statistically significant. Level of Evidence III, retrospective cohort.
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Affiliation(s)
| | | | - Keza Levine
- Hospital for Special Surgery, New York City, NY, USA
| | | | | | | | - Melanie Prior
- Hospital for Special Surgery, New York City, NY, USA
| | | | - David Scher
- Hospital for Special Surgery, New York City, NY, USA
| | | | - Emily Dodwell
- Hospital for Special Surgery, New York City, NY, USA
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Nagayama K, Shishido T, Ishida T, Iwasa N, Nishikawa Y, Tateiwa T, Masaoka T, Yamamoto K. Associations Among Changes in Body Composition, Activity, Muscle Recovery, and Obesity Following Total Knee Arthroplasty: A Retrospective Study. Cureus 2024; 16:e72282. [PMID: 39450212 PMCID: PMC11500624 DOI: 10.7759/cureus.72282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2024] [Indexed: 10/26/2024] Open
Abstract
PURPOSE Total knee arthroplasty (TKA) is expected to improve knee pain and enable patients to regain the ability to walk, but the associations between preoperative and postoperative changes in body composition, muscle strength, and activity remain unclear. In this study, we investigated the association between changes in body composition before and after TKA surgery, the recovery process of muscle strength, and changes in activity, as well as the effects of obesity on TKA. METHODS A total of 124 patients with unilateral knee osteoarthritis (OA) who underwent TKA were retrospectively evaluated. Body weight (BW) and body composition (body fat percentage (BFP) and diseased limb muscle mass (DLMM)), measured by bioelectrical impedance analysis, quadriceps muscle strength (QMS), measured using the isometric muscle strength meter, number of steps (NOS), and Japanese Orthopaedic Association (JOA) OA knee diseases treatment outcome criteria (JOA score) before the operation, at postoperative six months (PO6M), and at postoperative one year (PO1Y) after the operation were investigated and compared between the non-obese (BMI < 25 kg/m2) group, including underweight (<18.5 kg/m2) and normal weight patients (18.5 to 24.9 kg/m2), and obese (BMI ≥ 25 kg/m2) group, including overweight (25.0 to 29.9 kg/m2) or obese patients (≥30.0 kg/m2). RESULTS In all patients, JOA scores significantly improved from 59.7 preoperatively to 81.2 at PO6M, and 82.7 at PO1Y (both p < 0.01). QMS significantly increased from 112.4 N preoperatively to 144.0 N at PO6M, and 151.0 N at PO1Y (both p < 0.01). On the other hand, there was no significant change in BW, BFP, NOS, and DLMM. A comparison between the obese (n = 76) and non-obese (n = 48) groups demonstrated that there was no significant difference in JOA scores preoperatively, but scores at PO1Y were significantly higher in the non-obese group (p < 0.01), and QMS increased significantly postoperatively in both groups, but the enlargement rate at PO1Y was 1.4% in the obese group versus 10.4% in the non-obese group (p = 0.04). CONCLUSION In the body composition of TKA patients, BW, BFP, and DLMM/BW did not change significantly from preoperatively to PO1Y, but QMS and JOA scores showed significant improvement at PO6M and PO1Y compared to preoperatively. The obese patients showed less improvement in JOA scores than non-obese patients, and the rate of increase in QMS at PO1Y was smaller, suggesting that rehabilitation focusing on muscle-strengthening training is necessary even at PO6M, especially in obese patients.
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Affiliation(s)
| | | | | | - Norihiko Iwasa
- Orthopedics, Tokyo Medical University Hospital, Tokyo, JPN
| | | | | | | | - Kengo Yamamoto
- Orthopedics, Tokyo Medical University Hospital, Tokyo, JPN
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Tanpure S, Phadnis A, Nagda T, Rathod C, Kothurkar R, Gad M. Effect of total knee arthroplasty on contralateral knee: A prospective comparative gait analysis of non-operated legs in the Indian population. J Clin Orthop Trauma 2023; 45:102280. [PMID: 38037634 PMCID: PMC10685002 DOI: 10.1016/j.jcot.2023.102280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/17/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Biomechanics plays a crucial function in osteoarthritis. Changes in the biomechanical parameters of the contralateral knee following total knee arthroplasty (TKA) may result in pain in the contralateral knee. The objective of this study was to examine preoperative and postoperative gait measurements on the contralateral leg following a TKA for a variety of gait measures at a self-selected normal gait pace in a similar speed population. Method There were 11 patients included in the study, and their average age was 68 (7 females and 4 males). Gait analysis was performed at a sampling frequency of 120 Hz using nine cameras Qualisys motion capture systems (Qualisys AB, Sweden). To process the kinematic data, Visual 3D C-Motion Software was used. Results Ankle plantar flexion (0.01), knee abduction during the terminal stance (0.002), and knee adduction during the initial swing (0.01) all showed a significant difference. In spatiotemporal data, walking speed (0.01), stance time (0.01), step length (0.005), and stride length (0.001) all showed significant differences. There were significant differences in knee flexion-extension (0.04) values. Conclusion A change in the contralateral knee's biomechanics as a result of TKA is strongly suggested by significant alterations in the knee's stance phase, joint angle, and MAP. The research may help to modify the stride of the contralateral leg to decrease the advancement of osteoarthritis.
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Affiliation(s)
- Sanket Tanpure
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
| | - Ashish Phadnis
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
| | - Taral Nagda
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
| | - Chasanal Rathod
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
| | - Rohan Kothurkar
- Department of Mechanical Engineering, K. J. Somaiya College of Engineering, Mumbai, India
| | - Mayuri Gad
- Department of Orthopaedics, Jupiter Lifeline Hospital, Thane, India
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Vorster P, Matur AV, Palmisciano P, Conteh FS, Onyewadume L, Duah HO, Shukla GG, Chilakapati SS, Tao X, Gupta S, Shah S, Motley B, Cheng J, Virojanapa J, Adogwa O. Do Obese Patients Lose Weight After Lumbar Spine Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 175:122-129.e1. [PMID: 37059361 DOI: 10.1016/j.wneu.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Obesity is a major health care concern in the United States and is associated with high rates of postoperative complications after spine surgery. Obese patients assert that weight reduction is not possible unless spine surgery first relieves their pain and concomitant immobility. We describe the post-spine surgery effects on patient weight, with an emphasis on obesity. METHODS PubMed, EMBASE, Scopus, Web of Science, and Cochrane databases were systematically searched according to the PRISMA guidelines. The search included indexed terms and text words from database inception to the date of the search (15 April 2022). Studies chosen for inclusion had to have data reporting on pre- and postoperative patient weight after spine surgery. Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis. RESULTS Eight articles encompassing 7 retrospective and 1 prospective cohort were identified. A random effects model analysis demonstrated that overweight and obese patients (body mass index [BMI], >25 kg/m2) had increased odds of clinically significant weight loss after lumbar spine surgery compared with non-obese patients (odds ratio, 1.63; 95% confidence interval, 1.43-1.86, P < 0.0001). There was no significant difference in the raw weight change between BMI categories (mean difference, -0.67 kg, 95% confidence interval, -4.71 to 3.37 kg, P = 0.7463). CONCLUSIONS Compared with non-obese patients (BMI, <25 kg/m2), overweight and obese patients have higher odds of clinically significant weight loss after lumbar spine surgery. No difference in pre-operative and post-operative weight was found, although statistical power was lacking in this analysis. Randomized controlled trials and additional prospective cohorts are needed to further validate these findings.
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Affiliation(s)
- Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Fatu S Conteh
- Department of Neurosurgery, Loma Linda University Health, Loma Linda, California, USA
| | - Louisa Onyewadume
- School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Henry O Duah
- Department of Nursing Research, University of Cincinnati College of Nursing, Cincinnati, Ohio, USA
| | - Geet G Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sanjit Shah
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Justin Virojanapa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Mihalko WM, Johnson KC, Neiberg RH, Bahnson JL, Singhal K, Richey PA, Look AHEAD Research Group. The Association of Total Knee Arthroplasty With Weight Loss in the Look AHEAD (Action for Health in Diabetes) Clinical Trial. J Arthroplasty 2023; 38:S81-S87.e2. [PMID: 36933679 PMCID: PMC10200753 DOI: 10.1016/j.arth.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Patients who have obesity seldom lose weight after total knee arthroplasty (TKA). The Look AHEAD (Action for Health in Diabetes) trial randomized patients with type 2 diabetes who were overweight or had obesity to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). METHODS Of the total 5,145 participants enrolled who had a median 14-year follow-up, a subset of 4,624 met inclusion criteria. The ILI aimed at achieving and maintaining a 7% weight loss and included weekly counseling the first 6 months, with decreasing frequency thereafter. This secondary analysis was undertaken to determine what effects a TKA had on patients participating in a known successful weight loss program and specifically if there was a negative impact on weight loss or their Physical Component Score. RESULTS The analysis suggests that the ILI remained effective for maintaining or losing weight after TKA. Participants in ILI had significantly greater percent weight loss than those in DSE both before and after TKA (ILI-DSE before TKA: -3.6% (-5.0, -2.3); after TKA: -3.7% (-4.1, -3.3); both P < .0001). When comparing percent weight loss before to after TKA, there was no significant difference within either the DSE or ILI group (least square means ± standard error ILI: -0.36% ± 0.3, P = .21; DSE: -0.41% ± 0.29, P = .16). Physical Component Scores improved after TKA (P < .001), but no difference was found between TKA ILI and DSE groups before or after surgery. CONCLUSION Participants who had a TKA did not have an altered ability to adhere to intervention goals to maintain weight loss or obtain further weight loss. The data suggest patients who have obesity can lose weight after TKA on a weight loss program.
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Affiliation(s)
- William M. Mihalko
- University of Tennessee Health Science Center, Campbell Clinic Department of Orthopaedic Surgery, Memphis, TN
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca H. Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Judy L. Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kunal Singhal
- Department of Physical Therapy, University of St. Augustine for Health Sciences, Austin, TX
| | - Phyllis A. Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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Paravlic AH, Meulenberg CJ, Drole K. The Time Course of Quadriceps Strength Recovery After Total Knee Arthroplasty Is Influenced by Body Mass Index, Sex, and Age of Patients: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:865412. [PMID: 35692543 PMCID: PMC9174520 DOI: 10.3389/fmed.2022.865412] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction For patients with osteoarthritis who have undergone total knee arthroplasty (TKA), quadriceps strength is a major determinant of general physical function regardless of the parameters adopted for functional assessment. Understanding the time course of quadriceps strength recovery and effectiveness of different rehabilitation protocols is a must. Therefore, the aim of this study was to: (i) determine the magnitude of maximal voluntary strength (MVS) loss and the time course of recovery of the quadriceps muscle following TKA, (ii) identify potential moderators of strength outcomes, and (iii) investigate whether different rehabilitation practices can moderate the strength outcomes following TKA, respectively. Design General scientific databases and relevant journals in the field of orthopedics were searched, identifying prospective studies that investigated quadriceps’ MVS pre-to post-surgery. Results Seventeen studies with a total of 832 patients (39% males) were included. Results showed that in the early post-operative days, the involved quadriceps’ MVS markedly declined, after which it slowly recovered over time in a linear fashion. Thus, the greatest decline of the MVS was observed 3 days after TKA. When compared to pre-operative values, the MVS was still significantly lower 3 months after TKA and did not fully recover up to 6 months following TKA. Furthermore, a meta-regression analysis identified that the variables, time point of evaluation, patient age, sex, and BMI, significantly moderate the MVS of the quadriceps muscle. Conclusion The analyzed literature data showed that the decrease in strength of the involved quadriceps muscles following TKA is considerable and lasts for several months post-surgery. Therefore, we recommend to specifically target the strengthening of knee extensor muscles, preserve motor control, and apply appropriate nutrition to ensure a holistic quadriceps muscle recovery. Since age, sex, and BMI were found to be moderating factors in patients’ recovery, further research should include specific analyses considering these moderators.
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Affiliation(s)
- Armin H. Paravlic
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sport Studies, Masaryk University, Brno, Czechia
- *Correspondence: Armin H. Paravlic,
| | - Cécil J. Meulenberg
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
| | - Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
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Coelho A, Leal-Blanquet J, Sánchez-Soler JF, Torres-Claramunt R, Hinarejos P, Monllau JC. Patients lose weight after a total knee arthroplasty: myth or reality? INTERNATIONAL ORTHOPAEDICS 2022; 46:1299-1304. [DOI: 10.1007/s00264-022-05387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
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Grandizio LC, Foster BK, Torino DJ, Pavis EJ, Udoeyo IF. An analysis of body weight changes after shoulder arthroplasty. JSES Int 2021; 5:377-381. [PMID: 34136843 PMCID: PMC8178630 DOI: 10.1016/j.jseint.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background To determine if there are postoperative weight changes for patients undergoing primary shoulder arthroplasty (SA). In addition, we aimed to determine if glycemic control (hemoglobin A1C levels) change postoperatively for patients undergoing SA. Methods All patients 18 years of age or older who had undergone primary SA over a 12-year period were analyzed. Patients were excluded if they did not have a preoperative body mass index or if they had less than 1-year follow-up. Baseline demographics were recorded for all patients and comparisons were made between the obese and nonobese groups. Clinically meaningful weight loss was defined as a ≥ 5% reduction in body weight postoperatively. Results A total of 469 patients met inclusion criteria. Of them, 65% of patients were obese, and the mean preoperative body mass index for all patients was 33. With a mean follow-up of 40 months, 70% of patients demonstrated clinically significant weight loss. Compared with patients without obesity, patients with obesity lost significantly more weight (10 vs. 6 kg) and demonstrated significantly greater postoperative body mass index reductions (4 vs. 2). Overall, 72% of patients with obesity demonstrated clinically meaningful postoperative weight loss of ≥5% body weight. Patients with obesity who lost weight also saw a decrease in their postoperative hemoglobin A1C: for every 10 pounds of weight loss, A1C decreased by 0.08 units. Conclusions In our series, 72% of patients with obesity undergoing primary SA achieved clinically meaningful weight loss, with a mean follow-up of more than 3 years. Patients who lose weight after SA additionally demonstrate improved glycemic control. Surgeons and patients should balance the association between postoperative weight loss after SA with the potential increased risks of operative complications, particularly for severely obese patients.
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Affiliation(s)
- Louis C Grandizio
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA
| | - Brian K Foster
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA
| | - Daniel J Torino
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA
| | - Elizabeth J Pavis
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA
| | - Idorenyin F Udoeyo
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA, USA
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12
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Khow YZ, Goh GS, Chen JY, Lo NN, Yeo SJ, Liow MHL. Change in Body Mass Index after Simultaneous Bilateral Total Knee Arthroplasty: Risk Factors and Its Influence on Functional Outcomes. J Arthroplasty 2021; 36:1974-1979. [PMID: 33602589 DOI: 10.1016/j.arth.2021.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Previous studies evaluating weight changes following total knee arthroplasty (TKA) were performed on heterogenous cohorts. However, no study has evaluated weight changes in a cohort of simultaneous-bilateral TKA (SB-TKA) patients. This study aimed to evaluate the prevalence of patients who lost or gained weight, determine if postoperative weight change influences functional outcome, and identify predictors of weight change after SB-TKA. METHODS Prospectively collected registry data of 560 patients who underwent SB-TKA were reviewed. Patients were assessed preoperatively, at 6 months, and 2 years using the Knee Society Score, Oxford Knee Score, Short-Form 36, and range of motion. Change in body mass index (BMI) >5% was used to categorize patients into 3 groups: lost, maintained, or gained weight. Analysis of variance, Kruskal-Wallis test, and chi-squared test were used to compare functional outcomes between groups. Multivariable logistic regression evaluated predictors for postoperative weight changes. RESULTS At 2 years, 59% of patients maintained weight, 28% of patients gained weight, and 13% of patients lost weight. All groups experienced similar improvements in functional outcomes, rates of minimal clinically important difference attainment, and patient satisfaction (P > .05). Older patients were more likely to gain weight (P < .05). Patients with higher preoperative BMI were more likely to gain weight (P < .05) and less likely to lose weight (P < .05). Patients with greater preoperative comorbidities were less likely to lose weight (P < .05). CONCLUSION Up to 41% of patients experience significant weight changes after SB-TKA. Older patients with higher preoperative BMI were more likely to gain weight, while higher preoperative BMI with more comorbidities were less likely to lose weight following SB-TKA; however, postoperative weight changes do not appear to affect functional outcomes. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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13
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Tucker A, Warnock JM, Cassidy R, Napier RJ, Beverland D. Are patient-reported outcomes the same following second-side surgery in primary hip and knee arthroplasty? Bone Jt Open 2021; 2:243-254. [PMID: 33881349 PMCID: PMC8085620 DOI: 10.1302/2633-1462.24.bjo-2020-0187.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aims Up to one in five patients undergoing primary total hip (THA) and knee arthroplasty (TKA) require contralateral surgery. This is frequently performed as a staged procedure. This study aimed to determine if outcomes, as determined by the Oxford Hip Score (OHS) and Knee Score (OKS) differed following second-side surgery. Methods Over a five-year period all patients who underwent staged bilateral primary THA or TKA utilizing the same type of implants were studied. Eligible patients had both preoperative and one year Oxford scores and had their second procedure completed within a mean (2 SDs) of the primary surgery. Patient demographics, radiographs, and OHS and OKS were analyzed. Results A total of 236 patients met the inclusion criteria, of which 122 were THAs and 114 TKAs. The mean age was 66.5 years (SD 9.4), with a 2:1 female:male ratio. THAs showed similar significant improvements in outcomes following first- and second-side surgery, regardless of sex. In contrast for TKAs, although male patients demonstrated the same pattern as the THAs, female TKAs displayed significantly less improvement in both OKS and its pain component following second-side surgery. Conclusion Female patients undergoing second-side TKA showed less improvement in Oxford and pain scores compared to the first-side. This difference in outcome following second-side surgery did not apply to male patients undergoing TKA, or to either sex undergoing THA. Cite this article: Bone Jt Open 2021;2(4):243–254.
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14
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Siddiqi A, Smith T, McPhilemy JJ, Ranawat AS, Sculco PK, Chen AF. Soft-Tissue Balancing Technology for Total Knee Arthroplasty. JBJS Rev 2021; 8:e0050. [PMID: 31899697 DOI: 10.2106/jbjs.rvw.19.00050] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Improperly balanced total knee arthroplasties are at increased risk for complications including residual pain and/or instability, which are often corrected by a revision surgical procedure.
» Because of the morbidity and financial burden associated with revision total knee arthroplasty, different technological applications, such as tibial insert sensors and computer-assisted gap balancing, are being used to assist with soft-tissue balancing during primary total knee arthroplasty.
» Computer-assisted gap balancing increases the accuracy of mechanical alignment and improves the precision of balancing flexion and extension gaps during total knee arthroplasty. It is unclear whether this translates to improved short-term or long-term outcome measures. Considerations of this technology include increased cost, increased operative time, and a steep learning curve.
» Intraoperative sensors increase the accuracy of balancing by quantifying the mediolateral intercompartmental load distribution through the range of motion, which may lead to improved outcome scores, patient satisfaction, higher activity levels, and decreased pain. The advantages of this technology compared with computer assistance include decreased cost and no disruption of operative time or workflow. Limited availability with constrained implants, limited implant choices, and a lack of long-term follow-up data have reduced utilization of intraoperative sensors.
» Computer-assisted gap balancing and intraoperative sensors are not yet universally accepted, and the cost-benefit ratio associated with their use remains a consideration in today’s cost-conscious health-care environment. Future research should focus on longer-term follow-up to evaluate implant survivorship, cost-effectiveness, and clinical outcomes.
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Affiliation(s)
- Ahmed Siddiqi
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Tyler Smith
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
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15
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Mak WK, Bin Abd Razak HR, Tan HCA. Which Patients Require a Contralateral Total Knee Arthroplasty Within 5 Years of Index Surgery? J Knee Surg 2020; 33:1029-1033. [PMID: 31311039 DOI: 10.1055/s-0039-1692653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) of the knee often presents bilaterally. However, not all patients with severe bilateral knee OA require bilateral total knee arthroplasty (TKA). This study aims to identify predictive factors for contralateral TKA in patients presenting with severe bilateral knee OA undergoing unilateral TKA. We prospectively collected perioperative data from 209 consecutive patients of a single surgeon who had severe bilateral OA knees at presentation. All patients underwent unilateral TKA on the more symptomatic knee. Patients were then stratified by their need for a contralateral TKA within the next 5 years. Using regression analysis, we compared patients who underwent contralateral knee surgery within 5 years (n = 115) against patients who did not (n = 94), so as to create a predictive model. Significant factors identified by the multiple regression models were incorporated into a decision tree using classification and regression tree analysis. Body mass index (BMI), degree of varus angulation, and Oxford knee scores were identified as significant predictive factors. The generated decision tree model was able to stratify patients according to their BMI and Oxford scores into four subgroups, the highest with more than 90% odds of contralateral surgery and the lowest with less than 40% odds of contralateral surgery. BMI, degree of varus angulation, and preoperative Oxford knee scores seem to predict the need for contralateral TKA in patients with severe bilateral OA knees undergoing unilateral TKA. These patients should be counseled on their requirement for the second TKA based on these factors.
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Affiliation(s)
- Wai Keong Mak
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Hwee-Chye Andrew Tan
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore
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16
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Richey PA, Johnson KC, Neiberg RH, Bahnson JL, Singhal K, Coday M, Thomas F, Lewis CE, Mihalko WM. Association of the Intensive Lifestyle Intervention With Total Knee Replacement in the Look AHEAD (Action for Health in Diabetes) Clinical Trial. J Arthroplasty 2020; 35:1576-1582. [PMID: 32085906 PMCID: PMC7247950 DOI: 10.1016/j.arth.2020.01.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Evidence has established obesity as a risk factor for total knee replacement (TKR) due to osteoarthritis. Obesity is a risk factor for TKR. Randomized trials such as Look AHEAD (Action for Health in Diabetes) have shown long-term successful weight loss with an intensive lifestyle intervention (ILI). It is unknown, however, if intentional weight loss can reduce the risk of TKR. METHODS Look AHEAD randomized persons aged 45-76 with type 2 diabetes who had overweight or obesity to either an ILI to achieve/maintain 7% weight loss or to standard diabetes support and education (DSE). Reported knee pain was assessed using the Visual Analog Scale and Western Ontario McMaster University Osteoarthritis Index questionnaire in 5125 participants without previous TKR. Cox proportional hazard regression was used to model differences in risk of TKR in relation to randomization group assignment (ILI vs DSE) along with baseline body mass index category and baseline knee pain as potential confounders from baseline through Look AHEAD-Extension. RESULTS Baseline mean ± SD Western Ontario McMaster University Osteoarthritis Index knee pain scores did not differ by treatment assignment (ILI: 3.6 ± 2.9, DSE: 3.9 ± 3.0, P = .08); as expected due to randomization. During follow up, the 631 (12%) participants who reported having a TKR were more likely to have been heavier (P < .001) and older (P < .001) at enrollment, but risk of TKR did not differ by treatment group assignment (hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.91-1.25, P = .43). Heterogeneity of treatment effect was observed according to baseline knee pain (interaction P = .02). In persons without knee pain at baseline, there was a 29% reduced risk of TKR in ILI compared to DSE (HR 0.71, 95% CI 0.52-0.96). However, in persons with knee pain at baseline, there was no statistically significant association of treatment assignment with respect to subsequent TKR incidence (HR 1.11, 95% CI 0.92-1.33). CONCLUSION Findings suggest that intensive lifestyle change including physical activity, dietary restriction and behavioral changes to achieve weight loss for prevention of TKR may be most effective in preventing TKR prior to the development of knee pain.
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Affiliation(s)
- Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN; Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Judy L Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kunal Singhal
- Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - William M Mihalko
- Department of Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN
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Christiansen MB, Thoma LM, Master H, Voinier D, Schmitt LA, Ziegler ML, LaValley MP, White DK. Feasibility and Preliminary Outcomes of a Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement. Arthritis Care Res (Hoboken) 2020; 72:661-668. [PMID: 30908867 DOI: 10.1002/acr.23882] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To explore the feasibility, fidelity, safety, and preliminary outcomes of a physical therapist-administered physical activity (PA) intervention after total knee replacement (TKR). METHODS People who had undergone a unilateral TKR and were receiving outpatient physical therapy (PT) were randomized to a control or intervention group. Both groups received standard PT for TKR. The intervention included being provided with a Fitbit Zip, step goals, and 1 phone call a month for 6 months after discharge from PT. Feasibility was measured by rates of recruitment and retention, safety was measured by the frequency of adverse events, and fidelity was measured by adherence to the weekly steps/day goal created by the physical therapist and participant monitoring of steps/day. An Actigraph GT3X measured PA, which was quantified as steps/day and minutes/week of engaging in moderate-to-vigorous PA. Our preliminary outcome was the difference in PA 6 months after discharge from PT between the control and intervention groups. RESULTS Of the 43 individuals who were enrolled, 53.4% were women, the mean ± SD age was 67.0 ± 7.0 years, and the mean ± SD body mass index was 31.5 ± 5.9 kg/m2 . For both the control and intervention groups, the recruitment and retention rates were 64% and 83.7%, respectively, and adherence to the intervention ranged from 45% to 60%. No study-related adverse events occurred. The patients in the intervention group accumulated a mean 1,798 more steps/day (95% confidence interval [95% CI] 240, 3,355) and spent 73.4 more minutes/week (95% CI -14.1, 160.9) engaging in moderate-to-vigorous PA at 6 months than those in the control group. CONCLUSION A physical therapist-administered PA intervention is feasible and safe, demonstrates treatment fidelity, and may increase PA after TKR. Future research is needed to establish the effectiveness of the intervention.
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18
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Patterns of Weight Change and Their Effects on Clinical Outcomes Following Total Knee Arthroplasty in an Asian Population. J Arthroplasty 2020; 35:375-379. [PMID: 31563395 DOI: 10.1016/j.arth.2019.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This prospective cohort study was designed to evaluate weight change patterns and their effects on clinical outcomes following total knee arthroplasty (TKA) in the Asian population. We hypothesized that Asian patients will have a different pattern of weight change following TKA compared to Western patients and that weight loss following TKA will be associated with better clinical outcomes. METHODS A cohort of consecutive patients who underwent TKA from 2004 to 2015 was included. All patients received a conventional posterior-stabilized TKA implant and underwent a standard perioperative care pathway. Assessments were done preoperatively, at 6 months, and 2 years after surgery. The range of motion, Knee Society Score, Oxford Knee Score, and the Short-Form 36 questionnaire were used to assess outcomes. Height and weight of patients were recorded for body mass index (BMI) calculation. Patterns of weight loss following TKA in this cohort were charted. Clinical outcomes were then analyzed against the change in BMI. RESULTS A total of 602 patients (602 knees) were reviewed. Mean age was 66.39 ± 7.27 years. Mean BMI was 27.75 ± 4.51 kg/m2. Overall, 63.12% of all our patients gained weight following TKA. Moreover, weight loss did not influence patients' odds for better clinical outcomes. Furthermore, patients who were in the preoperative BMI category of obese class I were more likely to gain weight as compared to those in the normal category (odds ratio 0.35, 95% confidence interval 0.2-0.61, P < .001). Moreover, older people were more likely to gain more weight compared to younger people. We also showed that the mean 2-year Knee Society Knee Score was significantly higher in the patients who gained weight while the patients who lost weight had the highest mean 2-year Oxford Knee Score and the lowest mean 2-year Knee Society Function Score. CONCLUSION Asians tend to gain weight following TKA. However, this weight change following TKA does not affect clinical outcomes, which remain good across all BMI groups. LEVEL OF EVIDENCE Therapeutic Level III.
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19
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Malham GM, Wagner TP, Claydon MH. Anterior lumbar interbody fusion in a lateral decubitus position: technique and outcomes in obese patients. JOURNAL OF SPINE SURGERY 2019; 5:433-442. [PMID: 32042993 DOI: 10.21037/jss.2019.09.09] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Multilevel lumbar interbody fusion (LIF) surgery in obese patients is problematic, with positioning and anaesthetic risks during posterior approaches, vascular and visceral complications during anterior approaches, and lack of access to L5/S1 during lateral approaches. Modified anterior LIF (ALIF) via an anterolateral retroperitoneal approach in the lateral decubitus position permits access to L3/4, L4/5, and L5/S1 levels without patient repositioning. This study reports our initial experience with this lateral ALIF in obese patients and describes modifications of existing lateral and anterior techniques. Methods We retrospectively analysed a prospectively maintained registry including the first 30 consecutive patients who underwent lateral ALIF. In all patients, supine ALIF was relatively contraindicated because of obesity or previous abdominal surgery. All patients had a body mass index (BMI) ≥30 kg/m2. Fusion was assessed by high-definition computed tomography. Patient-reported outcomes included visual analogue scale pain scores, Oswestry Disability Index (ODI), and 36-Item Short-Form Survey (SF-36) physical and mental component scores (PCS and MCS). All patients underwent ≥2 years follow-up. Results At last follow-up (mean, 35.0 months) mean back pain improved 64%, leg pain improved 67%, ODI improved 54%, and PCS and MCS both improved 37% (P<0.05 versus preoperative for all). Mean BMI was unchanged postoperatively (P=0.83). Complications occurred in 7 (23%) patients: dysesthesia [2], retroperitoneal hematoma [2], radiculopathy [1], and subsidence [2]. Solid interbody fusion occurred in 19 (63%) patients at 12 months postoperatively and in 26 (87%) patients at 24 months. Conclusions Lateral ALIF enables L5/S1 anterior fusion in obese patients and permits multilevel fusion using a single position. Satisfactory clinical outcomes and complication rates are achieved despite unchanged BMI and 87% radiological fusion rates. Lateral ALIF appears to be a reasonable alternative to posterior, lateral, and supine-position anterior approaches for L3/4, L4/5, and L5/S1 interbody fusions.
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20
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Kilgas MA, DenHerder AE, Lytle LLM, Williams CT, Elmer SJ. Home-Based Exercise With Blood Flow Restriction to Improve Quadriceps Muscle and Physical Function After Total Knee Arthroplasty: A Case Report. Phys Ther 2019; 99:1495-1500. [PMID: 31392999 DOI: 10.1093/ptj/pzz110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/02/2019] [Accepted: 03/31/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND PURPOSE After total knee arthroplasty (TKA), persistent quadriceps muscle atrophy and weakness impairs physical function. Blood flow restriction (BFR) exercise is emerging as a potential method to improve muscle size and strength in clinical populations with orthopedic limitations. There are no randomized controlled studies documenting BFR exercise after TKA. This case report describes the use of home-based BFR exercise to increase quadriceps size, strength, and physical function after TKA. CASE DESCRIPTION A 59-year-old man (6 months post-TKA) performed body weight and walking exercises with BFR 5×/wk for 8 weeks. Blood flow in the TKA leg was restricted using a thigh cuff inflated to 50% of limb occlusion pressure. Lean leg mass, vastus lateralis thickness, knee extensor strength, and physical function were measured at baseline (6 months post-TKA), posttraining (8 months post-TKA), and long-term follow-up (14 months post-TKA). OUTCOMES After training, lean leg mass, vastus lateralis thickness, and knee extensor strength in the TKA leg increased by 4%, 14%, and 55%, respectively. Compared with baseline, posttraining knee extensor strength symmetry (TKA/uninvolved leg) increased from 64% to 98%. The patient's performance improved for the 30-second chair stand, 40-m fast walk, and 6-minute walk tests. Increased quadriceps and physical function were maintained at the long-term follow-up. DISCUSSION With enhanced quadriceps and physical function, the patient resumed independent physical activity. Muscle and strength gains surpassed those typically reported after TKA. Outcomes suggest that home-based BFR exercise was feasible, safe, and effective. BFR exercise after TKA is promising and warrants further research.
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Affiliation(s)
- Matthew A Kilgas
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan; and School of Health and Human Performance, Northern Michigan University, Marquette, Michigan
| | - Alicia E DenHerder
- Department of Kinesiology and Integrative Physiology, Michigan Technological University; and Department of Physical Therapy, Central Michigan University, Mt Pleasant, Michigan
| | - Lydia L M Lytle
- Department of Kinesiology and Integrative Physiology, Michigan Technological University; and Aspirus Keweenaw Outpatient Therapies, Calumet, Michigan
| | - Cameron T Williams
- Department of Physical Therapy, Central Michigan University; and Department of Kinesiology and Integrative Physiology, Michigan Technological University
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, 1400 Townsend Dr, Houghton, MI 49931 (USA); and Department of Physical Therapy, Central Michigan University
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21
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Zan P, Yao JJ, Liu K, Yang D, Li W, Li G. Weight changes after total knee arthroplasty in Chinese patients: a matched cohort study regarding predictors and outcomes. J Orthop Surg Res 2019; 14:200. [PMID: 31266523 PMCID: PMC6604226 DOI: 10.1186/s13018-019-1184-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 05/03/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare 2-year BMI changes between patients undergoing simultaneous bilateral total knee arthroplasty (TKA), staged bilateral TKA, and unilateral TKA. We also sought to determine the predictors of weight change and whether clinically meaningful weight changes affected outcomes. PATIENTS AND METHODS This retrospective, single-institution study included 202 Chinese patients who received simultaneously bilateral TKA, staged bilateral TKA, or unilateral TKA from 2008 to 2015. There were 49 simultaneous bilateral TKAs, 52 staged bilateral TKAs, and a matched 101 unilateral TKAs. RESULTS 66.8% (135/202) of patients lost weight after TKA surgery. However, 20.7% (42/202) of patients experienced clinically meaningful weight loss (a BMI decrease of more than 5%). Paired t test showed that 2-year BMI was significantly lower than preoperative BMI (p < 0.001). Weight loss was significantly different between the surgical strategy (p < 0.001). Preoperative BMI and age were predictive of clinically significant weight loss or gain (p < 0.05). Multiple linear regression showed that post-operative weight loss was associated with better Western Ontario and McMaster Universities Osteoarthritis Index and SF-36 scores (p < 0.001). CONCLUSION Patients after TKA experience weight loss. Age and preoperative BMI predict clinically meaningful weight change. Simultaneous bilateral TKA is associated with higher likelihood of weight loss. Clinically meaningful weight loss experiences better patient-reported outcomes.
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Affiliation(s)
- Pengfei Zan
- Department of Orthopedic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009 People’s Republic of China
- Department of Orthopedic Surgery, The Tenth People’s Hospital Affiliated to Tongji University, 301 Yanchang Rd, Shanghai, 200072 People’s Republic of China
| | - Jie J. Yao
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Kaiyuan Liu
- Department of Orthopedic Surgery, The Tenth People’s Hospital Affiliated to Tongji University, 301 Yanchang Rd, Shanghai, 200072 People’s Republic of China
| | - Dong Yang
- Department of Orthopedic Surgery, The Tenth People’s Hospital Affiliated to Tongji University, 301 Yanchang Rd, Shanghai, 200072 People’s Republic of China
| | - Weixu Li
- Department of Orthopedic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009 People’s Republic of China
| | - Guodong Li
- Department of Orthopedic Surgery, The Tenth People’s Hospital Affiliated to Tongji University, 301 Yanchang Rd, Shanghai, 200072 People’s Republic of China
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22
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Naylor JM, Mills K, Pocovi N, Dennis S, Hackett D, Hassett L, Brady B, Lewin AM, Adie S, Xuan W. Patient factors associated with weight gain and weight loss after knee or hip arthroplasty. Obes Res Clin Pract 2019; 13:371-377. [DOI: 10.1016/j.orcp.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 01/19/2023]
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Smith WA, Zucker-Levin A, Mihalko WM, Williams M, Loftin M, Gurney JG. A Randomized Study of Exercise and Fitness Trackers in Obese Patients After Total Knee Arthroplasty. Orthop Clin North Am 2019; 50:35-45. [PMID: 30477705 DOI: 10.1016/j.ocl.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Functional limitations persist in obese patients after total knee arthroplasty (TKA). This study assessed the effect of an exercise program (EP) and fitness trackers (FT) in obese patients with TKA. Sixty patients 1 year after orthopedic surgery were recruited and received a 16-week tailored EP; half were randomized to receive an FT. FT had no measurable effect compared with EP alone. EP improved knee range of motion, strength, and quality-of-life scores. This study provides preliminary evidence that a 16-week EP in obese individuals 1 year post TKA is feasible and effective in improving function and quality of life.
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Affiliation(s)
- Webb A Smith
- Department of Pediatrics, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, Memphis, TN 38103, USA.
| | - Audrey Zucker-Levin
- Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 636, Memphis, TN 38163, USA
| | - William M Mihalko
- Joint Graduate Program in Biomedical Engineering, Department of Orthopedic Surgery and Biomedical Engineering, Campbell Clinic, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN 38163, USA
| | - Michael Williams
- Department of Physical Therapy, Campbell Clinic Orthopaedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Mark Loftin
- Department of Exercise Science, School of Applied Sciences, George Street University House, University, MS 38677, USA
| | - James G Gurney
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, 228 Robison Hall, Memphis, TN 38152, USA
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Hoffman SA, Ledford G, Cameron KA, Phillips SM, Pellegrini CA. A qualitative exploration of social and environmental factors affecting diet and activity in knee replacement patients. J Clin Nurs 2018; 28:1156-1163. [PMID: 30461097 DOI: 10.1111/jocn.14719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine perceived social and environmental barriers and facilitators for healthy eating and activity before and after knee replacement. BACKGROUND Many patients undergoing knee replacement surgery are overweight or obese. While obesity treatment guidelines encourage diet and activity modifications, gaps exist in understanding social and environmental determinants of these behaviours for knee replacement patients. Identifying these determinants is critical for treatment, as they are likely amplified due to patients' mobility limitations, the nature of surgery and reliance on others during recovery. DESIGN This qualitative study used semi-structured interviews. METHODS Twenty patients (M = 64.7 ± 9.8 years, 45% female, 90% Caucasian, body mass index 30.8 ± 5.5 kg/m2 ) who were scheduled for or had recently undergone knee replacement were interviewed. Participants were asked to identify social and environmental factors that made it easier or harder to engage in healthy eating or physical activity. Deidentified transcripts were analysed via constant comparative analysis to identify barriers and facilitators to healthy eating and activity. This paper was written in accordance with COnsolidated criteria for REporting Qualitative research standards. RESULTS Identified social and environmental healthy eating barriers included availability of unhealthy food and attending social gatherings; facilitators included availability of healthy food, keeping unhealthy options "out of sight," and social support. Weather was the primary activity barrier, while facilitators included access to physical activity opportunities and social support. CONCLUSIONS Results provide salient factors for consideration by clinicians and behavioural programmes targeting diet, activity, and weight management, and patient variables to consider when tailoring interventions. RELEVANCE TO CLINICAL PRACTICE Practitioners treating knee replacement patients would be aided by an understanding of patients' perceived social and environmental factors that impede or facilitate surgical progress. Particularly for those directly interacting with patients, like nurses, physiotherapists, or other professionals, support from health professionals appears to be a strong facilitator of adherence to diet and increased activity.
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Affiliation(s)
- Sara A Hoffman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gwendolyn Ledford
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kenzie A Cameron
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Siobhan M Phillips
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christine A Pellegrini
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Pellegrini CA, Chang RW, Dunlop DD, Conroy DE, Lee J, Van Horn L, Spring B, Cameron KA. Comparison of a Patient-Centered Weight Loss Program starting before versus after knee replacement: A pilot study. Obes Res Clin Pract 2018; 12:472-478. [PMID: 30007535 PMCID: PMC6335652 DOI: 10.1016/j.orcp.2018.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/23/2018] [Accepted: 06/29/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Most patients risk gaining weight in the years after knee replacement, adding further concern to a population that is mostly overweight/obese prior to surgery. OBJECTIVE Via a randomised pilot study, we assessed changes in weight during a Patient Centered Weight Loss Program (PACE) initiated either before or after knee replacement, while simultaneously examining the feasibility of recruiting and retaining participants over 26 weeks. METHODS Recruitment outreach was made to 133 patients scheduled for knee replacement. Sixteen participants were randomised to a 14-session weight loss program that started either ≤6 weeks before surgery (PACE) or at 12 weeks post-op (Delayed PACE). Repeated measures ANOVAs were used to examine preliminary changes in weight, function, patient-reported outcomes, and physical activity across time (baseline/pre-op, 12 and 26 weeks after surgery) and group. RESULTS Retention was 75% and 69% at 12 and 26 weeks after surgery, respectively. Weight significantly decreased across the 26 weeks (P<0.001). A group by time interaction (P=0.03) demonstrated Delayed PACE [-7.6±5.9kg (-7.9±5.9%)] lost significantly more weight than PACE [-2.5±2.7kg (-2.6±2.6%)] participants at 26 weeks. Significant improvements across time were seen for all function and patient reported outcomes, however activity did not change. CONCLUSION Conducting a behavioural intervention was challenging but feasible in a knee replacement population, with preliminary evidence suggesting that initiating a program 12 weeks after surgery produces greater weight losses at 26 weeks compared to a program starting before knee replacement.
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Affiliation(s)
- Christine A Pellegrini
- University of South Carolina, Department of Exercise Science, Technology Center to Promote Health Lifestyles, 915 Greene Street, Suite 403, Columbia, SC 29208, United States; Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States.
| | - Rowland W Chang
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States
| | - Dorothy D Dunlop
- Northwestern University, Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Healthcare Studies, 633 N. St. Clair, Chicago, IL 60611, United States
| | - David E Conroy
- The Pennsylvania State University, Department of Kinesiology, 268U Recreation Building, University Park, PA 16802, United States
| | - Jungwha Lee
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States
| | - Linda Van Horn
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States
| | - Bonnie Spring
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States
| | - Kenzie A Cameron
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, United States; Northwestern University, Feinberg School of Medicine, Division of Internal Medicine and Geriatrics, Department of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States
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26
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Patients Less Likely to Lose Weight Following a Knee Replacement: Results From the Osteoarthritis Initiative. J Clin Rheumatol 2018; 23:355-360. [PMID: 28937470 DOI: 10.1097/rhu.0000000000000579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Knee replacement typically results in reduced pain and improved function, but it is unclear if these improvements lead to weight loss. OBJECTIVE The purpose of this study was to examine weight change patterns preoperatively and postoperatively among overweight/obese knee replacement patients. METHODS The study evaluated 210 overweight/obese patients from the Osteoarthritis Initiative who underwent a knee replacement during an 8-year longitudinal study. Average annual weight changes during 1- to 2-year intervals prior to, including, and subsequent to knee replacement were categorized as loss (≥-2.5%), maintain (>-2.5% to <2.5%), and gain (≥2.5%). Weight changes across time intervals were compared using logistic regression with generalized estimating equations, adjusting for demographic, health, and knee factors. RESULTS On average, patients lost -0.6 kg/y during the interval when the surgery was performed, but weight gain (0.9 kg/y) in the initial postoperative interval represented an overall net weight gain (0.3 kg/y) compared with presurgery. Continued weight gain (0.3 kg/y) was also seen among patients with additional follow-ups. Patients were significantly less likely to have a meaningful weight loss in the time interval immediately following the surgery compared with the interval in which the surgery took place (odds ratio, 0.37; 95% confidence interval, 0.18-0.79). CONCLUSIONS Overweight and obese patients initially lost weight during the interval including knee replacement; however, they were less likely to lose more than 2.5% of their weight in the 1 to 2 years immediately after the surgery. Knee replacement patients may benefit from weight management interventions both preoperatively and postoperatively.
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Chen JY, Xu S, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ. Change in Body Mass Index After Total Knee Arthroplasty and Its Influence on Functional Outcome. J Arthroplasty 2018; 33:718-722. [PMID: 29174759 DOI: 10.1016/j.arth.2017.10.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is often an assumption by patients that weight loss will occur once their knee pain is relieved by total knee arthroplasty (TKA). This study aims to evaluate (1) the change in patients' body mass index (BMI) after TKA; (2) if postoperative change in BMI influences functional outcome and survival rate of TKA; and (3) the predictive factors associated with change in BMI. METHODS Seven thousand seven hundred thirty-three patients who underwent a primary TKA between 2001 and 2010 were included in this study. Functional outcome scores collected at 2 years after surgery include the Oxford Knee Score, Knee Society Function Score, Knee Society Knee Score, Physical Component Score, and Mental Component Score of short form 36. RESULTS Among these patients, 1067 (14%) had reduction in BMI, 5045 (65%) maintained their BMI, and 1621 (21%) had gain in BMI. The differences in improvement in Oxford Knee Score, Knee Society Function Score, Knee Society Knee Score, and Physical Component Score among the 3 groups of patients were less than the known minimal clinically important difference of these scores. The 10-year survival rate of TKA was not influenced by patients' change in BMI after surgery (P = .435). Obese class I, II, and III patients were more likely to reduce their BMI after TKA than those with normal preoperative BMI (P = .002, P = .012, and P = .004, respectively), while older patients were less likely to have gain in BMI after surgery (P = .001). CONCLUSION A change in BMI after TKA did not influence the functional outcome clinically or the survival rate of the TKA implant.
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Affiliation(s)
- Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Sheng Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Pozzobon D, Ferreira PH, Blyth FM, Machado GC, Ferreira ML. Can obesity and physical activity predict outcomes of elective knee or hip surgery due to osteoarthritis? A meta-analysis of cohort studies. BMJ Open 2018; 8:e017689. [PMID: 29487072 PMCID: PMC5855486 DOI: 10.1136/bmjopen-2017-017689] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/14/2017] [Accepted: 11/23/2017] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis. DESIGN Systematic review and meta-analysis. DATA SOURCE AND ELIGIBILITY CRITERIA A systematic search was performed on the Medline, CINAHL, EMBASE and Web of Science electronic databases. Longitudinal cohort studies were included in the review. To be included, studies needed to have assessed the association between obesity or physical activity participation measured at baseline and clinical outcomes (ie, pain, disability and adverse events) following hip or knee arthroplasty. DATA EXTRACTION Two independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications. RESULTS 62 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that compared to obese participants, non-obese participants report less pain at both short term (standardised mean difference (SMD) -0.43; 95% CI -0.67 to -0.19; P<0.001) and long term post-surgery (SMD -0.36; 95% CI -0.47 to -0.24; P<0.001), as well as less disability at long term post-surgery (SMD -0.32; 95% CI -0.36 to -0.28; P<0.001). They also report fewer postsurgical complications at short term (OR 0.48; 95% CI 0.25 to 0.91; P<0.001) and long term (OR 0.55; 95% CI 0.41 to 0.74; P<0.001) along with less postsurgical infections after hip arthroplasty (OR 0.33; 95% CI 0.18 to 0.59; P<0.001), and knee arthroplasty (OR 0.42; 95% CI 0.23 to 0.78; P=0.006). CONCLUSIONS Presurgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed. PROSPERO REGISTRATION NUMBER CRD42016032711.
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Affiliation(s)
- Daniel Pozzobon
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Ohmori T, Kabata T, Kajino Y, Inoue D, Taga T, Yamamoto T, Takagi T, Yoshitani J, Ueno T, Ueoka K, Tsuchiya H. Three-dimensional limb lengthening after total knee arthroplasty in a simulation study. Mod Rheumatol 2018; 28:1029-1034. [PMID: 29385865 DOI: 10.1080/14397595.2018.1436119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Limb lengthening after total knee arthroplasty (TKA) has been reported in some cases, all of which were evaluated using two-dimensional images. To our knowledge, no case has been evaluated using three-dimensional (3D) images. We investigated 3D limb lengthening after TKA. METHODS We simulated 100 varus knees using 3D templating software. Virtual TKA was performed to maintain the original joint line by conducting a measured-resection technique. We examined the relationships of 3D distance between the femoral head center and ankle center before and after TKA, degree of hip-knee-ankle angle (HKA) improvement, and degree of flexion contracture angle improvement. RESULTS All cases showed limb lengthening (average, 9.4 ± 6.0 mm). The coefficients of correlation with limb lengthening and the degree of HKA improvement and the degree of flexion contracture angle improvement were good (0.730 and 0.751, respectively). The correlation between the degree of total improvement (the degree of HKA improvement + the degree of flexion contracture angle improvement) and limb lengthening was strong (r = 0.896). CONCLUSION The expected limb lengthening when performing measured-resection TKA is expressed as 0.58 × (the degree of HKA improvement + the degree of flexion contracture angle improvement) mm and is a useful index.
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Affiliation(s)
- Takaaki Ohmori
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Tamon Kabata
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Yoshitomo Kajino
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Daisuke Inoue
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Tadashi Taga
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Takashi Yamamoto
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Tomoharu Takagi
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Junya Yoshitani
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Takuro Ueno
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Ken Ueoka
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
| | - Hiroyuki Tsuchiya
- a Department of Orthopaedic Surgery , Kanazawa University Hospital , Kanazawa , Ishikawa , Japan
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Piva SR, Almeida GJ, Gil AB, DiGioia AM, Helsel DL, Sowa GA. Effect of Comprehensive Behavioral and Exercise Intervention on Physical Function and Activity Participation After Total Knee Replacement: A Pilot Randomized Study. Arthritis Care Res (Hoboken) 2017; 69:1855-1862. [PMID: 28217891 PMCID: PMC5563278 DOI: 10.1002/acr.23227] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/14/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To test the feasibility of a comprehensive behavioral intervention (CBI) program that combines intense exercises with an education program, to be implemented at a later stage (3 months) following total knee replacement (TKR), and to get a first impression of the effects of the CBI as compared to a standard of care exercise (SCE) program on the outcomes of physical function and physical activity. METHODS A total of 44 subjects participated in a 3-month program of either CBI or SCE, followed by 3 months of a home exercise program. Outcomes of physical function and physical activity were measured at baseline and at 6-month followup. Analysis of variance was used to compare statistical differences between groups, whereas responder analyses were used for clinically important differences. RESULTS The CBI was found to be safe and well tolerated. As compared to the SCE group, the CBI group had less pain (P = 0.035) and better physical function based on the Short Form 36 health survey (P = 0.017) and the single-leg stance test (P = 0.037). The other outcome measures did not demonstrate statistically significant differences between the 2 groups. Results from the responder analysis demonstrated that the CBI group had a 36% higher rate of responders in physical function as compared to the SCE group. Also, the CBI group had 23% more responders in the combined domains of physical function and physical activity. CONCLUSION The CBI program is feasible and improves physical function and physical activity in patients several months after TKR. Larger pragmatic randomized trials are needed to confirm the results of this study.
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Affiliation(s)
- Sara R Piva
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Gwendolyn A Sowa
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Abstract
Physical activity outcomes are poor following total knee arthroplasty (TKA). The purpose was to evaluate feasibility of a physical activity feedback intervention for patients after TKA. Participants completing conventional TKA rehabilitation were randomized to a physical activity feedback (PAF; n = 22) or control (CTL; n = 23) group. The PAF intervention included real-time activity feedback, weekly action planning, and monthly group support meetings (12 weeks). The CTL group received attention control education. Feasibility was assessed using retention, adherence, dose goal attainment, and responsiveness with pre- and postintervention testing. The PAF group had 100% retention, 92% adherence (frequency of feedback use), and 65% dose goal attainment (frequency of meeting goals). The PAF group average daily step count increased from 5,754 (2,714) (pre) to 6,917 (3,445) steps/day (post). This study describes a feasible intervention to use as an adjunct to conventional rehabilitation for people with TKA.
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Rossi B, Jayasekera N, Kelly FA, Eyres K. Patients' Perception of Bone and Tissue Excision, and the Size and Weight of Prostheses at Total Knee Arthroplasty. Surg J (N Y) 2017; 3:e110-e112. [PMID: 28825033 PMCID: PMC5553508 DOI: 10.1055/s-0037-1604010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 05/03/2017] [Indexed: 11/03/2022] Open
Abstract
The aim of this study is to ascertain patients' perception of the amount of bone and tissue excision and size and weight of their implanted prostheses at total knee arthroplasty (TKA). To our knowledge, no prior study in the English orthopaedic literature has analyzed these parameters against patient perception of TKA. In a prospective study of eight consecutive TKA (six primary and two single-stage revision TKA procedures) by a single surgeon, patients estimated the weight of their implanted knee. We assessed actual weights of their implants and bone cement. Patients estimated the size of their prostheses by sketching the tibial and femoral bone cuts upon a printout of an anteroposterior and lateral radiographs of their preoperative knee. We utilized an articulated plastic model knee for patient reference. Our study shows almost half a kilogram of weight is added postoperatively to the surgical site as a result of tissue excision, explanted material, and implanted prosthesis and cement. All patients overestimated the weight of their implanted prostheses and extent of bone excision. Thus, even 'well-informed' patients overestimate their bone resection and weight of implanted prosthesis at TKA. We postulate such misconceptions among TKA patients are common, and may impact negatively upon patient perception of TKA, their postoperative recovery and outcome.
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Affiliation(s)
- Benjamin Rossi
- Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Narlaka Jayasekera
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, Australia
| | - Fionnuala Anne Kelly
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, Australia
| | - Keith Eyres
- Department of Orthopaedics, Gold Coast University Hospital, Gold Coast, Australia
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Pellegrini CA, Ledford G, Hoffman SA, Chang RW, Cameron KA. Preferences and motivation for weight loss among knee replacement patients: implications for a patient-centered weight loss intervention. BMC Musculoskelet Disord 2017; 18:327. [PMID: 28764783 PMCID: PMC5540525 DOI: 10.1186/s12891-017-1687-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/19/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Most knee replacement patients are overweight/obese, yet are commonly excluded from evidence-based weight loss programs due to mobility limitations and barriers faced around the time of surgery. The purpose of this study was to identify knee replacement patient preferences for weight loss programs and qualitatively understand previous motives for weight loss attempts as well as strategies used to facilitate behavior changes. METHODS Patients who were either scheduled to have knee replacement or had one recently completed within the last 3 months were recruited to participate. Patients completed a brief weight loss program preference questionnaire assessing preferred components of a weight loss program (i.e. self-monitoring, educational topics, program duration). Qualitative interviews were completed to identify motives for and strategies used during past weight loss attempts. All interviews were transcribed, de-identified, and analyzed using constant comparative analysis. RESULTS Twenty patients (11 pre-operative and 9 post-operative) between 47 and 79 years completed the study (55% male, 90% White, and 85% with a BMI ≥25 kg/m2). Patients reported a preference for a weight loss program that starts before surgery, is at least 6 months in duration, and focuses both on diet and exercise. The majority of patients preferred to have a telephone-based program and wanted to track diet and physical activity on a smartphone application. The most common motive for weight loss mentioned by patients related to physical appearance (including how clothing fit), followed by wanting to lose weight to improve knee symptoms or to prevent or delay knee replacement. Strategies that patients identified as helpful during weight loss attempts included joining a formal weight loss program, watching portion sizes, and self-monitoring their dietary intake, physical activity, or weight. CONCLUSIONS This study provides a preliminary examination into the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programs as described by knee replacement patients. These results will help guide the development and adaptation of future patient-centered weight loss programs as well as help clinicians recommend targeted weight programs based on the specific preferences of the knee replacement population.
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Affiliation(s)
- Christine A Pellegrini
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA. .,Department of Exercise Science, University of South Carolina, Discovery I, 915 Greene Street, Suite 403, Columbia, SC, 29208, USA.
| | - Gwendolyn Ledford
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Sara A Hoffman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Rowland W Chang
- Department of Preventive Medicine, Medicine - Rheumatology, Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, 18th Floor, Chicago, IL, 60611, USA
| | - Kenzie A Cameron
- Department of Medicine - General Internal Medicine and Geriatrics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
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Lim CT, Goodman SB, Huddleston JI, Harris AHS, Bhowmick S, Maloney WJ, Amanatullah DF. Weight Gain After Primary Total Knee Arthroplasty Is Associated With Accelerated Time to Revision for Aseptic Loosening. J Arthroplasty 2017; 32:2167-2170. [PMID: 28318864 DOI: 10.1016/j.arth.2017.02.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity is a major health problem worldwide and is associated with complications after total knee arthroplasty (TKA). It remains unknown whether a change in body mass index (BMI) after primary TKA affects the reasons for revision TKA or the time to revision TKA. METHODS A total of 160 primary TKAs referred to an academic tertiary center for revision TKA were retrospectively stratified according to change in BMI from the time of their primary TKA to revision TKA. The association between change in BMI and time to revision was also analyzed according to indication for revision of TKA using Pearson's chi-square test. RESULTS The mean change in BMI from primary to revision TKA was 0.82 ± 3.5 kg/m2. Maintaining a stable weight after primary TKA was protective against late revision TKA for any reason (P = .004). Patients who failed to reduce their BMI were revised for aseptic loosening earlier, at less than 5 years (P = .020), whereas those who reduced their BMI were revised later, at over 10 years (P = .004). CONCLUSION Maintaining weight after primary TKA is protective against later revision TKA for any reason but failure to reduce weight after primary TKA is a risk factor for early revision TKA for aseptic loosening and osteolysis. Orthopedic surgeons should recommend against weight gain after primary TKA to reduce the risk of an earlier revision TKA in the event that a revision TKA is indicated.
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Affiliation(s)
- Chin Tat Lim
- Department of Orthopaedic Surgery, Stanford University, Stanford, California; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California; Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford University, Stanford, California; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Alex H S Harris
- Department of Orthopaedic Surgery, Stanford University, Stanford, California; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Subhrojyoti Bhowmick
- Department of Orthopaedic Surgery, Stanford University, Stanford, California; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford University, Stanford, California; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Stanford, California; Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
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Toye F, Room J, Barker KL. Do I really want to be going on a bloody diet? Gendered narratives in older men with painful knee osteoarthritis. Disabil Rehabil 2017; 40:1914-1920. [PMID: 28478692 DOI: 10.1080/09638288.2017.1323017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Jonathan Room
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Karen L. Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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Smith WA, Zucker-Levin A, Mihalko WM, Williams M, Loftin M, Gurney JG. Physical Function and Physical Activity in Obese Adults After Total Knee Arthroplasty. Orthop Clin North Am 2017; 48:117-125. [PMID: 28336036 DOI: 10.1016/j.ocl.2016.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obese patients are more likely to have osteoarthritis and total knee arthroplasty (TKA). This investigation sought to evaluate physical function, activity level, and quality of life (QOL). Obese participants near 1-year postsurgical follow-up appointment were recruited. Evaluation included QOL and activity questionnaire, medical histories, anthropometrics, strength, and aerobic capacity. Sixty participants completed assessments. Obese TKA patients have physical performance limitations and low physical activity levels 1 year after surgery and completion of postoperative rehabilitation.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/rehabilitation
- Body Mass Index
- Exercise/physiology
- Exercise/psychology
- Female
- Health Status
- Humans
- Male
- Middle Aged
- Obesity/complications
- Obesity/diagnosis
- Obesity/physiopathology
- Obesity/psychology
- Osteoarthritis, Knee/complications
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/psychology
- Osteoarthritis, Knee/surgery
- Physical Conditioning, Human/methods
- Physical Endurance
- Postoperative Complications/diagnosis
- Postoperative Complications/physiopathology
- Postoperative Complications/psychology
- Quality of Life
- Range of Motion, Articular
- Recovery of Function
- Surveys and Questionnaires
- Treatment Outcome
- United States
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Affiliation(s)
- Webb A Smith
- Department of Pediatrics, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 447R, Memphis, TN 38103, USA.
| | - Audrey Zucker-Levin
- Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, 930 Madison Avenus, Suite 636, Memphis, TN 38163, USA
| | - William M Mihalko
- Joint Graduate Program in Biomedical Engineering, Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN 38163, USA
| | - Michael Williams
- Department of Physical Therapy, Campbell Clinic Orthopaedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Mark Loftin
- Department of Health, Exercise Science, and Recreation Management, School of Applied Sciences, University of Mississippi, George Street House, MS 38677, USA
| | - James G Gurney
- Division of Epidemiology, Biostatistics & Environmental Health, School of Public Health, University of Memphis, 228 Robison Hall, Memphis, TN 38152, USA
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Schwartsmann CR, Borges AM, Freitas GLSD, Migon EZ, Oliveira GKD, Rodrigues MW. Do patients lose weight after total knee replacement? Rev Bras Ortop 2017; 52:159-163. [PMID: 28409132 PMCID: PMC5380789 DOI: 10.1016/j.rboe.2017.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/29/2016] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Several studies show that patients undergoing total knee arthroplasty (TKA) tend to maintain or gain weight after the procedure, which would result in increased wear of the prosthesis and new surgical interventions in a smaller period of time in comparison with patients with adequate body mass index (BMI). The aim of this study was to investigate the effect of TKA surgery on these patients' BMI. METHODS Initially the records were analyzed, chosen at random from 91 patients undergoing TKA during the period from August 2011 to July 2013. Patients were stratified by BMI as normal weight (BMI between 20 and 25), overweight (BMI between 25 and 30), and obesity (BMI > 30). They were re-evaluated in a minimum period of 18 months. RESULTS The mean age of the sample population was 68.1 years; 69.1 for men and 67.2 for women. The mean preoperative BMI was 27.24 kg/m2. Among the study participants, in the preoperative period, 17 patients had normal weight, 65 were overweight, and nine were obese. Postoperative analysis showed weight loss in 41 patients (46%), and weight gain in 50 patients (54%). The mean postoperative BMI was 27.16 kg/m2, in general, experiencing a slight decline in the mean BMI of 0.08 kg/m2. CONCLUSION Patients who underwent TKA did not achieve significant reduction in BMI after surgery.
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Affiliation(s)
- Carlos Roberto Schwartsmann
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
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Formby PM, Purcell RL, Baird M, Wagner M, Goodlett RP, Mack AW. No clinically meaningful weight changes in a young cohort following total joint arthroplasty at 3-year follow-up. ANZ J Surg 2016; 87:60-64. [PMID: 27905187 DOI: 10.1111/ans.13765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/19/2016] [Accepted: 07/30/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Total joint arthroplasty (TJA) is one of the most successful operations. There is little in the literature regarding weight change following TJA, particularly in a young cohort. METHODS Retrospective analysis of 181 primary total hip arthroplasty (THA) and 185 primary total knee arthroplasty (TKA) patients was conducted. We reviewed preoperative and post-operative weights and post-operative body mass index at 3 and 6 months, 1 year, 2 and 3 years. We evaluated expected versus actual weight gain, and performed subgroup analyses of obese versus non-obese patients and active duty versus civilian patients. We used a minimal clinically meaningful weight change from baseline of ≥5%. RESULTS One hundred and fifty-one (41.3%) patients were active duty military service members with the mean age of 53 ± 11.1 years. In TKA patients, statistically significant differences were found in mean weights at 3 months (-1.8%, P ≤ 0.0001) and 2 years (+1.9%, P = 0.0006). In THA patients, statistically significant weight gains were found at 6 months (+1.1%, P = 0.006). For obese TKA patients, significant weight changes were observed at 3 months (-2.5%, P ≤ 0.0001), and none in the obese THA group. There were no statistical or clinically meaningful weight changes in the non-obese TKA or THA groups. There was a clinically meaningful weight gain in active duty TKA patients at 3 years (5.18%, P = 0.17). CONCLUSION Despite a theoretical ability to lose weight following TJA, patients maintain their preoperative weight following TJA. We found a clinically meaningful weight gain at 3 years post-operatively only in active duty TKA patients. Overall, however, we found no clinically significant weight changes following TJA at 3-year follow-up.
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Affiliation(s)
- Peter M Formby
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Richard L Purcell
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Baird
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Matthew Wagner
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Ronald P Goodlett
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Andrew W Mack
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Association of Psychosocial Factors With Physical Activity and Function After Total Knee Replacement: An Exploratory Study. Arch Phys Med Rehabil 2016; 97:S218-25. [DOI: 10.1016/j.apmr.2015.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/10/2015] [Accepted: 09/10/2015] [Indexed: 11/22/2022]
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Walking on a compliant surface does not enhance kinematic gait asymmetries after unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2606-13. [PMID: 26708412 DOI: 10.1007/s00167-015-3931-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate gait asymmetries and the effect of walking on compliant surfaces in individuals with unilateral total knee arthroplasty (TKA), hypothesizing that asymmetries would increase as an effect of the compliant surface. METHODS Individuals with unilateral TKA ~19 months post-operative (n = 23, median age 59 years) recruited from one orthopaedic clinic and age- and gender-matched healthy individuals without knee complaints (n = 23, median age 56 years) walked at comfortable speed on a hard surface and on a compliant surface. 3D kinematic analyses were made for knee and hip angles in sagittal and frontal planes, stance time, step length, and gait velocity. RESULTS Shorter stance time (p < 0.01) and less peak knee flexion (p < 0.001) at weight bearing acceptance was found in the prosthetic side compared with the contralateral side. Larger knee (p < 0.01) and hip (p < 0.001) adduction was found compared with healthy controls. Neither asymmetries between the prosthetic and the contralateral side nor differences compared with healthy controls were enhanced when walking on compliant surfaces compared with hard surfaces. CONCLUSION The TKA group adapted their gait to compliant surfaces similarly to healthy controls. Gait asymmetries in the TKA group observed on hard surface were not enhanced, and adduction in hip and knee joints did not increase further as an effect of walking on compliant surfaces. Thus, unfavourable knee joint loading did not increase when walking on a compliant surface. This implies that recommendations for walking on soft surfaces to reduce knee joint loading are not counteracted by increased gait asymmetries and unfavourable joint loading configurations. LEVEL OF EVIDENCE III.
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Kulkarni K, Karssiens T, Kumar V, Pandit H. Obesity and osteoarthritis. Maturitas 2016; 89:22-8. [DOI: 10.1016/j.maturitas.2016.04.006] [Citation(s) in RCA: 226] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 01/23/2023]
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Does Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review. J Orthop Sports Phys Ther 2016; 46:431-42. [PMID: 27117726 DOI: 10.2519/jospt.2016.6449] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative strategies to instill behavioral change are required to narrow the gap between patient-perceived functional improvement and the actual amount of PA undertaken after THA and TKA. Registered with PROSPERO (registration number CRD42014010155). Level of Evidence Therapy, level 2a. J Orthop Sports Phys Ther 2016;46(6):431-442. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6449.
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Kahn TL, Snir N, Schwarzkopf R. Does Body Mass Index Decrease Over Time Among Patients Who Undergo Total Knee Arthroplasty Compared to Patients With Osteoarthritis? Data From the Osteoarthritis Initiative. J Arthroplasty 2016; 31:971-5. [PMID: 26718776 DOI: 10.1016/j.arth.2015.11.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/13/2015] [Accepted: 11/20/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although total knee arthroplasty (TKA) is associated with improved patient-reported function, pain, and quality of life, the effects on weight loss are less certain. In this study, we use data from a large, prospective cohort study of osteoarthritis (OA) patients to compare the changes in body mass index (BMI) across 6 years in OA patients who received TKA compared with OA patients who did not receive TKA. METHODS Using data from the Osteoarthritis Initiative, a prospective cohort study of patients with OA, our study divided patients into two groups: patients who received a TKA during the Osteoarthritis Initiative study (N = 140) and those who did not (N = 697). The initial BMI, final BMI, and change in weight over 72 months were compared between groups. Subgroup analysis was performed by dividing patients by their initial BMI, gender, and age. RESULTS The TKA group's change in weight, initial BMI, and final BMI were not significantly different from the non-TKA group over 72 months (weight change: -0.763 kg vs +0.191 kg; P = .597). Subgroups of women and patients aged 51-60 years with TKA gained more weight than respective non-TKA OA patients. CONCLUSIONS Overall, patients who received TKA did not lose or gain more weight than OA patients who did not receive TKA. Patients with longer follow-up after TKA (>2 years) still gained weight on average. Despite the improved patient-reported pain levels, function, and quality of life after TKA, it appears that TKA alone is not a sufficient intervention for obesity.
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Affiliation(s)
- Timothy L Kahn
- University of California Irvine Medical Center, Orange, California
| | - Nimrod Snir
- Division of Orthopaedic Surgery, Sorasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital For Joint Diseases, New York, New York
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Polat G, Ceylan HH, Sayar S, Kucukdurmaz F, Erdil M, Tuncay I. Effect of body mass index on functional outcomes following arthroplasty procedures. World J Orthop 2015; 6:991-995. [PMID: 26716096 PMCID: PMC4686447 DOI: 10.5312/wjo.v6.i11.991] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 06/05/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the body mass index (BMI) change in arthroplasty patients and its impact on the patients’ functional results.
METHODS: Between October 2010 and May 2013, 606 patients who were operated due to gonarthrosis, coxarthrosis, aseptic loosening of the total knee and hip prosthesis were evaluated prospectively. Patients were operated by three surgeons in three medical centers. Patients who were between 30-90 years of age and who were underwent total knee arthroplasty, total hip arthroplasty, revision knee arthroplasty, or revision hip arthroplasty were included in the study. We excluded the patients who cannot tolerate our standard postoperative rehabilitation program. Additionally, patients who had systemic inflammatory diseases, diabetes mellitus, or endochrinopathies were excluded from the study. The remaining 513 patients comprised our study group. Preoperative functional joint scores, height, weight and BMI of all patients were recorded. We used the Knee Society Score (KSS) for knee and Harris Hip Score (HHS) for hip patients. Postoperative functional scores were measured at 1st, 6th and 12th months and recorded separately at outpatient visits.
RESULTS: The mean age of the patients was 64.7 (range: 30-90) years (207 males/306 females) and the mean follow-up duration was 14.3 (range: 12-26) mo. We found that arthroplasty patients had weight gain and had an increase in BMI at the postoperative 1st, 6th and 12th months. The mean BMI of the patients was 27.7 preoperatively, 27.8 at the postoperative 1st month, 28.1 at the 6th month and 28.6 at the 12th month (P < 0.01). At the last visit, the mean postoperative HHS of the hip arthroplasty patients was 82.2 ± 7.12 (preoperatively, 52.3; 1st month, 78.2; 6th month, 81.1; 12th month, 82.2), and the mean KSS of the knee arthroplasty patients was 79.3 ± 4.31 (preoperatively, 35.8; 1st month, 75.2; 6th month, 79.1; 12th month, 79.3). Worse functional results were noted in the patients who had a BMI increase, however, this correlation was statistically significant only at the postoperative 6th month (P = 0.03).
CONCLUSION: To prevent the negative functional effects of this weight gain during the postoperative period, arthroplasty patients should be advised for weight control and risky patients should consult with a dietician.
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Arnold JB, Mackintosh S, Olds TS, Jones S, Thewlis D. Improvements in knee biomechanics during walking are associated with increased physical activity after total knee arthroplasty. J Orthop Res 2015; 33:1818-25. [PMID: 26135207 DOI: 10.1002/jor.22969] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/16/2015] [Indexed: 02/04/2023]
Abstract
Total knee arthroplasty (TKA) in people with knee osteoarthritis increases knee-specific and general physical function, but it has not been established if there is a relationship between changes in these elements of functional ability. This study investigated changes and relationships between knee biomechanics during walking, physical activity, and use of time after TKA. Fifteen people awaiting TKA underwent 3D gait analysis before and six months after surgery. Physical activity and use of time were determined in free-living conditions from a high resolution 24-h activity recall. After surgery, participants displayed significant improvements in sagittal plane knee biomechanics and improved their physical activity profiles, standing for 105 more minutes (p=0.001) and performing 64 min more inside chores on average per day (p=0.008). Changes in sagittal plane knee range of motion (ROM) and peak knee flexion positively correlated with changes in total daily energy expenditure, time spent undertaking moderate to vigorous physical activity, inside chores and passive transport (r=0.52-0.66, p=0.005-0.047). Restoration of knee function occurs in parallel and is associated with improvements in physical activity and use of time after TKA. Increased functional knee ROM is required to support improvements in total and context specific physical activity.
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Affiliation(s)
- John B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Shylie Mackintosh
- International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Timothy S Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Sara Jones
- International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Dominic Thewlis
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
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Updates in pediatric lower extremity deformity. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Singh JA, Lewallen DG. Are outcomes after total knee arthroplasty worsening over time? A time-trends study of activity limitation and pain outcomes. BMC Musculoskelet Disord 2014; 15:440. [PMID: 25519240 PMCID: PMC4301928 DOI: 10.1186/1471-2474-15-440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 12/10/2014] [Indexed: 01/23/2023] Open
Abstract
Background To examine whether function and pain outcomes of patients undergoing primary total knee arthroplasty (TKA) are changing over time. Methods The Mayo Clinic Total Joint Registry provided data for time-trends in preoperative and 2-year post-operative activity limitation and pain in primary TKA patients from 1993-2005. We used chi-square test and analysis for variance, as appropriate. Multivariable-adjusted analyses were done using logistic regression. Results In a cohort of 7,229 patients who underwent primary TKA during 1993-2005, mean age was 68.4 years (standard deviation (SD), 9.8), mean BMI was 31.1 (SD, 6.0) and 55% were women. Crude estimates showed that preoperative moderate-severe overall limitation were seen in 7.3% fewer patients and preoperative moderate-severe pain in 2.7% more patients in 2002-05, compared to 1992-95 (p < 0.001 for both). At 2-years, crude estimates indicated that compared to 1992-95, moderate-severe post-TKA overall limitation was seen in 4.7% more patients and moderate-severe post-TKA pain in 3.6% more patients in 2002-05, both statistically significant (p ≤ 0.018) and clinically meaningful. In multivariable-adjusted analyses that adjusted for age, sex, anxiety, depression, Deyo-Charlson index, body mass index and preoperative pain/limitation, patients had worse outcomes 2-year post-TKA in 2002-2005 compared to 1993-95 with an odds ratio (95% confidence interval (CI); p-value) of 1.34 (95% CI: 1.02, 1.76, p = 0.037) for moderate-severe activity limitation and 1.79 (95% CI: 1.17, 2.75, p = 0.007) for moderate-severe pain. Conclusion Patient-reported function and pain outcomes after primary TKA have worsened over the study period 1993-95 to 2002-05. This time-trend is independent of changes in preoperative pain/limitation and certain patient characteristics. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-440) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, England.
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McClelland JA, Feller JA, Menz HB, Webster KE. Patterns in the knee flexion-extension moment profile during stair ascent and descent in patients with total knee arthroplasty. J Biomech 2014; 47:1816-21. [DOI: 10.1016/j.jbiomech.2014.03.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 11/17/2022]
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Singh JA, Lewallen DG. Time trends in the characteristics of patients undergoing primary total knee arthroplasty. Arthritis Care Res (Hoboken) 2014; 66:897-906. [PMID: 24249702 PMCID: PMC4151514 DOI: 10.1002/acr.22233] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/05/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the time trends in sociodemographic and clinical characteristics of patients undergoing primary total knee arthroplasty (TKA). METHODS We used the Mayo Clinic Total Joint Registry to examine the time trends in patient demographics (body mass index [BMI] and age), underlying diagnosis, medical (Deyo-Charlson Index) and psychological comorbidity (anxiety and depression), and examination findings of primary TKA patients from 1993-2005. We used the chi-square test and analysis of variance. RESULTS In total, 7,229 patients constituted the primary TKA cohort; 55% were women. The mean age decreased by 1.3 years (69.3 to 68.0 years), mean BMI increased by 1.7 kg/m(2) (30.1 to 31.8 kg/m(2) ), and mean Deyo-Charlson Index increased by 36% (1.1 to 1.5) over the 13-year study period (P ≤ 0.001 for all). Compared with 1993-1995, significantly more patients (by 2-3 times) in 2002-2005 had a BMI ≥40 kg/m(2) (4.8% versus 10.6%), age <50 years (2.9% versus 5.2%), Deyo-Charlson Index of ≥3 (12% versus 22.3%), depression (4.1% versus 14.8%), and anxiety (4.1% versus 8.9%), and significantly fewer patients had an underlying diagnosis of rheumatoid/inflammatory arthritis (6.4% versus 1.5%; P < 0.001 for all). Compared with 1993-1995, significant reductions were noted in 2002-2005 for the physical examination findings of anteroposterior knee instability, mediolateral knee instability, moderate to severe knee synovitis, severe limp, fair or poor muscle strength, and absent peripheral pulses (P ≤ 0.001 for all). CONCLUSION In this large US total joint registry study, we found significant time trends in patient characteristics, diagnosis, comorbidity, and knee/extremity examination findings in primary TKA patients over 13 years. These secular trends should be taken into account when comparing outcomes over time and in policy-making decisions.
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Affiliation(s)
- Jasvinder A. Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, AL
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - David G. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN
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