Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2022; 10(30): 10967-10983
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.10967
Impact of being underweight on peri-operative and post-operative outcomes of total knee or hip arthroplasty: A meta-analysis
Yun-Ping Ma, Qiu Shen
Yun-Ping Ma, Qiu Shen, Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
Author contributions: Ma YP conceived and designed the study; Ma YP and Shen Q were involved in the literature search and data collection; Ma YP analyzed the data; Ma YP and Shen Q wrote the paper; Ma YP edited the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare no competing interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA checklist and the manuscript was prepared and revised according to the PRISMA checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiu Shen, RN, Nurse, Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, No. 1558 Sanhuan North Road, Huzhou 313000, Zhejiang Province, China. squ16871687@163.com
Received: March 14, 2022
Peer-review started: March 14, 2022
First decision: June 16, 2022
Revised: July 6, 2022
Accepted: September 16, 2022
Article in press: September 16, 2022
Published online: October 26, 2022
Processing time: 221 Days and 0.6 Hours
Abstract
BACKGROUND

Many systematic reviews have focused on assessing the effect of body mass index (BMI) on the outcomes and complications associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA), but primarily dealt with obesity compared to normal weight (NW). None of these reviews attempted to assess the effect of low BMI or underweight (UW) compared to NW in patients undergoing THA or TKA.

AIM

This review aims to compare specific operative outcomes such as operation duration, length of hospital stay, and post-operative complications including mortality, infections, deep vein thrombosis, etc. along with re-hospitalization and reoperation rates between UW and NW patients undergoing THA, TKA or both.

METHODS

An electronic search was performed in PubMed, Scopus, Excerpta Medica database (EMBASE), Web of Science (WoS), and Cochrane Central Register of Controlled Trials (CENTRAL) along with a manual search. The quality of the studies was assessed using the Newcastle-Ottawa scale for cohort studies. The data were subjected to both qualitative and quantitative analysis.

RESULTS

Thirteen retrospective and five prospective cohort studies were included. The quality of included studies was assessed to be good to fair. The length of hospital stay after TKA or THA was found to be significantly higher for UW patients when compared to NW patients, with a mean difference: 0.39 95%CI: [0.06, 0.72], P = 0.02 (in days). Studies presenting both THA and TKA together as total joint arthroplasty showed an increased incidence of mortality in patients treated with THA or TKA alone, Odds ratio: 4.18 95%CI: [2.88, 6.07]. A higher incidence of post-operative complications was also observed in UW patients undergoing THA.

CONCLUSION

UW patients undergoing THA or TKA had a higher incidence of post-operative complications and were associated with a higher readmission rate. Moreover, UW patients were associated with an increased incidence of mortality in the studies that reported THA and TKA together.

Keywords: Underweight; Total knee arthroplasty; Total hip arthroplasty; Systematic review; Meta-analysis

Core Tip: Many systematic reviews have focused on assessing the effect of body mass index (BMI) on the outcomes and complications associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA), but primarily dealt with obesity compared to normal weight (NW) patients. None of these reviews attempted to assess the effect of low BMI or underweight (UW) compared to NW in patients undergoing THA or TKA. The present analysis found that UW patients undergoing THA or TKA had with a higher incidence of post-operative complications and were associated with a higher readmission rate.