This study stratifies complication risk in primary total joint arthroplasty (TJA) based on body mass index (BMI). Demographics, co-morbidities, perioperative variables, and complications were reviewed for 22,808 patients. Chi-squared, one-way ANOVA, univariate and multivariable regression analysis were performed. Increasing BMI led to an increase (P 40 revealed an increase in combined complications (15.21-vs-17.40%), AKI (1.93-vs-3.87%), CA (0.22-vs-0.57%), reintubation (0.47-vs-0.95%), reoperation (2.36-vs-3.37%), and SI (0.82-vs-1.65%). Multivariable regression showed BMI>40 as an independent predictor for combined complications (OR=1.18), AKI (OR=1.79), CA (OR=3.94), reintubation (OR=2.56), reoperation (OR=1.44), and SI (OR=2.11). Morbid obesity confers increased risk for complications in TJA.

Complications of Morbid Obesity in Total Joint Arthroplasty: Risk Stratification Based on BMI

Aims The purpose of our study is to summarise the current scientific
findings regarding the impact of obesity on total hip arthroplasty
(THA); specifically the influence of obesity on the timing of THA,
incidence of complications, and effect on clinical and functional
outcomes. Materials and Methods We performed a systematic review that was compliant with the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines to identify prospective studies from the PubMed/Medline,
Embase, and Cochrane Library databases that evaluated primary THA
in obese (body mass index (BMI) ≥ 30 kg/m 2 ) patients. Results There were 17 articles included in the review, which encompassed
13 722 THA patients. Analysis of the included studies showed that,
when compared with non-obese patients, obesity was associated with
younger age at time of primary THA, and an increased incidence of
complications (up to four-fold). Results were mixed on the influence
of obesity on the outcomes of primary THA, with three studies showing
a detrimental effect on outcomes of a BMI ≥ 30 kg/m 2 ,
while eight studies showed no effect. Conclusion Obesity is associated with significantly younger age at time
of primary THA and obese patients are likely to experience a higher
rate of peri-operative complications. More investigation is needed
into the effect of obesity on clinical outcomes, as the current
literature is mixed. Cite this article: Bone Joint J 2017;99-B(1 Supple
A):31–6.

Obesity in total hip arthroplasty: does it make a difference?

This study utilized a national database to evaluate 90 day postoperative complication rates after total knee arthroplasty (TKA) in super obese (BMI > 50 kg/m(2)) patients (n = 7666) compared to non-obese patients (n = 1,212,793), obese patients (n = 291,914), morbidly obese patients (n = 169,308) and revision TKA patients (n = 28,812). Super obese patients had significantly higher rates of local and systemic complications compared to all other BMI groups as well as those undergoing revision TKA with higher rates of venous thromboembolism (VTE), infection, and medical complications. Super obesity is associated with dramatically increased rates of postoperative complications after TKA compared to non-obese, obese, and morbidly obese patients as well as those undergoing revision TKA.

Primary Total Knee Arthroplasty in Super-obese Patients: Dramatically Higher Postoperative Complication Rates Even Compared to Revision Surgery

This study used a national database to compare 90-day postoperative complication rates between three groups of patients who underwent total knee arthroplasty (TKA): (1) non-obese patients (n=66,523), (2) morbidly obese patients who did not have bariatric surgery (n=11,294) and (3) morbidly obese patients who underwent bariatric surgery prior to TKA (n=219). Morbidly obese patients who underwent bariatric surgery prior to TKA had reduced rates of major (OR 0.45, P=0.001) and minor (OR 0.61, P=0.01) complications compared to morbidly obese patients who did not have bariatric surgery. Bariatric surgery prior to TKA appears to be associated with less risk of postoperative complications, although not to the same level as non-obese patients.

Bariatric Surgery Prior to Total Knee Arthroplasty is Associated With Fewer Postoperative Complications.

Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting. Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30-day re-admission rates were around 6% for both THA (6.1%) and TKA (5.9%), without any statistically significant differences between BMI groups in univariate analysis (p > 0.4), but there was a trend of a protective effect of overweight for both THA (p = 0.1) and TKA (p = 0.06). 90-day re-admission rates increased to 8.6% for THA and 8.3% for TKA, which was similar among BMI groups, but there was a trend of lower rates in overweight and obese TKA patients (p = 0.08 and p = 0.06, respectively). When we adjusted for preoperative comorbidity, high BMI in THA patients (very obese and morbidly obese patients only) was associated with a LOS of >4 days (p = 0.001), but not with re-admission. No such relationship existed for TKA. Interpretation - A fast-track setting resulted in similar length of hospital stay and re-admission rates regardless of BMI, except for very obese and morbidly obese THA patients.

/pdf/does-bmi-influence-hospital-stay-and-morbidity-after-fast-3se6rd99sl.pdf

Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?

The purpose of this study was to compare the clinical and radiographic outcomes of primary total knee arthroplasty (TKA) in obese and nonobese patients. A total of 210 knees in 174 obese patients who had a mean body mass index (BMI) of 34 kg/m2 (range, 30 to 39.9 kg/m2) and who had undergone a primary TKA between 2006 and 2010 were reviewed. There were 115 women and 59 men who had a mean age of 62 years (range, 36 to 84 years) and a mean follow-up of 57 months (range, 24 to 82 months). These patients were compared with a group of nonobese patients who had a BMI of less than 30 kg/m2 (range, 19 to 29.9 kg/m2). The evaluated outcomes included implant survivorship, Knee Society objective and functional scores, complication rates, radiographic outcomes, University of California Los Angeles (UCLA) activity score, and the length of hospital stay between obese and nonobese patients. There were no significant differences in the overall septic and aseptic implant survivorship (98.8 vs. 98.6%) and mean postoperative Knee Society objective and function scores (90 and 87 points vs. 91 and 89 points), respectively. Obese patients had significantly higher complication rates (10.5 vs. 3.8%) and had achieved a significantly lower mean postoperative UCLA activity score (5 vs. 6 points). However, there were no differences in the length of hospital stay for the two cohorts. Although the authors encourage all patients to lose weight as much as possible prior to their TKA, it is encouraging that obese patients had achieved excellent clinical outcomes at early to mid-term follow-up.

Does obesity affect the outcomes of primary total knee arthroplasty

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Does obesity affect the outcomes of primary total knee arthroplasty